Inspection on 02/02/10 for Boroughbridge Manor & Lodge

This inspection was carried out on 2nd February 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Boroughbridge Manor & Lodge 20/08/09

Boroughbridge Manor & Lodge 16/12/08

Boroughbridge Manor & Lodge 21/08/08

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

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Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for older people Name: Address: Boroughbridge Manor & Lodge Roecliffe Lane Boroughbridge York YO51 9LW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 0 3 0 2 2 0 1 0 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 41 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 41 Information about the care home Name of care home: Address: Boroughbridge Manor & Lodge Roecliffe Lane Boroughbridge York YO51 9LW 08456038218 01423326377 boroughbridgelodge@orchardcarehomes.com www.orchardcarehomes.com Orchard Care Homes.Com Limited care home 76 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 76 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - Dementia Code DE Date of last inspection Brief description of the care home Boroughbridge Manor And Lodge can accommodate up to 76 older people, who require help with personal care including some people with mental health needs. The home is situated in its own private grounds, only a short distance from the market town of Boroughbridge. All of the bedrooms are well equipped and have en-suite facilities. People can access all floors by stairs or a passenger lift. At the inspection in February 2010, the acting manager told us the weekly fees range from £650 to £700. People pay extra for things like hairdressing, chiropody, newspapers, personal toiletries and dry cleaning. Information about the home, including the last inspection report can be Care Homes for Older People Page 4 of 41 76 0 Over 65 0 76 Brief description of the care home requested from the manager. The Statement of Purpose and Service User Guide is also available on request. Care Homes for Older People Page 5 of 41 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 key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. A self assessment, called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. The outcome of a random inspection, completed on 29 October 2009, to check progress in meeting requirements and recommendations made at the key inspection on 20 August 2009. Comment cards sent to some people who use the service (seven returned), some staff Care Homes for Older People Page 6 of 41 (six returned), some relatives (three returned) and some health professionals (four returned). A site visit was also carried out over two days, on 2nd and 3rd February 2010. On the first day, two inspectors were present. One inspector completed the site visit on the second day. The visit overall took approximately twelve hours to complete. During the site visit to the home, several people who live there, some staff, the manager, the Operations Manager, a relative and a health professional were spoken with. A number of care plans were looked at. We also looked at some staff records, including recruitment and training files, and some information about health and safety. We also looked at the communal areas, and a sample of peoples bedrooms, with their permission. Care practices were also observed, where appropriate, and a good deal of time was spent watching the general activity, to get an idea about what it is like to live at Boroughbridge Manor and Lodge. The manager and the Operations Manager were available throughout the site visit, and we gave them detailed feedback both during this visit, and at the end. 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 where it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirements is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 41 What the care home does well: What has improved since the last inspection? What they could do better: The staff could make sure that risk to people is properly assessed, and this risk is documented in their care plan, and regularly reviewed. They could make sure that important information about people is communicated through the care plans, so that information is not lost or forgotten. This will help to aid good communication between the home, visiting professionals, and others with an interest in the home, such as relatives. Care Homes for Older People Page 8 of 41 For people who manage their own medication, staff could make sure that risk to them is properly assessed, and regularly reviewed. This would help to determine whether the individual is safe and willing to manage this task, and that they have the right facilities, which they use, to store their medications and creams away safely. For the people who staff look after medication on their behalf, better management and auditing needs to be in place to make sure that this is being stored, recorded and administered safely and correctly. People could be given more information about the daily activities that take place at the home, so they can plan ahead events that they would like to attend. Those people with dementia needs could be provided with more specific activities to help make their lives more interesting and stimulating. The mealtimes on The Lodge could be more consistent, so that at every meal, people have a good social experience, where they get the attention they need in a dignified and timely way. People who have a liquidised meal could have this served on their plate in separate components, so they too can experience different tastes and textures. The manager could devise a more organised way of checking that all staff have completed their compulsory training, and provide updates where this has not been achieved. Staff, especially those who work on The Lodge, could all complete training in dementia awareness, so they have up to date information about good practice, which they can then use in their daily work. Staff could also have a training update about the role of the local authority, who they have a right to report to directly about any safeguarding concerns which they may not wish to report to the company. This will provide extra protection for the people who live at the home. The environment is pleasant, but on The Lodge, there could be more work done to make it more interesting and more stimulating for people. More landmarks and additional signeage could be also provided, so that people with dementia can find their way round more independently. Staff could make sure that they deliver soiled or contaminated linen to the laundry in the correct bags. This will help to make sure the staff working there are not handling soiled linen unnecessarily, and will reduce the risk from cross infection. They could also make sure that sluice rooms are kept locked when they are not in use. This would stop people from entering the room by mistake, and potentially coming to harm. Staff have been allowed to provide care to people after it has been checked that they have not been barred from doing so, but before their full police check has been returned. A better system of recording how they will be closely supervised could be developed. This would provide evidence that these staff have never been allowed to work alone with vulnerable people during this interim period. New staff could also have a more detailed, nationally recognised Skills for Care induction. This would help to promote good, consistent practice which meets with current minimum standards. Confirmation could be sought to make sure that water is stored correctly, and that actions have been taken to address any requirements of recommendations following the last routine visit made by the Environmental health officer to the kitchen. This will ensure that the right action has been taken to keep people safe. Care Homes for Older People Page 9 of 41 Clear lines of accountability could be established at the home, so that people can be assured that even without the input of the manager, systems will be in place to maintain good communication with those who have an interest in the home. Visiting professionals could also be asked their views about how the home operates, so that everyone can be assured that it is running in peoples best interests. 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 10 of 41 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 41 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed before they are admitted, to make sure their needs can be met. Evidence: The acting manager told us that everyone referred to the home is assessed by her, before they are assured that the home can meet their needs, and a place offered to them. As part of this assessment, the manager gets information from other professionals, such as the care manager, or hospital staff. This helps her to make better decisions about whether the home will have the resources to care for the individual concerned. The staff we asked said that this information is shared with them. This helps to make sure that people get the right care and support as soon as they arrive. We were told that everyone is given a copy of the homes brochure. They can keep this, and read it at their leisure. When they arrive, people are also given a copy of the Care Homes for Older People Page 12 of 41 Evidence: service users guide, which they can keep in their room. This tells them more about the facilities available, and important information, for instance, about how to complain. Of the seven people who returned their surveys, two did not know if they had received enough information before they moved there. One said they hadnt, but two said they had. One person commented I didnt want to come here but a man came to see me one day and I came here. But in a way Im happy I came here. Health professionals answered usually or sometimes when asked whether the care assessment arrangements ensure that accurate information is gathered and that the right service is planned for people. The home has been through a difficult period, during which time admissions referred by the local authority were suspended. Following identified improvements, this suspension has now been lifted, and admissions are now being made at a maximum of two each month. This will allow these admissions to be managed properly, and will give the manager the time she needs to make improvements at the home. It will also help to make sure that people, their families and the professionals who support them, get a good, consistent service. The home does not provide intermediate care. Therefore standard 6 is not applicable. Care Homes for Older People Page 13 of 41 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. More attention is needed from staff with regards to the management of risk, and the safe handling of medication, to ensure that people get the right care. Evidence: The acting manager is keen to make changes at Boroughbridge Manor and Lodge, to improve outcomes for the people who live there. She and the Operations Manager have worked hard to drive forward improvements, after it was judged at the last key inspection in August 2009 that outcomes for people with regards to their health and personal care were poor. The manager had taken up her post at the home only three days before that key inspection, and at a follow up random inspection in October 2009, we found some good improvements were being made. At this inspection, we looked at a number of care plans, spoke to people and staff, and looked at some medication, to see what progress had been made in meeting the two requirements made following the random inspection. From the evidence seen, we concluded that these had been met. However, some new requirements have been made, because there are still shortfalls which need to be addressed with priority, to Care Homes for Older People Page 14 of 41 Evidence: ensure people living there receive safe and consistent care. The manager already knew that improvements were needed, and had some plans in place to address some of the issues we raised. Peoples care plans are designed so they are easy to complete, because they rely on a number of assessments, which help staff to decide whether or not the person is at risk, whether staff need advice from other professionals, and whether a care plan is needed to support the person to maintain their health, safety and welfare. The format is good, because it reminds staff to look at peoples emotional and social wellbeing, as well as their personal care needs. The manager has devised a calendar, to remind staff when the care plans they have responsibility for, need reviewing. Most seen had been reviewed on a monthly basis. The quality of the plans though was inconsistent. One seen was very good, because it talked about the person in a very individual way, which meant that anyone reading it would understand about the persons preferences, and the support they needed to remain independent. It made comments like x likes a bubble bath every other night. Staff to wash her back and feet if she is finding it difficult to reach, x will empty her tablets from the medicine pot into the palm of her left hand then place a few at a time into her mouth. Staff to provide a glass of cold water which x will sip from until all her tablets are swallowed. This is good information about a persons specific preferences, which, when followed, will help them to experience good care. Other plans needed to consider peoples needs further, to make sure that the support people get is individual to them. The main shortfall in other peoples plans, was around the staffs ability to measure and monitor risk properly, in relation to pressure area care, nutrition, moving and handling, constipation, risk from falls, and aggression. Sometimes the staff or the manager could explain what care was being given, and why. But there was often a lack of written information for staff to follow, to ensure that people got good, safe, consistent care. For instance: One care plan was completely out of date, and did not support the care that person needed from staff at this stage of their life. The assessment to check this person was not at risk from pressure sores had not been completed properly since it was started in July 2009. However, we could see that the right steps had been taken to obtain support from the local community health team, who visit the home very regularly, and who said that staff cared for the person well. Equipment had been provided Care Homes for Older People Page 15 of 41 Evidence: accordingly to help this person maintain healthy skin. The increased risk from, and occurrence, of falls had not been considered in their care plan either. This meant that this person could have come to harm through the lack of proper assessment. The manager took steps to put this right straight away. The equipment used to test that one persons blood was within acceptable limits had not been working for some time. And the signs that should help alert staff that this persons diabetes had become unstable were not written down in their care plan. This person had none of the essential risk assessments completed to help staff monitor their nutrition, risk to pressure sores, falls because of poor eyesight, or how to manage behaviour which challenges others. These were all important parts of this individuals care, and monitoring these better would alert staff when advice from other health professionals was needed, and would help to maintain a consistent approach to care. In another plan, a health need experienced by that person had not been considered in some of their risk assessments completed by staff, which meant that some of the assessment outcomes were wrong, stating that the person was at low risk, when in fact they were at medium risk from, for instance, nutritional problems. There is a communication book and handover record, which is completed by staff in addition to peoples care plans and daily records. Using these additional records increases the chance of important information being omitted from the care plans, or of information being duplicated unnecessarily. It can also result in staff losing information, or failing to pass on information to their colleagues, visiting professionals and relatives. Visiting professionals and relatives have had some concerns about whether important information is passed on effectively between staff, and to them. For instance: A visiting professional commented that there seemed to be different records all over. They said they were not sure how this information was passed on between staff. They said Staff carry out the care, but they dont always tell us when people are ill. Another professional said they had experienced continued problems with the dementia unit. For instance where some, but not all staff, have waited too long before letting them know that someone may need support from them. Surveys returned from visiting professionals told us that staff sometimes or never seek advice, and act upon it, to meet peoples social and health care needs, and to improve their well being. One commented that the home could do better if they were to write better care plans, and if staff were to talk more to people, and listen to them. They also thought Care Homes for Older People Page 16 of 41 Evidence: that staff could have better handover meetings and communicate more. Another said the home could do better if they were to seek advice from expert professionals, act on the advice given, communicate that advice effectively to all of the staff involved in the care of residents, and generally be more effective in meeting the individual needs of residents. Staff views about the way information was shared at the home also differed. Two thought this always worked well. Three said it usually worked well. Whilst one thought it worked well only sometimes. We saw an example where important information about a medication order had not been written down by staff, so it took longer to track why it had not been delivered to the home from the chemist. In another example, peoples fluid charts, which are kept separate to their care plans, had not been updated properly. The manager gave assurance that these people had received sufficient fluids, but because staff had sometimes not completed the records, it looked as if these people had not received fluids after 4pm. When asked in their survey, one visitor said they were usually kept up to date about important issues affecting their relative/friend, one said they sometimes were, and one said that this was never the case. They said the home could do better if they were to Contact us more re our relatives issues/care, ie hospital visits etc, and Keep me informed of when relative has been to doctors or even minor illnesses. Only seem to find out when visiting. We spoke to the manager after receiving a comment that one person had been taken to hospital without an escort, when they were ill. The manager agreed that this had happened in the past, and said that important records had not always been sent with people, who left the home for medical attention. She gave assurance though that this has been addressed. It is now the policy that people are always escorted to hospital by a staff member in emergency situations, and only if someone has the capacity to attend a routine appointment alone, would this be permitted. We looked at two peoples records, which confirmed that staff had informed the family straight away when their relative had been admitted to hospital. Despite these shortfalls relating to communication, which must be addressed, we received some positive feedback about the efforts being made by the manager. One professional said the manager was making things better and that she was trying hard to improve the home through the close management of staff. Another said they had recognised some good elements of care, and identified some improvements, during the time that the manager has been present to oversee the home. We also received comments from a relative at this site visit, which were again more positive. Care Homes for Older People Page 17 of 41 Evidence: They said the carers were excellent, and that their only issue was with agency staff, which are now not used as much as before. They said their relative had improved since moving there, and gave examples to show how they have become more independent. Although another said that some (very few) of the staff are pleasant. People living at Boroughbridge Manor and Lodge made more consistent comments about the care there. All said in their surveys that they were happy with their care. When asked whether they received the care and support they need, six out of seven said always, with the remaining person stating usually. They said that staff always or usually listen and act on what they say, and they all agreed that they get the medical support they need. When asked what the home does well, they made comments like Care and attention, Everything, Very kind and considerate. Look after me when I am poorly. Very thankful for all the support from the staff, I am well looked after, I have a great feeling of care from people who look after me and staff are always present, and Staff overall are very good and Im well looked after, and the attention I receive is very good. People we spoke to on the day also made very positive comments, and staff were seen speaking to individuals with respect and kindness. People had been assisted with their personal appearance, and looked well groomed. They said things like I am perfectly happy with the care. I dont have many needs, but staff are always there to assist if necessary. They are nice, kind, courteous and respectful, Im fine here. Its very nice. Everyone looks after me very well, Theyre very nice here and Were very happy here - each and every one of us. The staff are lovely. However, staff are still using communal toiletries for people. This is not good practice. People should have their own. The manager was not aware that this was still happening, and said she would put this right. Staff have had training in administering medicines, and some people have been assessed as being able to look after these themselves. The manager has started to complete spot checks of medication, to make sure staff are administering them properly, and managing risk to people who look after their own. For instance, she had identified during an audit that one person had not received one of their medications for a week. She had already addressed this, referred the matter to the local authority as a potential safeguarding issue, informed the commission about the error, and had completed individual supervision with the staff member concerned. She had kept records of this, so we could see clearly what action she had taken. However, we looked at a number of peoples medication, and noted that there are still shortfalls which need to be given further attention: Care Homes for Older People Page 18 of 41 Evidence: Where people look after their own medication, this had not always been risk assessed. In one case, a staff member did not know that the medication was prescribed, and kept in the persons room. It was not being stored in the persons locked facilities, and the MAR chart, which had been hand written by a staff member, did not say this was for self administration, or where it was to be applied. A number of hand written entries onto the MAR charts, had not been signed by a second person to evidence that the directions had been checked to make sure they were clearly and correctly recorded. The controlled drugs register had been signed, and the medication to be given booked out, some two hours before it was administered. This is unsatisfactory practice. Following the advice given at recent training sessions, only one staff member signs the controlled drugs register if there is no other staff member trained to countersign this. However, there are staff trained in the safe handling of medicines in other areas of the home, who could witness that this has been checked out correctly. It would be good practice to consider this. In a number of cases, the number of remaining tablets delivered in boxes did not always tally with the amount which the records stated should be remaining. This makes it difficult to see whether the medication has been given as prescribed by the persons doctor. The medication fridge on one floor was not working properly, and could not be locked, because the key was missing. Medication was still being stored in there, and was being used. But the directions on the box told staff that this should not be stored in the fridge once opened. This was put right at the time, and the manager told us that a new fridge is on order. Staff were not sure where one persons medication, to be used in an emergency, was stored. And their care plan made no reference to this medication, and where staff should look for this if it was needed. The medication needs to be more closely audited, and staff need to make sure they follow good practice, in line with the training they have received, to make sure people get their medication as prescribed. Care Homes for Older People Page 19 of 41 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Steps are being taken to provide more opportunities to meet peoples social needs. More could be done however to make sure the mealtime is a social event for everyone. Evidence: The formal activities programme is organised by someone who does this for a number of homes owned by the company, and not directly by the home staff. There is a range of activities and entertainments which are advertised, and which people can choose to join in with. Forthcoming activities for February included entertainment, craft making, Valentines tea, Pancake Day, chocolate fountain and cocktail afternoon, and a visit from the local school choir. A hairdresser also visits the home regularly. People said they enjoyed this event. As well as social activities, a regular religious service is organised for people to attend. Some individuals also have regular visits from their priest. This helps to meet their spiritual needs. Daily activities also take place. These are not advertised. The manager prefers these to take place in accordance with peoples wishes on the day. This does make it more difficult for people to plan ahead what they would like to attend. Staff on each unit organise these activities, which include dominoes, knitting, walks around the grounds Care Homes for Older People Page 20 of 41 Evidence: and jigsaws. There was little recorded in peoples care plans about what they had done. The daily records explained more about what personal care they had been assisted with. So it was difficult to tell what people had actually enjoyed, and what they might wish to do again. However, one person said I can make choices and theres plenty to do. We received some comments that people would like to have more activities. When asked what the home could do better, one person said More activities. More trips out of the home. Others we spoke to on the day said there could be more going on. A staff member said that there could be more activity equipment, and more local outings. People in The Manor occupied themselves on the day we visited. One was completing a jigsaw. Others spent time chatting to each other after lunch, before retiring to their room. On The Lodge, people have dementia needs, and may need more support to meet their social needs. We observed periods where these people were not stimulated, and had little other than the television to entertain them. At other times, some people on this unit were playing dominoes. We asked the manager what specific activities she had planned for these people, to help stimulate them. She stated that she is currently developing a more structured programme, and is introducing more tactile activities. For instance, she plans to create a market stall, and to provide soft toys that people can carry them around with them. She said that some people on this unit also enjoyed making cakes. When we asked relatives in their surveys whether the home responded to the different needs of people, and supported people to live the life they choose, they replied usually or sometimes. And a health professional said that often they visit The Lodge, and find that people are not stimulated. They were concerned that this could result in increased agitation and aggression between this group of people. When asked if the care service responds to the diverse needs of individuals, three professionals said sometimes, and one said never. These surveys were completed in December 2009, and the manager told us she has had other more pressing priorities to concentrate on since taking up post. She assured us though that the daily activities programme will be given more attention. As part of this, she has created a daily schedule, which will show what has been organised, who has assisted people with the activities, and who has attended. Once linked to peoples preferences in their care plans, this will help to make sure that people are supported to join in activities which will help make their lives more interesting. Care Homes for Older People Page 21 of 41 Evidence: People can have their visitors whenever they wish. This helps them to maintain contact with those who are important to them. We asked people if they were able to make decisions in their daily lives. People who were able to respond said that they could. On the day, we saw people getting up at varying times, and their care plans told staff what time they like to retire. People were also dressed in individual styles, which helps to maintain their identity. There is a four weekly menu in place, which offers choice at each mealtime. There is a satellite kitchen on every unit, to which the meal is delivered from the kitchen in a hot trolley. Drinks and snacks can be prepared by staff whenever people want them. These are provided between meals. We saw people living on The Lodge enjoying pieces of fresh fruit that had been prepared by staff, followed by a cup of tea, on the mornings we visited there. When asked in their surveys, completed in December 2009, whether people liked the food, five of those who returned their surveys said always, with two stating usually. One person said The food is good. On the day, people said things like The meals are OK - we get a choice at each mealtime. We have nice mealtimes. I like spicy food, so sometimes we get a takeaway curry. Someone living there also said The food was poor, but now its good. I complained and it was put right straight away. I asked for fresh salmon, and now I get it. One survey included a comment from a visitor though that people did not get the choice that the service users guide had assured them that they would. This person said The meals are extremely poor, but sadly as many of the people in there do not want to upset anyone they say the food is nice when asked. They continued the teas are outrageous. A staff member said in their survey There could be more choice at meal times. They were given choice at lunch time but now this has been taken away. Another said there could be more option at mealtimes. However, we spoke to a staff member on the day, who said that the manager has sorted out the food. People now get choice, they said, including different meals for different floors, depending upon peoples requests. The manager also confirmed that, since we have received the survey response, the previous chef has left, and two replacements are now in post. She said however that the comments made at the time were true, in that people were not getting the choice they should have been. She informed us that the new chefs are taking the time to make sure people get a varied choice of menu. For instance, on the day we visited, one person told us they had enjoyed an omelette, which they had requested. The also said that the people on their unit liked kippers, and that these had been especially ordered by the chef, so they could have these for tea. Another person said The best thing is on a morning when we wake up and get a lovely hot cup of tea. Care Homes for Older People Page 22 of 41 Evidence: We observed, and listened to, part of a lunchtime on The Manor. The table was nicely set out, and people could help themselves to condiments. Staff served the meal to people, and the atmosphere was relaxed and informal. People stayed behind later to chat to one another around the table, which made the whole event a social occasion. We observed on The Lodge, where people with dementia live, that individuals were offered a verbal choice of main meal. It can be easier for people with dementia to choose what they would like, if they are shown each meal on offer, so they can pick the one which appeals to them most. People were also served their meal on cold plates. Serving food on warmed plates helps to keep it warm for longer. This is helpful for people who take longer to eat their meal. One person commented on this. On this unit, people do not get their table set with condiments. We noted on the first day that staff did not spend a lot of time with people. Someone sat for a long period of time before being assisted with their meal. And another had help half way through their meal from a carer who cut it up for them. This individual may have preferred to have had this help before the meal was brought to them, to maintain their dignity, and to assist them in being more independent. On the second day we observed the mealtime again, and the experience was more relaxed. One staff member sat and chatted with people whilst assisting discreetly. This made it a more pleasant outcome for people, which they should experience every mealtime. We visited the kitchen, and spoke to the cooks. They knew that some people were on special diets, and they explained how they add extra nourishment to meals for people who have nutritional problems. They also explained how they try to cater for individual choices, and said that there is alway a choice of hot and cold menu at each meal time. Meals which need to be pureed are sent to each unit, where the care staff liquidise the meal together. It is more pleasant for people if each separate component of the meal is liquidised separately, so people can experience different textures and tastes. It also helps to make the meal look more appetising. Care Homes for Older People Page 23 of 41 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are now better protected from abuse, because any concerns, however minor, are acted upon by the manager, and reported to the right people. Evidence: In their surveys completed in December 2009, we asked people, relatives, professionals and staff, questions about complaints, and how they are handled by the home. People living at the home all agreed that there was someone they could speak to informally at the home if they were not happy. Six out of seven people knew how to make a formal complaint. We spoke to someone on the day, who said they would be confident to go to the manager with any problems they may have. The staff who returned their surveys also said they knew what to do if someone raised concerns about the home. Health professionals responded less positively. When asked if the home had responded appropriately if they, a person using the service, or another person, had raised concerns, two answered usually, one answered sometimes, and one answered no. The three visitors who returned their surveys also had mixed views. Two said they did not know how to make a formal complaint, and when asked if the home had responded appropriately to concerns raised, one answered usually, and one Care Homes for Older People Page 24 of 41 Evidence: sometimes. The remaining person said this question was not applicable. Since these surveys were returned, the manager has improved access to the complaints procedure, which is now displayed in the foyer, so everyone can see it. She has also written to peoples families, to introduce herself, and to invite them to meet with her to discuss the care provided. We also looked at the complaints record, and could see that there have been no formal complaints made to the service since the last random inspection in October 2009. Instead, the manager showed us some letters of commendation she has received, where the home had been complimented on the care given to people living there. In contrast to previous inspections, where it was judged that people were not properly safeguarded, the manager was also able to show us that she has responded quickly, and has alerted the local authority, wherever she feels an event has affected a persons welfare. She has kept a record of each of these events, and has also let the Care Quality Commission know about each one. She stated that she works closely with the local authority, who have now begun to admit people to the home once again, because, she states, they have seen improvements there. Staff have completed training in safeguarding adults. We spoke to them about their understanding of safeguarding. All were very clear that they would report any concerns to a senior member of staff straight away, if they thought someone living at the home had been, or was being, abused. Senior staff in turn said they would report to the manager. One said they felt supported to do so. They said this was different from the past, because now they received lots of feedback from the manager if they raised any concerns, which encouraged them to go to her. This combined approach will help to keep people protected from abuse. People we spoke to during our visit said they would be happy to report any issues to the staff, or to the manager, who they said they see regularly. Staff though were not so clear about the role of the local authority, who they can report to directly should they wish to, or of there was something they needed to report which they did not feel they could discuss with any member of the management. The manager said that she will reinforce with staff how they can do this, in forthcoming supervisions. Care Homes for Older People Page 25 of 41 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable environment, some areas of which need to be more fit for purpose to meet individual needs. The infection control systems need to be improved to maintain good safety precautions. Evidence: When we visited, the home was clean and tidy, and free from unpleasant smells. People who returned their survey said this was always or usually the case. Corridors were free from equipment, which was stored away when not in use. Bathrooms were sometimes used for this purpose. However, this meant that main thoroughfares, used by people living there, were mainly free from obstacles. The accommodation is on three floors, with a passenger lift available to assist people to each floor. One area called The Manor, accommodates people who need help with their personal care only. Those people accommodated in The Lodge, have dementia care needs. Each area is separated into three smaller units, one on each floor, which all have a communal sitting and dining areas. This layout helps to make the accommodation feel more homely. There are communal bathrooms and toilets throughout the home. Everyone has their own bedroom, which has a toilet, hand wash basin and shower. This means people can be assisted with their personal care in the privacy of their own Care Homes for Older People Page 26 of 41 Evidence: room. Bedrooms are well equipped with a flat screen television. There are lockable facilities, which people can use to secure away their valuables. People can have a key to their own room if a risk assessment, completed first, decides that it is safe for them to do so. The most senior staff member on each floor has a master key to each room, and we were told there is also a spare key in the office, so staff are able to access locked rooms in an emergency. Some steps have been taken on The Lodge to make the environment more interesting for people with dementia. This includes an indoor sensory garden area, and some wall decorations designed for people to touch. There is more work to be done there. To help people find their way around the home more independently, more landmarks to help them recognise rooms such as the toilet areas, need to be provided. The manager is aware of this, and has plans to address it. The manager said in the Annual Quality Assurance Assessment that there were also plans to improve the laundry service, by reviewing the end to end process. We visited the laundry, and looked at the systems in place there. Care staff are not always using the proper bags when delivering soiled or infected linen there. This increases the risk from cross infection. It also means that the laundry staff may also be at additional risk from handling soiled items they are not aware are contained within general linen. The equipment is available for staff to use, and they must make sure that they do so. Disposable gloves were available in the laundry but aprons were not. The manager said she would make sure there is a ready supply available, to help protect staff from spillages. Care Homes for Older People Page 27 of 41 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are being made for people in the provision of a consistent staff team. Further training will assist staff to understand individuals specific needs better. Evidence: When our surveys were completed and returned to us in December 2009, staff had mixed views about whether there were enough of them to meet peoples needs. Two said there were usually enough of them. Two said this was sometimes the case. And two said it was never the case. A visiting professional spoken to more recently said that the quality of care provided is dependent upon the staff on duty. They felt that The Lodge in particular is understaffed, and that the unit relies quite heavily on agency staff. People living at the service however gave a different view. Although one said that the home could do better if they had more staff, six out of seven who returned their surveys said the staff are always available when needed. One said this was usually the case. None of those spoken with on the day raised concerns that they did not get the attention they needed. One said I dont have many needs, but the staff are always there to assist if necessary. Staff did not seem rushed when we visited, although sometimes they could have used their time to interact with people more on The Lodge. Care Homes for Older People Page 28 of 41 Evidence: The manager told us there has been a major improvement since the surveys were sent out, in the number of employed staff who work at the home. Previously, there was a large number of agency staff working there, which can cause problems with continuity for people. However, more staff have been recruited, and very few agency staff will be needed once all of these staff have been deployed and inducted. This should help to improve the experience people have, because they will be supported by staff who they know better, and who understand their needs more. Staff spoken with on the days we visited felt there were usually enough of them to assist people, and to make sure they received their care as they would wish to. Two staff members said this had improved since the manager had arranged to have people reviewed, and moved people to more appropriate placements where their increasing needs could be better met. We looked at the files of two recently recruited staff. They showed us that the right checks had been completed before these staff were allowed to provide care. This helps to protect people from unsuitable workers. One of these staff had started to provide care after it had been confirmed they were not barred from doing so, but before the full police check had been returned. This is acceptable in exceptional circumstances, so long as the person is supervised in the interim. However, there was no evidence to show how this had been achieved, although the manager gave assurance that the person did not work alone. It is important that the supervision arrangements are clearly documented to show who is responsible for this supervision, so that it is clear that anyone employed under these circumstances has not worked alone with vulnerable people until the full checks have been obtained. New staff complete an induction period, where their work is overseen, and where support and guidance given is by a more senior member of staff. Skills for Care induction has not yet been introduced. This should be considered, as it is nationally recognised, and looks at minimum standards that staff should be achieving when providing people with care and support. A number of staff have commenced, or have completed, National Vocational Qualifications in Care, and there is a rolling programme in place for all to achieve this award. This is good, because it underpins daily good practice, and provides a benchmark for good care standards. When we asked relatives whether the staff have the right skills and experience to look after people properly, one said usually, and two answered sometimes. We also Care Homes for Older People Page 29 of 41 Evidence: asked visiting professionals whether they thought staff had the right skills and experience to support peoples social and healthcare needs. All three answered sometimes. The manager said she has made sure that staff have received up to date compulsory training, so they know how to work in a safe way. Further training into specific topics is now being looked at, so staff can improve their knowledge and skills. She needs to have in place a better way of tracking what training staff have had, as this was difficult to evidence on the day. It is important that staff have a good basic knowledge of the differing needs of people living in the service. Some training has been undertaken, and we were told that the district nursing team are also providing some updates, for instance, about how to manage continence. Some staff have completed training in dementia care. It is important that everyone working especially in The Lodge has some training in dementia awareness, so they know they are working towards best practice when supporting people, writing their care plans, and when communicating with other health professionals who support them. The manager should source this, and other relevant training, as part of the ongoing staff training provision. Care Homes for Older People Page 30 of 41 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 manager is keen and enthusiastic, and wants to run the home in peoples best interests. Evidence: The manager has been in post since August 2009, but was away from the home for a period of nine weeks, following the random inspection in October 2009. She agrees that progress in making further improvements had been slower than she had wished, because of her extended absence during this period. However, a number of shortfalls raised in this report relate to issues within the staff team, in how they communicate with each other, and also with people with an interest in the home, such as relatives and visiting professionals. She is aware that these issues need to be addressed so that the home operates smoothly even when she is not there. However, she is back at work now, and is continuing with her ongoing plan to improve the service. She has experience in the running of care homes, and is very enthusiastic about the challenges that she has before her to improve this service. She is currently preparing her application to become registered with the Care Quality Commission. Care Homes for Older People Page 31 of 41 Evidence: We received lots of positive comments about the manager. Someone living at the home said she was very good. A staff member said they felt much happier now she was in post. They said they see plenty of her, and said she is lovely, she listens, and that she takes things on board. Another staff member said they had also noticed changes, in that the home felt more stable, and the staff morale had improved. Someone else working there said the home was definitely getting there, but felt that improvements would not happen overnight. They continued that the manager is very approachable. Finally, we were told The home has picked up a lot now. Before (the manager) came it had gone down hill. If we have any problems, we just go and tell the manager. The operations manager for the company visits the manager at least weekly, to provide support and guidance. Both have a common interest to improve the quality of the service for those who live there. Since taking up post, the manager has commenced meetings for staff, residents and relatives, so she can communicate with them about the changes she intends to make there. She also sends out a monthly news letter, to keep people informed about what is happening at their home. Quality assurance surveys go out to people and their relatives every six months. The collective results are discussed in resident and relative meetings. Monthly shorter surveys are also sent out to discuss specific topics, such as the laundry, and the meals. The manager said she has seen an improvement in the general response from people. As yet, surveys have not been given by the home to visiting professionals. It is recommended that this is done, so they too have the opportunity to say what the home does well, and where improvements could be made. People can look after their own personal allowance if they wish to. Otherwise, the home can manage it for them. Computerised records are kept to show what has been spent on their behalf. One persons allowances we looked at did not tally properly, because the person had too much cash remaining, according to the records, and there was a bill which had not been accounted for. The manager agreed to look into this, to see where the record keeping had gone wrong. From the information provided prior to the site visit, and from the documents seen at our visit, there was some evidence to show that the home is kept maintained, so that the premises remain safe for people. Staff check the temperature of the bath water before people are assisted into it, to make sure it is not too hot for them. Though sluice rooms which should have been kept locked were not. This poses unnecessary risk to people who may enter the room by mistake, and harm themselves. The Care Homes for Older People Page 32 of 41 Evidence: manager could not produce the last certificate to show that the water system has been treated, to reduce the risk to people from Legionella. The manager has asked Head Office to provide her with a copy of the latest check. In house checks are also carried out by the maintenance staff. There were some gaps in the recording of these. The fire alarm should be checked weekly according to the records, to make sure it remains in working order in the case of fire. But there was an occasion where the check had been missed. In addition, the manager could not find evidence to show that the emergency lighting has been checked regularly. She has agreed to make sure this check is reinstated. Staff have completed compulsory training now in areas such as fire safety, moving and handling, food hygiene and infection control. We were also told that there is always a First Aider on duty. There should be clear instructions for staff so they know on each shift who this designated First Aider is, so there is no delay in seeking their attention in an emergency. As stated in Staffing, it was difficult for the manager to evidence who has had compulsory training, and when, because the records are not yet organised enough. She needs to make sure that everyone is up to date with all areas of compulsory training, and arrange further update where it has fallen behind. The manager has asked Head Office for a copy of the report following the last routine inspection conducted by the Health and Safety Officer. This will allow her to see whether there is anything outstanding from this report which still needs to be completed. At our site visit, we noted that food stored in the kitchen fridges was not dated, to show when this had been first prepared, or opened. Staff should make sure they do this, so that it is always clear when items need to be disposed of, in order to reduce the risk to people from food poisoning. Care Homes for Older People Page 33 of 41 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 34 of 41 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 Peoples care plans must be kept up to date, to reflect their current needs. This is so staff understand what these needs are, and to make sure people get consistent care to meet these needs, regardless of who is on duty. 31/03/2010 2 7 13 Risk to people must be 31/03/2010 properly assessed and monitored, taking into account peoples physical, social, mental and emotional needs. This is so that their plans of care identify precisely how risk is to be minimised, and what steps staff must take to make sure people remain safe. 3 8 14 Relevant information about people who live at the home must be passed on to relevant professionals when 12/02/2010 Care Homes for Older People Page 35 of 41 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 they are involved in a persons care. This will make sure peoples needs can be properly assessed and identified. 4 9 13 An audit must be carried out 31/03/2010 of the medication systems at the home to check the following: The management of medication which arrives in boxes. Those systems in place to support and monitor people who self medicate. Staff practice in the safe handing of medication, to make sure that they are carrying on good practice. Action must be taken to put right any shortfalls identified. This will confirm whether staff are taking their responsibilities seriously, and whether people are receiving their medication as prescribed. 5 9 13 There must be clear instructions for staff regarding the use of 12/02/2010 Care Homes for Older People Page 36 of 41 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 medication in emergency situations, and where this medication is located. This will make sure that the right action is taken, should the person present with symptoms which may mean that the medication is required. 6 9 13 People who manage their 12/02/2010 own medication must do so only after a risk assessment has been completed, which must then be regularly reviewed. The assessment must consider whether the person is able and willing to take on this responsibility, and to check they have, and use, suitable lockable facilities in which to store it. This will keep people safe from avoidable harm. 7 26 13 The proper equipment must be made available, and used, when handling or delivering soiled or infected linen. This is so the risk of cross infection is kept to a minimum. 8 38 13 Certificates/reports must be obtained to check: 31/03/2010 12/02/2010 Care Homes for Older People Page 37 of 41 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 Action has been taken to protect people from the risk of Legionella. Action has been taken in response to any requirements made in the last Environmental Health Officers report. This will help to protect people. 9 38 13 Checks must be undertaken to make sure that all staff have received compulsory training, and updates must be provided where it has not. This will make sure that all staff have been updated in how to work in a safe and competent way. 10 38 13 Sluice room doors which 12/02/2010 staff are instructed to keep locked must remain so when not in use. This will help to protect those people who may enter the room by mistake, from harm. 31/03/2010 Care Homes for Older People Page 38 of 41 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 8 Consideration should be given to recording information about peoples ongoing care in only one place, so that this information does not get lost. This will help to aid good communication with colleagues working at the home, visiting professionals, and relatives. Hand written entries on peoples Medication Administration Records should clearly state what medication is prescribed for the person, and the full directions for administration. Hand written entries should always be countersigned by a second member of staff. Medication, including controlled drugs, should be signed for at the point they are to be administered, and not in advance. This is so the records remain accurate, and a true account of what the person has received. It would be good practice for another staff member in the building, who is qualified to do so, to witness the administration of controlled medication, and to sign to say they have done so. The instructions for the correct storage of medication should always be followed, to make sure it is maintained at the correct temperature. 2 9 3 12 Consideration should be given to advertising the list of daily activities, so people are able to plan ahead what they would like to attend. Further thought could be given to the provision of activities for people with dementia needs, so they have a wider range of interesting and stimulating activities to meet these needs. 4 15 More thought is needed to make sure people living in The Lodge experience consistent mealtimes which are a social event, and where staff anticipate their needs in advance, and act upon them. Liquidised meals should be served in separate portions, so people can enjoy different tastes and textures, and so that the meal itself looks more appetising for them. 5 18 Staff should be reminded about the role of the local authority and how to contact them. This is so people can be Care Homes for Older People Page 39 of 41 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 assured that staff know how to report directly any concerns they may have about their welfare, should this be required. 6 19 The environment on The Lodge should be made more interesting for people. There should also be more landmarks, and signeage, to help people find their way around more independently. There should be clear records in place to show how staff, deployed before the return of the police check, will be supervised. This is to evidence that they have not been allowed to work alone with vulnerable people until all the necessary checks, to confirm they are suitable workers, have been returned. Consideration should be given to the provision of Skills for Care induction, so people can be assured that staff caring for them have been inducted to current national standards. 8 30 Dementia care training for all staff, especially on The Lodge, should be provided. This is so people, their families and visiting professionals can be assured these staff have the necessary skills and knowledge to care for those living there. A better way of tracking what compulsory and additional training staff have had should be devised, so that it is easy to see which staff need updates, and when. This will help to make sure important training does not fall behind. 9 32 Clear lines of accountability should be established at the service, so that senior staff accountable to the manager are clear about their roles and responsibilities with regards to day to day management and communication both within the home, and with others with an interest in it. Visiting professionals should be surveyed, so that their collective comments about what the home does well, and where it could do better, can be understood and acted on, where this will improve outcomes for people living there. There should be clear instructions for staff to use at any time, which tells them which staff member to go to in an emergency situation, which requires First Aid attention. Opened or previously prepared food should be dated, so staff know when it must be disposed of. This will reduce the risk to people from food poisoning. Page 40 of 41 7 29 10 33 11 38 12 38 Care Homes for Older People 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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