Inspection on 07/05/09 for Barnfield Manor Care Home

This inspection was carried out on 7th May 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barnfield Manor Care Home 28/07/09

Barnfield Manor Care Home 03/06/08

Barnfield Manor Care Home 14/11/07

Barnfield Manor Care Home 09/01/07

Barnfield Manor Care Home 06/09/06

Barnfield Manor Care Home 09/05/06

Barnfield Manor Care Home 22/02/06

Barnfield Manor Care Home 05/10/05

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Barnfield Manor Care Home Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH     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: Susan Richards     Date: 0 7 0 5 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 37 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 37 Information about the care home Name of care home: Address: Barnfield Manor Care Home Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH 01246855899 01246852953 jane.watson@hallmarkhealthcare.co.uk 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) : Hallmark Healthcare (Holmewood) Ltd care home 39 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 39 The maximum number of service users who can be accommodated is 39. The registered provider may provide the following category of service only:- Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Dementia - Code DE Date of last inspection Brief description of the care home Barnfield Manor Care Home is located in the village of Holmewood, close to shops, a post office and local amenities. It is on a direct bus route to Chesterfield and within a short distance of Junction 29 of the M1 motorway. The home provides personal care and support for up to 40 older persons with dementia delivered from a team of care and hotel services staff and with a newly appointed acting manager. Accommodation is over two floors, providing level access throughout, together with environmental adaptations and equipment to assist those who may have mobility problems, including a shaft lift and emergency call system. There is a choice of lounge and dining space and communal bathing and toilet facilities. A majority of single room Care Homes for Older People Page 4 of 37 Brief description of the care home accommodation is provided, with many having en suite toilet and wash hand basin. There is an enclosed patio garden area, which people can access via the rear lounge, which provides seating and planting and safe provision for people who may wander. There is also gated access to a central enclosed garden, although supervised access is required for people here given the layout of the garden, which has a large raised bordered lawn area. Car parking is also provided to the front of the home. Kitchen and laundry services are centralised with a separate single storey building located within the grounds, which provides laundry and staff facilities. The range of fees charged per week are as follows: For those who are funded via local authority arrangements 350 to 370 pounds per week. For those who are private funded 360 to 450 pounds per week. There are additional charges for hairdressing, private chiropody, toiletries and newspapers, which are charged as per vendor. People are provided with service information, including that relating to fees charged and what they cover in the homes service guide. A copy of the most recent inspection report is also available in the home. Care Homes for Older People Page 5 of 37 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 quality rating for this service is 1 star. This means the people who use this service experience good quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire or AQAA, which we ask the home to complete on an annual basis in order to provide us with key information about the service. We did not receive any survey returns from the ten we sent out to people who use the service and also to staff. At this inspection there were twelve people accommodated. We used case tracking in Care Homes for Older People Page 6 of 37 our methodology, where we looked more closely at the care and services that three people receive. However, to their given mental capacities we were only able to obtain limited direct verbal feedback from them. Where possible we spoke with their advocates and we observed staff interactions with them. We looked at their written care plans and associated health and personal care records and also their private and communal accommodation. And we also took into account feedback received from people as collated by the home via their internal quality assurance and monitoring systems. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the acting manager about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian religion and falling under the category of dementia for the purposes of their care. What the care home does well: What has improved since the last inspection? What they could do better: Improve record keeping practises concerned with individuals needs assessment and care planning. So as to ensure that these effectively determine, underpin and account for care to be delivered to each service user. And also to account for individuals mental capacity to make key decisions about their lives and to consent to their care and treatment. Develop policy guidance for staff to follow with regard to care planning requirements for any service user subject to any variable dose medicines instructions or verbal changes to medicines instructions. Keep records of all concerns raised outside the formal complaints process, including any action that is determined as a result of these. Information should be included in the homes statement of purpose regarding its kitchen and catering arrangements and the fact that the first floor of the home is not currently in operation or open to admissions. Care Homes for Older People Page 8 of 37 Complete the works identified from the Local Fire Authority Officers recommendations, necessary to provide for operation and use of the first floor of the home. Ensure that the acting manager fully completes the registered manager application process with the Commission. 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 37 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 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People continue to be suitably informed during their admission to the home and their needs are mostly accounted for. Although record keeping practises do not always best underpin these. Evidence: At our last key inspection we found that people were well informed and supported during their admission to the home and their needs were well accounted for. We recommended that the homes key service information provided for existing and prospective service users be made available in alternative formats that may further assist people. At this inspection we found that most key service information can be made available in large print format and discussions with representatives of some service users told us they received the information they needed to assist them in choosing the home, along Care Homes for Older People Page 11 of 37 Evidence: with an agreed written contract. At our visit there were twelve people accommodated, including one person receiving respite care. All residents were British white and of Christian based religion. We looked at the recorded needs asssessment information for three of those people. For the most part these were reasonably well recorded and included comprehensive lifestory information about each person, along with their know daily living and lifestyle preferences, which assisted in promoting their personhold Additionally, each persons care file contained policy guidance for staff to assist them in completing these in accordance with the standardised format used. However, we did find some omissions of recording, including in respect of individuals capacity to make key decisions about their lives or to consent to their care and treatment, including their medicines as detailed under the healthcare section of this report. Two of the three, did not have any information recorded regarding specific legal instructions relating their assessed financial needs and arrangements. Although we found from speaking with staff and a relative that for two of those people, there were in fact specific legal arrangements in place in relating to their personal finances. For the same two people, there was no needs assessment information recorded relating to their cognitive abilities, event of death, nor their personal property and possessions that they had brought with them into the home. Although discussions with staff told us that they were in fact conversant with those peoples needs in respect of their cognitive abilities. We found that a range of validated scoring tools were in use for staff to record in respect of each person, to assist them in determing any risks to peoples personal safety, including relating to their mental status. However, for one of the people case tracked, the person completing the scoring tool relating to their mental status had not understood the instructions for determining this, which meant it was incorrectly completed. We also found that some recorded risk assessments did not have regularly recorded reviews, which is contrary to the homes policy guidance and with recognised best practise. We discussed these with the manager who agreed to review these. And we have made a corresponding requirement about record keeping under the management section of this report. Care Homes for Older People Page 12 of 37 Care Homes for Older People Page 13 of 37 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. Peoples healthcare needs are being met, although care planning records do not consistently underpin or effectively account for practise. Evidence: At our last key inspection we found that peoples healthcare needs were usually well met in an inclusive manner, promoting their personhood and rights to be treated with dignity and respect. Although we found that care planning arrangements in respect of emergency admissions were not clearly determined. Because of this we made a requirement that where a person is admitted as an emergency, that written care plans be effected as soon as is reasonably practicable. At this inspection there were no further people admitted via emergency arrangements, although there was clear policy information in place for staff to follow in this event. In our annual quality assurance questionnaire completed by the home, they told us that they ensure peoples care plans are in accordance with their actual needs and are regularly reviewed. They told us about improvements they have made relating to Care Homes for Older People Page 14 of 37 Evidence: ensuring staff have the information they need to assist them in providing care and support for people. This included the introduction of a revised care planning policy and a communication record book, which we saw at our visit. They also told us about improvements they aim to make over the coming months by maintaining a robust staff training programme and by providing staff with clear instruction as to the management of peoples medicines, which are to be taken only when required. They also gave us some other information that we asked for relating to medicines kept at the home and promoting good nutrition. Which for the latter, tells us that the home has a formal measure of assessing peoples nutritional needs and determining any risks to these, but that to date staff have not received any formal training in this area. At this inspection we found that, whilst people had signed their agreement with their care plans, that there was no formal assessment information recorded as to their individual mental capacity to make key decisions about their lives or to consent to their care and treatment. We have made a recommendation about this under Section One of this report. We also found for each person that we case tracked, they did not have written care plans in place in respect of many areas where specific needs were identified, including risk assessed needs and identified changes in their needs. Examples that we found included personal hygiene and refusal of personal care, falls management, communication, agitation and aggression and medicines, including for variable doses and changes of instructions. Although preferred daily living and night routines were well accounted for and care plans that were in place were person centred. However, discussions with staff on duty told us that they were conversant with peoples risk assessed needs and the care interventions they required. And we found that changes to peoples needs and necessary care interventions were often being recorded elsewhere, such as within their daily record, or within the staff communication book. A copy of the homes revised care planning policy and procedural guidance for staff was placed in the front of each persons care file, providing clear information for staff to follow. However, when we spoke with the manager and staff about these, we found that these were not clearly understood or followed. We spoke with relatives of two people who live at the home who visited them frequently. And who told us they felt the needs of the service user they visited were being met and that they received the care and support that was expected and agreed. They also told us that staff treat people with respect and promote their dignity and we observed the same during the course of our visit. We also saw results of a recent satisfaction survey that the manager had started to Care Homes for Older People Page 15 of 37 Evidence: collate, with four returns received to date out of twelve circulated. All rated the quality of care as good and said that the service user was treated with dignity and respect. They also rated communication with them about any changes to the service users medical or personal care as good. When we looked at the arrangements for the ordering, receipt, storage, admininstration and disposal of peoples medicines, we found these to be overall satisfactory. We observed a senior carer who was trained in this area for a period of time where she conducted a medicines round. She did so in a safe and sensitive manner, affording patience with people. We found that medicines administration records were properly completed, clearly detailing personal information for identification purposes and with records indicating medicines given and by who or detailing the relevant coded reason, if for any reason they were not given. However, as detailed above, there was no written care plan in place in respect of peoples capacity to consent to their medicines, or where there were variable doses and instructions, including changes to these. All medicines were suitably stored, within a locked dedicated room use for this purpose, providing two medicines trolley for transporting medicines around the home and the necessary storage cupboards, including for any controlled medicines that may be stored at the home, or medicines that may require refrigeration, with daily refrigeration temperatures checked and recorded to ensure these lie within the correct range. The medicines room was clean and tidy and up to date medicines product information and guidance was in place for staff to refer to as necessary. The senior carer administering medicines at the time of our visit and also the manager who was present, advised that the newly appointed deputy manager was to develop care plan protocols for medicines. Although there was no target date identfied for their completion. Medicines audits are undertaken at regular intervals, with the most recent during May 2009. The manager also provided us with a copy of their pharmacy suppliers last visit to the home in April 2009, which had also identified that there were no care planning protocols in place in respect of peoples medicines. Care Homes for Older People Page 16 of 37 Evidence: Care Homes for Older People Page 17 of 37 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. People are well supported to engage in social and daily living activities in accordance with their known preferences and routines and to maintain contacts with their families and friends. Evidence: At our last key inspection we found that introduced and planned developments for peoples daily living and activities arrangements were positive and in peoples best interests. And that they received nutritious and wholesome meals. In our annual quality assurance questionnaire completed by the home, they told us that as far as possible they promote peoples freedom of choice and control over their lives, particularly in respect of their daily living routines. And that they continue to provide people with well balanced nutritious meals in a choice of surroundings and to promote good nutrition for people. They told us about some of the improvements they have made, which include a monthly managers surgery for clients and their families or representatives and also holding themed social evenings on a monthly basis. They also told us that they are Care Homes for Older People Page 18 of 37 Evidence: aiming to improve to ensure they keep better records of activities provided, offer more outdoor activities and to look at ways of engaging peoples friends and relatives in their social activities. At this inspection we saw the activities coordinator, who works between this home and its sister home on the same site, organising activities for people. During the morning people were offered handmassage and footspa therapy on an individual basis. Some people watched TV in an a separate area and some listened to music. However, we did find at lunchtime that that whilst music was playing in the dining area, where people were seated for lunch. That the TV was also left on in the alcove for the duration of the meal. This meant that people sitting to the rear of the dining room had both within their hearing range, which may be potentially confusing and unsettling for people with dementia and who may not be able to verbalise this. However, lunch was served and individually plated by the cook from a hot trolley brought from the main kitchen where it is prepared at Holmewood Manor, which is located in the same grounds. We are advised that this is agreed with the environmental health authority. However, that snacks and drinks can be prepared from the kitchen at Barnfield Manor at any time. We saw from visiting the kitchen that food were available to enable this. Although people were consulted about their meal choices in advance, they were asked again at the point of serving, with an alternative for each course and a choice of drinks offered. One person decided she did not want anything on the menu but said she would like something lighter. Staff encouraged her with suggestions as to other alternatives and the cook arranged for a soup of her choice to be sent from the kitchen. Tables were attractively set, including table cloths and napkins, drinking glasses and posies on each. And assistance was provided for people in a sensitive and unhurried manner. The daily menu was displayed, which matched food served. Another service user declined lunch and said he wished to rest in his room. Staff respected his wish and returned later, at which point he chose to accept a meal. Many residents choose to move to a different lounge after lunch, located to the rear of the building,which has a patio door accessing an enclosed well kept courtyard garden with seating for people, and with easy access to their own rooms. A small number of people watched TV in a separate TV area off that lounge and one person who is a keen gardener was supported to continue with potting plants in the courtyard garden. And then later went out with a visiting relative. A number of relatives visited people during the course of our visit and spoke about a recent themed seaside event day held, which people enjoyed. Photographs of people engaging in this recent event were being Care Homes for Older People Page 19 of 37 Evidence: posted onto the activities noticeboard. People also told us about an outside theatre players group who regularly come into the home with a recent war time themed singing and dancing event held. The manager provided us the results of four satisfaction surveys they had received to date following their recent circulation. Two people rated the effectiveness of the activities programme as good and two rated it as average. All four rated the quality and variety of food as good. Two rated the dining room presentation at meal times as excellent and two rated it as good. We saw that the environment had been developed further to assist people in their sensory and orientation needs associated with their dementia. These included tactile, visual and reminscence aids. And that each lounge area was provided with magazines, a TV and music system. People told us about a range of activities and entertainments that are regularly organised and we saw that information is provided for people about these, along with a company monthly newsletter and key information and contact details for local advocacy services. We that staff approached people with sensitivity and encouragement to enable them to engage and make decisions during the course of their day. And we saw that people had brought some of their own personal possessions into the home, which they kept in their own rooms. Although peoples individual mental capacities were not clearly recorded within their needs assessment information, including as to arrangements for their personal finances. We have made a recommendation relating to this under the Choice of Home section of this report. Individual records were in place detailing peoples engagement in activities and each person whose care records we examined had personal and social profiles and lifestory information in place. These were recorded in depth and staff demonstrated good knowledge of these and peoples past lives. We saw that people case tracked engaged in activities and had regular family contacts, both in and outside the home in accordance with their known lifestyle preferences and choices. Care Homes for Older People Page 20 of 37 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. Peoples complaints and concerns are usually taken seriously and acted on and they are protected from harm and abuse. Evidence: At our last key inspection we found that peoples rights to complain and to be protected from harm and abuse were taken seriously by the home and where necessary acted on. In our annual quality assurance questionnaire completed by the home, they told us that inform people about how to complain or where to seek advice about any complaints they may have. That they record and act on all complaints received, including liaison with relevant outside health and social care agencies as necessary. And that they ensure staff know their responsibilities concerned with protecting people from harm by way of regular training. They told us they have received one complaint investigated via joint agency safeguarding procedures relating to the alleged financial abuse of a named resident. And they provided us with written confirmation as to the action taken by them as a result of that investigation, which is satisfactory. The manager also told us at our visit about recent concerns raised by staff relating to a personnel issue, although there was no written record in respect of those concerns nor any investigation or action taken by Care Homes for Older People Page 21 of 37 Evidence: the manager as discussed with us. Since our last inspection one person has raised concerns with us about peoples freedom to wander to their own rooms from the front lounge and dining area, due to the location of electronic key pad locks between there and their own rooms. At this inspection we saw that staff were sensitive and responsive to ensuring peoples freedoms and found that they encourage people to make use of the lounge dining area located to the rear of the home, particularly during the afternoon and evening, when people tended to wander more. As this enabled direct access for them to their bedrooms and into an enclosed safe garden area. However, peoples recorded needs assessment records did not account for any potential restrictions on peoples liberty that may arise, given their mental capacity, including from the use of electronic key pad locks sited in the home. Discussions with and observations of staff practise told us that whilst they were aware of the need to promote peoples liberty and safety, that they had not received any training and instruction relating to the Deprivation of Liberty and Mental Capacity Act 2005. However, this was planned and we have referred to this under the Staffing section of this report. We saw from looking at the daily records for one person we case tracked and from speaking with staff about their care that this person had frequent episodes of agitation and aggression. As detailed under the Health care section of this report, there was no written care plan in place detailing care interventions to be followed by staff. Although staff spoken with were conversant with recognised approaches in dealing with aggression. And also described a consistent approach towards that aspect of the persons care. We also saw that some staff had undertaken training in this area since our last inspection and with further planned. Anonymous concerns were raised with us prior to our inspection visit alleging a lack of food availability in the kitchen to enable people to have snacks out of hours. However, discussions with staff and observations as to food availability at our visit did not indicate this to be so. We understand that the food refrigerator there had previously been out of action, but had recently been replaced. Staff that we spoke with were conversant with their role and responsibilities concerned with dealing with complaints and concerns and also safeguarding people from harm and abuse. We saw from training records that all staff receive safeguarding vulnerable adults training as part of their induction and with regular updates. And that they are provided with the necessary policy and procedural guidance to assist them in these Care Homes for Older People Page 22 of 37 Evidence: areas. At this inspection we saw that the information about how to complain, together with a copy of the homes complaints procedure is provided in their service guide for people. And that the complaints procedure is openly displayed in large print format within the home. Peoples representatives told us that they knew how to complain or to speak with if unhappy. Care Homes for Older People Page 23 of 37 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. People benefit from their immediate environment, which suits their needs and is safe and clean. Evidence: At our last key inspection we found a satisfactory programme of environmental upgrading and repairs underway, which should benefit people accommodated there. We made a requirement that matters raised in the most recent report of the Fire Officer, from Derbyshire Fire and Rescue service authority be complied with by 30 June 2009. And asked the home to tell us in writing when the works are completed. The provider has told us about works completed to the ground floor of the home and at this inspection we found that due to further works being necessary as recommended by the Fire Officer, to the first floor of the home. That the first floor is not in operation for use by service users. Although the homes statement of purpose does not detail this. At this inspection we found there were twelve people accommodated on the ground floor only. We found all areas of the ground floor to be clean, comfortable, odour free, warm and well lit, well furnished and suitably equipped. Lounge and dining areas were well Care Homes for Older People Page 24 of 37 Evidence: thought out, with the rear lounge completely refurbished since our last visit. The TV snug area off that lounge provides black and white large photo type pictures of yesteryear famous film stars with a large wall mounted flat screen TV there. TVs and music systems are provided in both lounges There are a variety of sensory aids and adaptations suitable for people with dementia, together with an orientation board and large faced clock. Peoples own rooms were personalised and furnished and equipped to suit their needs, including touch sensory bedside lighting. There had been a recent visit from the environmental health officer, with the kitchen remaining closed for main food preparation. Snacks and drinks are prepared here only, with main meals suitably transported from Holmewood Manor, a sister home located in the same grounds. Suitable hand washing facilities are provided for staff and the separate laundry facility is suitably equipped and clean and tidy. The manager provided us with results collated to date following the cirulation of a recent satisfaction survey to peoples relatives. Out of four returns to date, all rated the comfort and cleanliness of the home to be good and also the quality of decor and furnishings and external grounds. Care Homes for Older People Page 25 of 37 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. Peoples needs are met from staff that are being suitably recruited, inducted, trained and deployed. Evidence: At our last key inspection we found that overall peoples needs were met from staff that for the most part were effectively recruited, inducted, trained and deployed, although further development of the staff training programme would better assist staff in consistently promoting peoples rights and best interests. We made a requirement that staff receive recognised training in responding to and dealing with aggression from any service user. We also recommended that they develop their rolling programme for training to include Human Rights and Mental Capacity Act 2005 and use the Department of Healths staffing tool to assist in determining staffing levels. At this inspection we found that good progress was made towards achieving these and have referred to our findings below. In our annual quality assurance questionnaire completed by the home they told us that staff receive a comprehensive induction on their commencement and are supported to Care Homes for Older People Page 26 of 37 Evidence: undertaken NVQ training in care. Although feel they could improve their record keeping relating to their staffing arrangements. However, they indentified some improvements, which they feel are reflected in staff morale, no agency staff use and a minimal staff turnover. They told us that they have established staff champions for taking forward dining and bathing experiences for people, which they intended to develop over the coming months and ensure that all staff attend regular and necessary training. We saw at this inspection that a number of staff had undertaken training in these areas. They gave us some statistical information that we asked for concerned with their staffing numbers, skills and arrangements, including that nine out of fourteen care staff have achieved at least NVQ level 2. At this inspection staff described overall satisfactory recruitment, induction, training and deployment arrangments and records that we examined told us the same. Staff told us about developments in their induction programme, appertaining to fire, first aid, dementia, infection control, safeguarding people and medicines awareness. And we also saw developments in their ongoing training programme, including use of bedrails and dealing with aggression and challenging behaviour. Staff responsible for administering medicines also undertake additional certificated training, which includes an assessment of their competency. And we saw that certificates of that training were provided in their personal files. The home collates monthly training statistics in respect of the percentage of staff achieving key areas of training, in order to monitor progress and to plan accordingly. This includes updates and refreshers in accordance with their rolling training programme. We looked at these for April 2009 and saw that they were overall satisfactory. We saw that training in dealing with challenging behaviour and aggression had commenced with 30 percent of staff achieving this and further training planned for this. We also saw from looking at the training programme, staff discussions and additional information provided by the manager. That Mental Capacity Act 2005 and equality and diversity training was organised and with further identified via the training programme. However, there was no formal training plan in respect of care planning and records and record keeping. We have identified significant omissions that we found in the recording of peoples needs assessment and care planning records under the Healthcare, Choice of Home and management sections of this report. Care Homes for Older People Page 27 of 37 Evidence: Care Homes for Older People Page 28 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is reasonably well managed and run with peoples overall health, safety and welfare promoted and protected. Although record keeping does not always effectively underpin or account for care practise and delivery, which may potentiate omissions of care. Evidence: At our last key inspection we found the arrangements for the management and administration of the home to be significantly improved, more effectively promoting peoples safety and best interests. The acting manager has been in post since July 2007 and has continued to manage the home for a significant time period. We made a requirement at our last inspection, that she submit an application for registration to the Commission. We also made a recommendation that quality assurance systems be further developed by making available the results of any satisfaction surveys to relevant parties and in establishing Care Homes for Older People Page 29 of 37 Evidence: an annual development plan for the home. We found at this inspection that the acting manager had commenced the initial process towards her registration application by submitting an enhanced criminal record check application via the Commission. As is necessary for her to proceed with her registration application. We also saw that the manager had begun to collate the results of their most recent satisfaction survey, with four returns to date out of twelve circulated. These show overall satisfaction with the quality of care, including the promotion of dignity and respect for people, the environment, communication, food and activities in the home. The manager advised she planned to share these via formal meetings once fully collated. Although no one had attended the most recent one on April 2009. However, the manager felt these could also be shared via the manager surgeries to be held. We saw copies of reports from the most recent quality monitoring visits made to the home on behalf of the registered provider and looked at the most recent monthly services audits undertaken via management. The most recent audit gave an overall percentage score of ninety two percent, with the lowest scores for training completion and care plans. There was however a staff training plan and training matrix in place in respect of the former, which has developed considerably since our last key inpsection. Although no action plan was seen concerning any care planning record improvements that may be required. We have made a requirement under the Healthcare section of this report about care plans, together with a requirement here about record keeping. We saw that the manager has achieved areas of training and development over the last twelve months and also holds the Registered Managers Award. We saw that the home offers to handle and safekeep personal monies on residents behalf and that the arrangements for these, including safekeeping and record keeping are satisfactory. And with regular audits of these undertaken via external management. Staff described satisfactory arrangements for ensuring safe working practises, including the provision of relevant policy and procedural guidance for them to follow, access to core health and safety training and the provision of necessary equipment. And during the course of our visit we observed the environment to be clean and generally safe and free from any observable hazards. Staff spoken with were also conversant with their role and responsibilities concerned with the reporting and recording of any accidents or incidents in the home. And were Care Homes for Older People Page 30 of 37 Evidence: provided with details of who to contact in the case of an emergency or crisis, including out of hours management cover. Care Homes for Older People Page 31 of 37 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 19 23(4)(a) & (c) Adequate precautions must be taken against the risk of fire and for the review and maintenance of fire precautions and equipment. You must ensure that matters raised in the Fire Officers report of their said visit to the home in March 2008 are complied with as stated. (Original timescale 30/11/07 - extended to 30/06/08 due to additional information re fire officers visits). The timescale for achievement of this is after this key inspection. See environment section of this report for further detail. So as to meet with the requirements of the local fire authority and to ensure adequate fire precaution necessary to enable the first floor of the home to be operational. 31/07/2008 2 31 Sec 3 CSA 2000 The acting manager must submit an application for registration under the Care Standards Act 2000 to the Commission. Due to action taken by the 03/08/2008 Care Homes for Older People Page 32 of 37 acting manager to enable her to submit this. We have agreed an extended timescale to 31 July 2009 So as to ensure that the acting manager does not continue to manage the home without registration under the Care Standards Act 2000. And in the best interests of people admitted there. Care Homes for Older People Page 33 of 37 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 Written care plans must be 31/07/2009 formulated in accordance with peoples assessed needs and set out in detail the action which needs to be taken by care staff to ensure that all aspects of a persons health, personal and social care needs are met. And kept under review. So as to determine and account for how a service users needs in respect of their health and welfare are to be met. 2 9 13 Written care plan protocols must be in place in respect of each service users medicines. Together, where necessary, with a clear written plan for staff to follow in the event of any variable dose or special instruction for medicine presribed to any service user. 31/07/2009 Care Homes for Older People Page 34 of 37 So as to ensure the safe administration of medicines to any service user in accordance with the British Royal Pharmaceutical Guidance for Great Britain. 3 30 18 Training must be provided for care staff in respect of care planning and records and record keeping. So as to ensure that staff receive the training they need appropriate to the work they are to perform. In this instance with regard to their responsibilities for determing and completing peoples needs assessment and care planning records. 4 37 17 Effective record keeping 31/08/2009 must be ensured in respect of service users individual needs assessments and care plans. So as to effectively underpin, determine and account for the care to be delivered to any service user as may necessary to promote their health and welfare. 31/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Risk assessments concerned with personal safety and risk should be reviewed monthly, and with a record kept. So as Page 35 of 37 Care Homes for Older People to ensure that any changes in need are clearly determined in a timely manner. 2 3 Peoples needs assessment records should include account for their individual mental capacity to make key decisions about their lives, including as to their care and treatment, in accordance with the principles of the Mental Capacity Act 2005. The homes medicines policy should provide reference for staff to follow in respect of any variable dose or special instructions concerned with their prescribed medicines, including for their care planning requirements. A record should be kept of any concerns raised outside the formal complaints procedure, including action determined. Information should be included in the homes statement of purpose regarding its kitchen and catering arrangements and the fact that the first floor of the home is not currently in operation or open to admissions. 3 9 4 5 16 19 Care Homes for Older People Page 36 of 37 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). 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