Inspection on 30/07/09 for Berkeley House

This inspection was carried out on 30th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Hawkhills

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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: Berkeley House 2 Berkeley Court Off Greenwich Avenue Bilton Grange Hull HU9 4UY     The quality rating for this care home is:   two star good 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: Eileen Engelmann     Date: 3 0 0 7 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 30 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 30 Information about the care home Name of care home: Address: Berkeley House 2 Berkeley Court Off Greenwich Avenue Bilton Grange Hull HU9 4UY 01482718007 01482718008 berkeleygrange@hhcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hadrian Healthcare (Hull) Ltd Name of registered manager (if applicable) Mr Amanda Dawn Griffiths Type of registration: Number of places registered: care home 84 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 who may be accommodated is 84 The registered person may provide personal care (excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories: Dementia (CodeDE); Old Age, not falling within any other category (CodeOP) Date of last inspection Brief description of the care home Berkeley House is a purpose built care home which provides personal care for people who may have dementia or who are an older person. The environment is spacious, welcoming and decorated/furnished to extremely high standards, with a wide range of communal spaces including nine lounges and five dining rooms. Personal accommodation is provided in single bedrooms, each with an en-suite shower facility: Care Homes for Older People Page 4 of 30 Over 65 0 84 84 0 Brief description of the care home there are two bathrooms on each floor of the home, fitted with hoists for assisted bathing. Information given to us by the manager on 30/07/2009 was that the weekly fees are from 359.50 GBP to 600.00 GBP and top up fees from 15.00 GBP to 35.00 GBP. The amount of fees payable are dependent on the type of care required and the type of room facilities chosen by the individual. Care Homes for Older People Page 5 of 30 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: two star good 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: Information has been gathered from a number of different sources over the past 4 months since the service was registered with the Commission for Social Care Inspection, this has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out with the manager, staff, visitors and people using the service of Berkeley House. The visit took place over 1 day and included a tour of the premises, examination of staff and peoples files, and records relating to the service. Questionnaires were sent out to a selection of people living in the home and staff and their written response to these was adequate. We received 3 back from staff (30 ) and 7 from people using the service (70 ). Informal chats with a number of people, visitors and staff took place during this visit; their comments have been included in this report. Care Homes for Older People Page 6 of 30 The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. We have not received any formal complaints about the service in the 4 months it has been open. Nine safeguarding referrals have been made by the home (up to the time of our visit 30/7/09), four were around money going missing in peoples rooms, one around medication, one relating to an altercation between two people using the service and three around care practises. Five have been investigated by the safeguarding team from Hull social services, three were resolved and two are ongoing. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 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 wanting to use the service undergo a needs assessment before they are admitted to the home. The service has received copies of the care management summary and care plan for most of the people living in the home. For people who are self funding the service is able to demonstrate how they have undertaken the assessment, but this process needs to be more robust. Evidence: Seven people answered our questionnaires and said they had received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. Three peoples care and records were looked at as part of this visit, each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The manager told us that a formal letter, offering placement or not, is sent out to the enquirer once she has reviewed the needs assessment. Care Homes for Older People Page 10 of 30 Evidence: We found that the homes need assessment is very basic and requires more detailed information about each persons personal care and physical well-being. We discussed with the manager the need to ensure any decisions made around care should be risk assessed and well documented and spent some time talking about how the homes assessment process could be developed to include more information around equality and diversity such as race, age, gender (including gender identity), sexual orientation, disability, religion or belief. There was little evidence that the person or their representative had contributed to the homes assessment and the manager must ensure the person at the centre of the assessment or their representative signs the assessment to show they agree with what has been written. People using the service and relatives are very pleased with the care and support given by the staff, they said the staff are caring and friendly and everyone is well looked after. Survey responses show that everyone using the service is confident about the care and satisfied that the individual needs of the people living in the home are being met. Information from the Annual Quality Assurance Assessment and discussion with the people living in the home indicates that all of the people are of white/British nationality, although there are a number of people with different faiths and religions. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Checks of the staffing rotas and observation of the service showed that the home is able to offer a limited choice of staff gender to people who express preferences about care delivery, as they employ 2 male care staff. Discussion with the people living in the home indicates that they have no difficulties communicating with the staff and that they can express their preferences of staff gender for individuals giving their personal care. Information from the staff files and staff training matrix given to us on this visit (30/7/09) indicates that the staff have been given a corporate induction, but there was no evidence that staff who are new into care have been given an induction in care tasks which meets Skills for Care criteria. There have been three safeguarding allegations made in the past four months around care practices/attitudes of staff, the registered person must be able to demonstrate that staff individually and collectively have the skills and experience to deliver the services and care which the home offers to provide. Care Homes for Older People Page 11 of 30 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. The health, personal and social care needs of the people living in the home are being met by the service and staff. People who use the service are supported and helped to be independent whenever possible. Evidence: Information from the surveys indicates that the people who responded are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. Individual care plans are in place for all people using the service and the three examined set out the health, personal and social care needs identified for each person. Risk assessments were seen to cover pressure sores, nutrition, moving/handling and activities of daily living. Information about the persons social interests, likes and dislikes, and contact with their family and friends is included within the individuals care plan. The format of the care plans is satisfactory, however staff practices around recording in the care plans is variable. In the three care plans we Care Homes for Older People Page 12 of 30 Evidence: looked at staff had not recorded the care given to each individual on five occassions in the past month. One individual self medicates but the risk assessment done by the staff does not have the signature of the person using the service or their representative and there is no indication whether their GP was consulted; there was no care plan for this aspect of care either. In one care plan the monthly evaluation of the care being given was included within the daily notes, this is acceptable practice but whoever had done the evaluation did not then amend the care plan to reflect the changes in care that were taking place to meet the individuals needs. Staff were also consistently leaving spaces between the entries on the daily notes, this is not acceptable practice and must stop, as it could potentially allow an individual to alter/amend the care notes at a later date. These concerns were discussed with the manager who said she would audit the care plans and speak to staff as soon as possible about the recording processes. People said that they have good access to their GPs, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people and relatives indicate they are satisfied with the level of medical support given to the people living at the home. Entries in the care plans specify where individuals have dietary needs and specialist diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. Information given to us in the Annual Quality Assurance Assessment completed by the manager (2/7/09), indicates that four people at the home have developed a pressure sore in the past four months and pressure relieving equipment has been provided by the Community Nurses. Discussion with the staff indicated there is a good relationship with the District Nurse team who provide advice and help around this area of care. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. We have already discussed earlier in this report the need to improve the medication risk assessments. The home uses Lloyds Pharmacy as their medication supplier and has a pop out system of medication, plus some boxes and bottles where medication is not suitable for putting into the heat-sealed system. Checks of the medication records show that overall these are well maintained and kept up to date. All staff responsible for administration of medication have received basic medication training and they are waiting for places on a distance learning course with Lloyds on safe handling of medication. Care Homes for Older People Page 13 of 30 Evidence: We found two areas where staff could improve their medication practice; where staff are handwriting medication onto the MAR sheets (transcribing) there should be two staff initials against the information to show that two people have checked that what is written (medication name, strength of medication, type of medication such as tablet or liquid, and how it is to be administered) is clearly and correctly recorded, and matches what is on the medication packet or bottle from the pharmacy. Staff should also be consistently recording the quantities of medication received from pharmacy on the MAR sheet, to create a clear audit trail for anyone wishing to check the stock levels in the home. The manager told us that she had picked up on these issues during a recent audit of the system and was taking action to improve staff practices. Peoples comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Care Homes for Older People Page 14 of 30 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 using the service are provided with choice and diversity in the activities and meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. Evidence: The home employs an activity co-ordinator to deliver a programme of events on a daily basis Monday to Friday, with flexible hours for evening or weekend sessions as and when required. At the moment there is a good range of group activities and one to one sessions taking place, which reflect the interests of the people living in the home and also their gender. As you enter the home there is a large foyer with activity boards and information about forthcoming events, to one side is a small coffee shop/fund raising area where there are items on sale to people and visitors. Events taking place each week include bingo, quizzes, craft work and exercise classes, a keyboard player comes in once a weeek and the Pat-a-dog scheme visits every fortnight. Everyone who answered our surveys said there was always something for them to do and were clearly satisfied with the entertainment on offer. Trips out are organised by the activity person and transport is arranged through local taxi companies who have wheelchair accessible transport. Care Homes for Older People Page 15 of 30 Evidence: The manager said that there are regular church visitors within the home and people could go to the local church services and religious celebrations as requested. The home provides special meals and cakes for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. People are on the whole very positive about the home and its service. Individuals said on admission people are told to treat Berkeley House as their home and are given support and encouragement by the staff to make the most of the facilities on offer. One visitor said to us that the home offers marvellous living space and visitors and relatives are made welcome at any time. Information about advocacy services is on display in the home and discussion with the manager indicated that no one at the home is currently using an advocacy service. There are information leaflets available for staff, visitors and people using the service around the Mental Capacity Act (MCA) and Deprivation of Liberty (DOL). The manager told us that 25 of the staff have attended training on current legislation around MCA and DOLs, this was provided by the Local Authority and other staff are waiting for places on this course. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. People spoken to are satisfied that they can access their personal allowances when needed. There are meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action were needed. The home has provided people using the service with a computer and internet facilities so they can keep in touch with family and friends and access a wide range of information and news. We saw people partaking of meals throught our visit to the home, and the menus show that the home offers individuals a substantial breakfast, a light midday meal and the main meal is served in the late afternoon/evening. People we spoke to were very happy with the meal times and the choices on offer. Tea - trolleys were taken around by the staff midmorning and afternoon and offered people choices of fruit smoothies, tea/coffee, juice and a vast array of home-made cakes. Each dining room has a small servery area with kettles and fridges so people and visitors can make their own drinks if wished. The food we saw served was well presented and those eating said the meals are delicious, the home caters for my no-fat diet, and I have never eaten so well. Care Homes for Older People Page 16 of 30 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 home has a satisfactory complaints system with some evidence that people feel that their views are listened to and acted upon. Visitors and people using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. Evidence: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. Peoples survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said I would speak to the staff or the manager if I had a problem. Checks of the complaints record showed that there have been nine complaints made to the manager since the home opened, and these were investigated and responded to in a timely and appropriate manner. Records show that the manager deals with minor niggles/grumbles on a daily basis. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Care Homes for Older People Page 17 of 30 Evidence: Information from the staff training matrix given to us during this visit (30 July 2009) indicates that the majority of staff have attended safeguarding of adults training and are booked to attend dementia awareness sessions in September 2009. These training sessions are part of the homes rolling programme of staff development. Safeguarding issues and outcomes areas such as health care, staff supervision, staff training, complaints and safeguarding of adults have been looked at as part of this visit. We have been notified of nine safeguarding allegations in the past four months, four related to theft within the home and the police have been notified about the missing money from peoples bedrooms, and people have been asked to use the lockable facilities in their room to store valuables in. For the other five allegations one was around a medication error, and the member of staff was disciplined and received additional support and training around medication giving, one related to an altercation between two people using the service and the service has ensured staff now do regular observations of the two individuals to prevent further issues, three were around care practises(one has been investigated by the safeguarding team from Hull social services and resolved, and two investigations are ongoing). Care Homes for Older People Page 18 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within this home is excellent, providing people with a spacious, attractive and safe place to live. Evidence: Berkeley House is a is a newly registered, purpose built care home and it provides people with a high quality, well finished building incorporating ample living accommodation and an effective and efficient working environment. Walking around the home it is clear that the environment is spacious, welcoming and decorated/furnished to extremely high standards. People living in the home are very satisfied with their bedrooms and commented on the beautiful interior and exterior of the home. Accommodation is provided over three floors, all bedrooms are single with en-suite shower facilities and each room has its own thermostat to control the temperature. There are two communal bathrooms on each floor and all are fitted with hoists. Corridors and walkways throughout the home are wide enough for people to walk around in comfort and ease, even when they need equipment to aid their mobility. Good sized storage cupboards are provided to keep equipment and other products out of bedrooms and communal areas. The home has a wide range of communal spaces including nine lounges and five dining rooms. Outside of the home there is a secure, garden area provided with a range of seats and tables for people to use whilst taking Care Homes for Older People Page 19 of 30 Evidence: in fresh air and enjoying the summer weather. The environment is clean, warm and comfortable and few malodours were present. Comments from the day of this visit indicate that the people using the service find the home to be clean and tidy and they are satisfied with the laundry service provided by the home. The laundry in the home is sited in a very spacious facility with seperate rooms for dirty linen and clean linen. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. The staffing matrix supplied to us on 30 July 2009 indicates that infection control training is part of the rolling programme of training and that all of the staff have attended this in the last four months. Care Homes for Older People Page 20 of 30 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 sufficient staff employed within the home to ensure that the care needs of people using the service are met, however the staff induction process needs to be more robust to encourage the development of a competent staff team. Evidence: We spoke to two people who use the service during this visit, and they were satisfied with the care they receive and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us that staff are friendly, helpful and supportive and we enjoy life in the home. At the time of this visit there were 50 people in residence and the staffing rota showed that the following staffing levels are in use - from 8am to 2pm there are seven care staff on duty, from 2pm to 8pm there are seven care staff on duty and from 8pm to 8am there are five care staff on duty. Information from the Annual Quality Assurance Assessment (completed 9 June 2009 by the manager) about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the service, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the minimum hours asked for in the recommended guidelines. 47 of care staff at the home have an NVQ 2 or above in care and eight more staff Care Homes for Older People Page 21 of 30 Evidence: are completing this training. All new starters have to complete a corporate induction which covers the policies and procedures of the home, its aims and objectives and basic mandatory training. We found that the home does not have a induction for new care staff , which meets Skills for Care criteria. The registered person must ensure that inexperienced staff or new staff with no previous knowledge of caring, undertake this type of induction in order to develop the necessary skills and knowledge to meet the needs of those using the service. The majority of employees are up to date with safe working practice training including health and safety, fire, moving and handling, first aid, safeguarding of adults and infection control. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of three staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: The registered manager is a registered nurse with an active PIN from the Nursing and Midwifery Council, she has experience of looking after people with mental health and learning disabilities. The registered manager has spent the last five years working at management level and keeps her skills and knowledge up to date with regular training sessions pertinent to her role. Policies and procedures within the home are up to date and meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager and senior staff complete in-house audits of the home and its service on a monthly basis, and the registered person does spot checks and completes the regulation 26 visits. Care Homes for Older People Page 23 of 30 Evidence: Meetings for people using the service are held on a regular basis and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Feedback is sought from the people living in the home and relatives through a number of themed (admission, food, accommodation) satisfaction questionnaires, and the provider company plan to send out a more comprehensive survey/questionnaire about the service on a yearly basis. The manager is aware of the need to produce a development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Checks of the finance systems within the home found that handwritten records are kept for peoples personal allowances; the administrator on a daily basis up dates these. Information from the administrator indicates the majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the persons individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. Care Homes for Older People Page 24 of 30 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 25 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must 01/11/2009 ensure that the homes needs assessment is robust and involves the prospective service user, his/her representatives (if any) and relevant professionals. So that anyone coming into the home knows that the service can meet their needs. 2 4 18 The registered person must 01/11/2009 ensure that staff individually and collectively have the skills and experience to deliver the services and are which the home offers to provide. So that people using the service and their representatives know that the home they enter will meet their needs. Care Homes for Older People Page 26 of 30 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 3 7 17 The manager should make 01/11/2009 sure that staff are recording the care, given on a daily basis, within the care plan of each individual. So each person receives appropriate and continuous care to meet their needs. 4 7 17 The manager should make sure that staff do not leave gaps between their daily recordings of care in the care plans. To prevent any possibility of records being altered/amended at a later date. 01/11/2009 5 7 15 The registered person must make sure that care plans are evaluated at least monthly, updated to reflect changing needs and current objectives for health and personal care, and actioned. So each person receives appropriate and continuous care to meet their needs. 01/11/2009 6 28 18 The registered person must 01/11/2009 ensure that new staff who have no previous experience of care work complete an induction which meets Skills of Care criteria. Care Homes for Older People Page 27 of 30 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 So people using the service can be confident that they are being looked after by skilled and competent individuals, and young or inexperience staff are not placed into a situation they cannot manage. 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 The manager should consider how the homes assessment process could be developed to include more information around equality and diversity such as race, age, gender (including gender identity), sexual orientation, disability, religion or belief. The manager should ensure that information about peoples preferences regarding staff age and gender for giving personal care, is recorded in the individual care plans. The manager should make sure that staff are consistently recording the quantities of medication received from pharmacy on the MAR sheet, to create a clear audit trail for anyone wishing to check the stock levels in the home. The manager should make sure that where staff are handwriting medication onto the MAR sheets (transcribing) there are two staff initials against the information to show that two people have checked that what is written (medication name, strength of medication, type of medication such as tablet or liquid, and how it is to be administered) is clearly and correctly recorded, and matches what is on the medication packet or bottle from the pharmacy. 50 of care staff should achieve an NVQ 2 in care by the end of July 2010. 2 9 3 9 4 28 Care Homes for Older People Page 28 of 30 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 5 33 The manager should ensure there is an annual development report created from the quality assurance process, to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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