Inspection on 18/08/09 for Caradoc House

This inspection was carried out on 18th August 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Caradoc House 25/09/08

Caradoc House 10/10/07

Caradoc House 16/04/07

Caradoc House 29/11/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Caradoc House Ludlow Road Little Stretton Church Stretton Shropshire SY6 6RB Lead Inspector Rebecca Harrison Key Unannounced Inspection 18th August 2009 10:30 DS0000068051.V377188.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 2 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 Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Caradoc House Address Ludlow Road Little Stretton Church Stretton Shropshire SY6 6RB 01694 723626 01694 722200 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Supercare (UK) Ltd Manager post vacant Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category (OP) 14 The maximum number of service users who can be accommodated is: 14 25th September 2008 Date of last inspection Brief Description of the Service: Caradoc House is registered to provide accommodation and personal care for up to 14 people over the age of 65. At the time of the inspection seven people were living at the home. The home is situated in Little Stretton, one mile south of the Market town of Church Stretton. Accommodation is provided over two floors. A ramp is available to aid access to the front of the building and rooms situated on the first floor are accessible via two chair lifts. The home provides ten single bedrooms and two double bedrooms, en-suite facilities are currently not provided although there are plans to offer this facility to four of the rooms in the future. Shared areas include a lounge and a dining room. A small outside seating area is provided to the front of the property in addition to car parking facilities. The second floor of the building provides living accommodation for the owner. People who use the service and their representatives are able to gain information about this home from the Statement of Purpose and Service User Guide. Inspection reports are made available for people to read. These are also available on our website at www.cqc.org.uk The current fees charged range from £360.00 to £385 per week according to the room occupied. Additional charges are made for newspapers, toiletries, dry Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 5 cleaning, chiropody and hairdressing. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate outcomes from the service they receive. The visit to the service was undertaken by two inspectors over 6.5 hours. We arrived at the home at 10.30am. The people who live and work at the home did not know that we were coming. A range of evidence was used to make judgements about this service. All of the residents were involved in the inspection process; we met with three staff, the manager and a visitor. We looked at some parts of the home and sampled a number of records to include staff training, recruitment, quality assurance and health and safety records. We received eleven completed surveys from residents, representatives and staff informing us of their views of the home and some of the feedback gained has been included in our report. The care received by two people was looked at in detail. This included looking at personal records such as care plans, health records, daily records and discussing their care with them and the staff who support them. We also had the opportunity to observe people being supported by the staff on duty. This helps us gain information and understand the experiences of people who use the service and the quality of care they receive. We looked at the outcomes for people living at Caradoc House and information to produce this report was gathered from the findings on the day of our visit and also the information that we have received, or asked for, since our last key inspection. The manager completed an Annual Quality Assurance Assessment (AQAA) document for us, as requested. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. This provided us with some information and informed us about how they are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. What the service does well: People appear well looked after by a team of staff who know them well. Staff are friendly and helpful and communicate well with residents and visitors. Staff monitor the individual needs of people living at Caradoc House and work with health and social care professionals to ensure their health and wellbeing is promoted. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 7 People told us the home does the following well: Provides very good personal care, good housekeeping, provides the food which individuals prefer, they look after me very well Staff are always very nice and work as a team Just being looked after They are very kind I like my food Makes sure the service users are well cared for The home is very clean Its homely and not institutional, staff are kind and caring, my visitors are made welcome and all my wishes respected We are all satisfied with the steps that Caradoc take regarding our relative’s overall care, and the considerable trouble that staff at Caradoc have gone to in order to redress particular aspects of her care. X has always reported that shes very happy at Caradoc and has always said how kind staff are The managers and staff at Caradoc House show great kindness and care to our Mother... What has improved since the last inspection? What they could do better: Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 8 The law requires that the home must have a registered manager in place. Although previous inspection reports have highlighted this as a need, we have yet to receive a complete managers application for registration. This must be seen as a matter of priority in the best interests of people who live and work at Caradoc House. Some medication practices require review in order to better protect people who need support with the management of their medication. For example all incoming medication must be checked to ensure residents are receiving the medication as prescribed. An individualised protocol should also be drawn up for a person who receives medication as required. This will ensure staff know exactly when to administer medication and are consistent in meeting the persons specific health needs. Feedback gained about the service is very mixed. Comments include: This is the ideal home for our mother, we feel she is well cared for and she is very happy and content...there is nothing at present that the home could do any better All of the staff are very nice but they have to do everything including the cleaning and young girls who dont know how to cook are expected to cook a meal sometimes The owners have changed and the new people dont seem to take a lot of interest and they dont see them from one week to another Things are improving although I remain concerned regarding the quality of care and staffing levels provided Other feedback indicates that people would like to see the manager taking a more active role within the service and being more readily available to respond to the individual needs of the residents, staff and visitors to the home. 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. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 does not apply to this service) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about Caradoc House is made available to help prospective residents and their representatives make an informed choice about whether the home is suitable to meet their individual needs. An assessment of their needs is undertaken prior to admission to ensure Caradoc House is the appropriate service for them. EVIDENCE: Prospective residents and their representatives are provided with information about Caradoc House through the Statement of Purpose and Service User Guide. Each resident is provided with a copy of these documents which contain information about the service provided. The admissions procedure states The home accommodates service users with low dependency needs which was an accurate reflection of our observations and the current staffing levels provided. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 11 People told us that they were satisfied with the information they received about the service prior to their admission. Prospective residents and those close to them are encouraged to visit the home and meet with staff and residents. The first month of the placement is considered a trial period and enables the individual to make an informed choice as to whether Caradoc House is suitable to meet their individual needs. Records seen on behalf of the person most recently admitted to the home evidence that a needs assessment had been undertaken by the manager prior to admission. This detailed information about the persons health and personal care needs, medical history and activities of daily living. The manager considered the service is able to meet the persons needs and discussions held with the individual concerned indicate that they have settled into the home well. Another resident spoken with confirmed she was very happy and comfortable at the home. She was unable to recall how long she had lived at Caradoc House, but remembers she was asked about what she liked and did not like when she arrived. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the 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 using the service are involved in planning and reviewing their care. Care plans are person centred and provide staff with most of the information required to ensure peoples health and personal care needs are met in a way that they prefer. Staff support people with the management of their medication however some practices need to be reviewed to fully safeguard residents health and wellbeing. The actions of staff and their approach to care ensures that residents are treated with respect and their right to privacy is upheld. EVIDENCE: Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 13 We looked at the care records held on behalf of two people who live at Caradoc House. Care plans have been redesigned and written in the first person, as if the individuals are telling others about themselves. The person most recently admitted told us that she had been involved in forming her care plan and had been asked about her needs and personal preferences, which was reflected in the information held on file. The care plans sampled included information about peoples personal and health care needs, routines to include preferred rising and retiring times, where they prefer to spend their time, equipment required to assist daily living, medication, activities, risk management and health monitoring tools. One file sampled contained information about how staff are to positively support an individual to alleviate any anxiety experienced as a result of her memory loss. We advised the manager to further develop care plans to include the level of assistance a person requires to attend to their personal care needs. This will ensure individuals receive the appropriate care and assistance they need. Records sampled evidence that peoples needs are regularly reviewed and any identified risks are assessed to include falls, weight, pressure areas, manual handling tasks etc. One person who uses a frame to help her mobilize told us that this helps to keep her safe from falling and that staff always ensured the frame was in easy reach to maintain her independence. People told us that the home makes sure they always or usually get the medical care they need and records sampled evidence that peoples health is monitored and any concerns are referred to the appropriate healthcare professional and outcomes stated. Feedback gained evidence concerns are now being referred sooner in the best interests of individuals concerned. During our visit a health professional visited the home to see an individual, as requested in response to some health concerns. We advised the manager to ensure any health issues are clearly documented for example we noticed a resident with one condition that had not been recorded in the persons care plan. The manager committed to action this. The manager demonstrated an understanding of the medication procedure and reported that there have been no medication errors since our last inspection. Staff spoken with confirmed that they receive training so that they are able to administer medication safely. No one currently self administers their own medication although this should be considered if an individual chooses to do so, based on a risk assessment. Since our last visit the manager has obtained advice in addition to a copy of the local authoritys procedures for safe handling and administration of medication. One of the people whose care we looked at in detail is prescribed medication as required. Although the home has a generic protocol in place regarding this, we advised the manager to develop a protocol specific to the individual concerned. This will ensure staff know when they are to administer medication in the persons best interests. Another persons medication was not being stored as recommended. The manager committed to review this in addition to ensuring all incoming Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 14 medication is checked and signed for to provide greater safeguards and ensure people receive the medication they are prescribed. Observations evidence that staff are sensitive to the needs of the individuals in their care. Staff were seen promoting privacy and dignity and interacted with residents in a professional manner. One person told us that all the staff were always very kind to her and would always knock before entering her room. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides some opportunities for people to engage in activities based on their personal preferences however some individuals who remain in their own rooms can experience isolation which may not promote their self-esteem and wellbeing. People are generally provided with a varied diet according to their dietary requirements and choice. EVIDENCE: People living at Caradoc House are given opportunities to take part in some activities if they choose. Routines are flexible and residents are able to rise and retire as they wish. During our visit the hairdresser visited and several of the residents had their hair done. One resident was supported to access the community and people seated in the lounge were entertained by a member of staff who played the keyboard. Activities undertaken were documented on the daily records of the people whose care we looked at in detail, although these Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 16 were minimal. People told us that music sessions are available but that other activities are limited and would therefore welcome greater opportunities for structured activities both within the home and the local community for example card games, local walks, swimming, and trips out. Some people prefer to spend their time in their own rooms, watching TV or reading. The manager agreed to review the programme of activities in consultation with the residents. Records show that some individuals prefer to remain in their own rooms although observations made and feedback gained from some individuals indicate that at times they do experience isolation. The manager agreed to review this to ensure that regular interaction across the day is supported. Residents are encouraged to maintain relationships with people important to them and they told us that their relatives and friends are made welcome when they visit the home. One relative told us Our mother is very happy at Caradoc and we are always made to feel welcome whatever time of day or evening we visit. She is always given choices about joining in activities or staying in her room, she is never put under pressure to do things she does not like The admission assessment process considers personal preferences in respect of food and mealtime routines so they are understood and respected. These preferences are incorporated into the care plan. There is a food and nutrition policy in place for the home, setting out the commitment to choice in respect of content and location of meals taken. Following consultation with residents, the main meal of the day is served at tea time and people we spoke with told us they much prefer this arrangement. The majority of residents told us that they enjoy the food provided although one person said they never like the meals. Most of the current residents eat their meals in the dining room which is bright, airy and comfortably furnished. We had the opportunity to observe lunch, which was a social occasion. The care files sampled contained individual preferences so that staff have an understanding of peoples likes and dislikes. It was confirmed that the views of residents are taken into account when designing menu options. For example, it was stated that for summertime, residents had requested ice cream and fresh fruit be provided rather than hot puddings with custard. The manager also confirmed that residents are encouraged to maintain their fluid intake, as observed during our visit. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives have access to a complaints procedure, which is accessible and ensures the views of people are listened to. Staff receive training so that they have an understanding in adult protection to ensure people they support are protected from abuse, ensuring their well being. EVIDENCE: Residents and their representatives have access to a complaints procedure, which is displayed in the home and included in the Statement of Purpose and Service User Guide. Feedback gained indicates people know how to make a formal complaint if they are not happy with the service provided although one person was not aware of the procedure. We have not received any concerns or complaints about Caradoc House in the last 12 months and no complaints have been received by the home, as confirmed by the manager. Staff have access to the local multi-agency policies and procedures in relation to adult protection and all staff have now received training in relation to adult protection, as recommended by our previous inspection. The manager has also attended a protection of vulnerable adults course for managers to develop her knowledge of the local procedures. Minutes of staff meetings also evidence that Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 18 adult protection and whistle blowing are discussed amongst the staff team so that they are aware of their responsibility to ensure residents are safeguarded. Since our last visit one referral under safeguarding adult procedures was made and investigated but not substantiated. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the environment continue to be made to provide people living at Caradoc House with a clean, comfortable and well maintained place to live where they feel safe and secure. EVIDENCE: A number of environmental improvements have been made to the home to enhance the living accommodation for people living at Caradoc House. A second chair lift has recently been installed providing greater accessibility to bedrooms on the opposite wing of the house. The lounge and dining room have been redecorated and a floor covering in one bedroom replaced. Some light fittings have also changed in accordance to residents choice. Work has commenced to provide en-suite facilities to two bedrooms and a further two en-suite bedrooms are planned for the future. This will enhance the overall Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 20 living accommodation and will help reduce the demand for communal bathrooms. We looked at the shared areas of the home and some of the bedrooms of the people we spoke with and whose care we looked at in detail. The home is welcoming, and the bedrooms seen were personalised and equipped to meet their individual needs. There are no restrictions in place for residents and feedback gained indicates people enjoy the facilities provided. The areas of the home we toured were found clean although a slight offensive odour was detected in the lounge, which the manager committed to address. Residents spoken with confirmed that the home, including their bedrooms, were always clean and tidy and that bedding was regularly changed. Three staff have completed training in the control of infection and contamination and a further two staff are booked to attend this training shortly. Substances such as cleaning products that could cause harm to people are safely stored and the necessary data sheets on their safe use available. An infection control audit has recently been undertaken by Shropshires Prevention and Control Training and Development Nurse and matters arising are currently being addressed by the manager. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by a committed, trained staff team who know them well and work hard to meet their individual needs. Shortfalls in recruitment practices do not fully ensure that the home only appoints people who are suitable to work with vulnerable people living at Caradoc House. EVIDENCE: Residents are cared for by a team of staff who appear committed to their work and know them well. One of the care workers on duty regularly interacted with the residents in the communal lounge throughout the morning, checking they were comfortable, giving them their papers and having a general chat. They also sat in the lounge and interacted whilst completing paperwork. Of the five permanent care staff employed, two have obtained a care qualification known as NVQ at level 2 or above in care and one is due to commence the award shortly. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 22 Feedback gained from staff evidence they enjoy their work and have developed positive working relationships with the residents. One of the carers on duty told us that she enjoys her role very much; she loves the residents and has opportunities to attend training. Another member of staff reported she enjoys her job and the variety it provides. The home provides a minimum of two care staff to seven residents. Some concerns regarding staffing levels have been raised during staff meetings which was also reflected in some of the feedback we gained. The manager considered that staffing levels are appropriate to meet the assessed needs of the current people accommodated although reported that this would be reviewed based on higher occupancy levels. Staffing would also have to be reviewed if the needs of individuals increased given the layout of the home and that staff are expected to undertake a number of roles to include caring, cooking and cleaning. The manager reported that she is trying to recruit a cook and two care assistants to cover holidays and training but that she and the provider continue to live on site and are readily available to assist where necessary. We were advised that there have been ongoing communication issues with staff employed from overseas. We also experienced this when we telephoned the home and the staff member left in charge was unable to assist us with a query. Managers are providing opportunities for staff to learn English through courses run by a local college and have made information available in their own language to assist such as care plans, training resources and other important documentation. A representative told us: Although some of the staffs English is not their first language, this does not stop them from giving first class care and attention and showing great kindness to the residents in Caradoc House. This was clearly evidenced through observations we made during our visit. We looked at the recruitment records for two staff employed since our last visit. We were advised that a resident was involved in the interviewing and selection process and very much enjoyed this role and her views were listened to and acted upon. Although staff files were well presented they did not contain all of the documentation required by Law. For example neither application form contained a full employment history. One member of staff had commenced work before a second reference had been secured. Although the manager confirmed that the member of staff did not have direct contact with the residents during this period. Another staff members application form was dated after the two references had been obtained and the interview documentation was not dated. The manager advised us that she requested a second application as she was unhappy with the initial completed application. Although we were assured that both staff have applied for registration on the Worker Registration Scheme (as required for citizens of one of the eight relevant countries of the European Economic Area), there was no evidence available at the time of our visit to support this. We have previously identified shortfalls in Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 23 recruitment practices and the provider did review and improve recruitment practices in the best interests of people receiving a service but this has lapsed. We have therefore made a requirement and intend to undertake a compliance visit to the home to review recruitment practices in the near future. Feedback gained from staff surveys and discussions held with staff on duty indicate people are provided with good training opportunities. Staff spoken with were positive about the approach of the home to staff training and the minutes of staff meetings held evidence that training is a regular area for discussion. New staff receive induction to ensure they are competent and confident to carry out their duties. Two staff were receiving training in the Mental Capacity Act on the day of our visit. The manager has developed a training matrix to identify individual staff training needs and the training undertaken. Staff confirmed that they receive training that is relevant to their role, helps them understand and meet the individual needs of people and keeps them up to date with new ways of working. Training undertaken or booked includes infection control, medication, protection of vulnerable adults, Mental Capacity Act, Deprivation of Liberty Safeguards, food hygiene, manual handling, fire and first aid. The manager advised that training in bereavement has also been arranged. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a committed management team however action needs to be taken to improve some processes in the best interests of people living at Caradoc House. The home is maintained in a manner, which ensures the safety of people using the service and the staff team. EVIDENCE: The manager has been in post for over two years and although previous inspection reports have highlighted a need for the home to have a registered manager in place, we have still not received a completed application for Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 25 registration. We were advised that an application was submitted in May 2009 however the correct process has not been followed. The manager reported that she has completed the qualification required of her position and is currently awaiting certification. She stated that she has also undertaken other relevant training to include the Mental Capacity Act Deprivation of Liberty Safeguards, Protection of Vulnerable Adults for managers and medication in addition to attending workshops for managers on a monthly basis. Feedback about the management and leadership of the home is mixed. Some comments were positive regarding the changes implemented and the home has received a number of compliments to include: We would just like to express our thanks to the management and dedicated staff of Caradoc House for the care, love and attention that our mother receives within the home...Her wishes, dignity and privacy at all times is respected and this is very important to her and to us. Once again thank you to everyone on your continued care and kindness. We would not hesitate to recommend residency at Caradoc House, situated in the beautiful Stretton hills of Shropshire. Other comments gained indicate that people would like to see the manager taking a more active role within the service and being more readily available to respond to the needs of the residents, staff and visitors to the home. As previously stated the manager has recently undertaken training in the Deprivation of Liberty Safeguards and obtained information about this legislation. She confirmed that there are no restrictions in place and therefore no applications for authorisation have been made to the local authority. We were advised that the home no longer holds responsibility for residents finances and that these are managed by residents and their representatives. We advised the manager to record information regarding financial management in peoples care plans. Lockable storage facilities are available and an inventory of belongings was seen on the files sampled. People we spoke with told us that they feel safe living at the home. We looked at a variety of health and safety records and the checks that staff do to prevent people from being placed at risk of harm. A health and safety audit has recently been undertaken by an external source and recommendations made are being addressed. Records seen evidence equipment is serviced as required to ensure its safety and staff spoken with confirmed they receive training in safe working practices for example manual and handling, food hygiene, fire safety and infection control to ensure peoples safety. The manager reported that advice was sought from the fire department in relation to the second chair left and confirmed that there are no outstanding requirements made by the Fire or Environmental Health Departments The accident book was reviewed and compared to the monthly managers report there were some anomalies in recording where the report reflected less Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 26 or more accidents then were recorded in the accident book. The manager agreed to reinforce with staff the importance of recording in the accident book. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x N/A x x 3 Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Timescale for action Regulation Staff recruited by the home must 01/10/09 19 have all required preemployment checks undertaken. Schedule 2 This is to ensure that people living at the home are cared for by staff that have been suitably checked. 12 An application for registration 01/12/09 must be submitted for a suitable, competent and experienced manager in the best interests of people who live and work at Caradoc House. Regulation Requirement 2. OP31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Greater opportunities for stimulation through leisure and recreational activities should be reviewed with people living at the home, which suits individual need and preferences. Appropriate information relating to medication must be DS0000068051.V377188.R01.S.doc Version 5.2 Page 29 2. OP9 Caradoc House kept to ensure that staff know how to use and monitor all medication including when required to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. Caradoc House DS0000068051.V377188.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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