Inspection on 04/06/09 for Elmfield House

This inspection was carried out on 4th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elmfield House 26/06/07

Elmfield House 16/01/06

Elmfield House 10/10/05

Elmfield House 21/10/04

Elmfield House 11/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Key inspection report Care homes for older people Name: Address: Elmfield House Church Lane Bisley Surrey GU24 9ED     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: Suzanne Magnier     Date: 0 4 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Elmfield House Church Lane Bisley Surrey GU24 9ED 01483489522 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Linda Ann Marsh,Mr Alex James Findlay care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 15 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Elmfield House is a care home providing a service for up to fifteen older persons. A specified number may have a mental disorder or dementia. The large detached property is located on the village green in Bisley and consists of individual rooms all of which have ensuite facilities. A large communal lounge, dining area and a small Care Homes for Older People Page 4 of 36 Over 65 0 0 15 15 15 0 Brief description of the care home conservatory that has patio doors leading onto an enclosed garden is available and accessible for people to use. The bathrooms and toilets are accessible for individuals and include a walk in shower facility and hoist support if required to safely assist individuals. Laundry facilities are provided and two stair lifts are available enabling people easy access to the first floor. In the vicinity of the home are a selection of shops, the village post office and a public house. The home is well presented and the environment well maintained. The service is appropriate for individuals with a high level of mobility and independence. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The last inspection of the care home was on the 26th June 2007. This inspection was an unannounced Key Inspection conducted by Ms S Magnier Regulation Inspector. Any additional standards assessed during the inspection have been incorporated within the report. The registered manager represented the service throughout the day despite having been on night duty the previous evening. For the purpose of the report the people using the service are referred to as people or individuals. The inspector arrived at the service at 08.00 and was in the home for eight hours leaving the service at 16.00. The inspection was a thorough look at how well the service was meeting the key National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. The Care Homes for Older People Page 6 of 36 Care Quality Commission Inspecting for Better Lives involves an Annual Quality Assurance Assessment AQAA to be completed by the service, which includes information from a variety of sources. This document was received by the commission by the deadline set and it was noted that the document was brief and gave limited information about the service generally. It is the expectation of the commission that further AQAA documents be completed more fully and is supported by appropriate evidence. Some information from the submitted AQAA has been included within the report. The information contained in this report was gathered mainly from observation by the inspector and speaking with a number of individuals and care staff. Surveys relating to this key inspection were not sent to people assoiciated with the service on this occassion. A full tour of the premises was undertaken and documents sampled during the inspection included some individuals care plans, daily records and risk assessments, medication procedures, some health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the registered manager about the findings of the visit. No complaints have been received by the commission or the home however one safeguarding vulnerable adults referral has been recently made, the outcome of which is not concluded. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. The requirement made during the last inspection in June 2007 has been complied with. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? The homes environment has improved due to an extensive refurbishment with the inclusion of five more bedrooms and a re designed garden area for individuals to use. The fire and call bell system within the home has been renewed. Staff have undertaken Seniorcise activity training and Music for Life group has visited the home. A small green house has been supplied for individuals to use if they choose to. Care Homes for Older People Page 8 of 36 One staff member has achieved the NVQ Assessors Award which will promote more staff to undertake their NVQ training and be assessments will be able to be undertaken within the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 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. Prospective individuals are provided with information, including a visting the home, in order that they can make an informed choice about using the services provided. Individuals who may wish to use the service have a full needs assessment prior to using the service in order to ensure that the homes staff have the skills and abilities to meet the individuals assessed needs. Evidence: The home has been granted registration in March 2009 by the commission for five additional rooms. The registered manager confirmed that the Statement of Purpose and the Service User Guide and brochure were currently being updated and developed to incorporate the documented changes in the homes provision of services and facilities. The Statement of Purpose, supplied to the commission, following the inspection was an accurate document to comply with the Care Homes Regulations as amended 2006. Care Homes for Older People Page 11 of 36 Evidence: The registered manager evidenced through, the two care plans sampled by the inspector, that they understood the importance of having sufficient information through the completion of a full needs assessment for all individuals considering admission to the home. The registered manager has advised through the AQAA that an improvement to the home has been recognised to consider training a senior member of staff to undertake the initial needs assessments for prospective individuals due to the expansion of the home and the registered managers resources. There was evidence to support that the care needs assessments had been completed by the registered manager, the individual or their representative prior to admission to the home. The registered manager was reminded that all assessments must be signed on completion of the documentation. Admissions to the home only take place if the registered manager is confident that the homes staff have the skills and experience to support the individuals assessed needs. The registered manager confirmed that individuals are encouraged to have a trial period at the home in order that they feel they can have the time to make the choice, get to know other other individuals at the home and staff and have time to settle in their new surroundings. The home does not offer intermediate care. Care Homes for Older People Page 12 of 36 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. Individuals care plans were up to date and the provision of personal care and support reflected a person centred approach. Individuals health care needs are well met. The monitoring of risk assessments needs to be strenghenned to ensure the safety and wellbeing of individuals in the home. Medication procedures are not robust and must be strengthenned to ensure the safety and welfare of individuals in the home. Support and care is provided in a way which promotes individuals privacy and dignity. Evidence: The principles of the home are that individuals remain in control of their daily lives and that the home is home from home. This was evidenced by observing individuals moving freely around the home and having choices about where they wanted to have their meals, where they wanted to be during the day either in their room, having a lie in or nap after lunch, choosing to take part in activities, being in the lounge, dining room, conservatory or garden. Two care plans were sampled and it was evident that those individuals newly admitted to the home had had their care plans developed from the pre assessment Care Homes for Older People Page 13 of 36 Evidence: documentation. The care plans were generally well written to allow the reader to gain an overview of the individuals medical, social and personal care needs and how they preferred to receive support and care from staff. There was evidence to support that individuals and their representatives had been involved in the development of their care plans as one care plan sampled had been signed by the individual. The homes staff are reminded that if a person is unable to sign their care plan this is clearly documented within the plan. The care plans sampled were person centred and included a range of information about the individual for example their life experiences, past occupation, and social history, how they like to communicate, their skills and abilities, interest and hobbies, and how they like to make choices in their daily lives, their likes and dislikes including food, lifestyle preferences for example having a lie in in the morning, and how they liked to be supported if they are experiencing difficulties during the day or night. There was recorded evidence to support that the home has mainitained links with the local general practitioner who visits the home when required. The AQAA confirms that individuals can retain their own GP if they choose to whenever possible. Records within the care plans sampled evidenced that district nurse visits are arranged for individuals who require specfic interventions and referrals to other health care professionals, for example chiropodists, opticians, dentist and specialist health care professionals are made in order to maintain the health and welfare of all individuals at the home. There was documented evidence to support that individuals body weight is measured and where necessary, following an assessment with the relevant healthcare professional pressure releiving equipment is used to support and promote an individuals tissue viability. Whilst sampling the care plans it was noted that there was no evidence to support that a recognised screening tool to identify individuals state of nourishment had been completed. It is recommended as good practice that a recognised malnutrition universal screening tool be documented as part of the individuals care plan in order to ascertain the individuals nutritional state to ensure the wellbeing and welfare of the individual. The registered manager confirmed that no individuals currently residing at the home had pressure ulcers. The care plans were up to date and the AQAA advised that the plans are reviewed six monthly yet the two sampled had been reviewed more regularly which was concluded as best practice in order to reflect the changing needs of the individual and the actions taken by staff as a result of any changes to the care and support being provided. Care Homes for Older People Page 14 of 36 Evidence: In discussion with the registered manager it is recommended that the format of care plans be designed and updated to further develop a more person centered approach. The care plans demonstrated some evidence of individuals equality and diversity and the AQAA has identified that the registered manager is planning to access more training for staff to promote their awareness of equality and diversity both in regard to the individuals supported at the home and also for the workplace. The care plans sampled contained limited risk assessments for example one individual had had a fall in the home and a risk assessment had not been completed following the event. During the inspection it was identified that some individuals experience difficulties during their daily lives and the hazards being presented need to be documented within a risk assessment format, to evidence that measures are in place to reduce the hazards as far as reasonably practicable to ensure the saftety and well being of the individual and others in the home. The homes medication procedures were not robust and there were a variety of significant shortfalls. The registered manager explained that the home have recently introduced a monitoring dosage system from a leading chemist and there had been difficulties with the new procedures. A new drugs trolley has been provided due to a change in systems used to administer medication and the trolley was observed to be securely locked. It was observed that medicines were left in individual pots on peoples breakfast trays and staff confirmed that they administered the medication to the individual and signed the medication administration sheet following having given the medicines. The medication charts for all indivduals receiving medicines were sampled and the majority of the records contained irregularities which included no signatures to confirm medicines had been administered, why medication had not been given, handwriiten entries on the medication charts of medicines for example Paracetamol and Senna with no indication of prescribing doctor, the dates on one medication chart had been altered which had not be recognised by staff as incorrect and had resulted in staff signing to confirm they had administered medicines which were for the previous day. The use of as required medicines were discussed and it was apparent that there was a verbal protocol in which the registered manager would be consulted before as required medicines for example Diazepam are administered by staff yet there were no written procedures or individual guidelines available to ensure the safeguarding of individuals receiving as required medicines or safeguards for the homes staff administering the medication. Care Homes for Older People Page 15 of 36 Evidence: The procedures for the use of homely remedies was sampled and the document was not current and had not been reviewed for several years and it is required that all household remedies administered by staff to individuals must have been authorised by the individuals general practitioner and the practice reviewed appropriately in order to safeguard the individual and promote their welfare and well being. It was identified that an individual continues to prefer to retain their independence by adminstering their own medicines there was no written policy and procedure on self handling medicines and it has been required that this must cover risk assessments, storage, supply of medication and arrangements for the monitoring of the health of the individual. The use of covert medicines used in the home was discussed with the registered manager and this has been report more fully in the Complaints and Protection section of the report. The medication policy and procedures sampled was not dated and was a complex document. In discussion with the registered manager it was agreed that the medication policy and procedures needed to be updated to reflect the procedure of ordering, safe adminstration, delivery and disposal of medicines. There was recorded evidence to support that staff had received medication training and the registered manager was aware of some of the shortfalls and had been proactive in seeking resolution to some of the difficulties within the new medication system. It is concluded that the current medication practices in the home did not constitute save practice to ensure the wellbeing and welfare of persons receiving medicines in the home and several requirements have been made in order to ensure the safety and well being of people receiving medicines in the home. Throughout the day the inspector observed that people were addressed in a polite and courteous way by all staff and there was evidence of meaningful professional relationships between staff and individuals at the home. Individuals at the home called the registered manager and staff by their first name and despite an emergency situation in the home, which was professionally handled by the registered manager and paramedics, the staff continued with their duties efficiently. Care Homes for Older People Page 16 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights of choice about their daily routines and the range of activities offered is promoted. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet in spacious and pleasant surroundings. Evidence: The registered manager advised that most people living in the home prefer not to take part in too many group activities which is an opportunity for staff to be able to offer quality one to one time. It was observed that staff were at hand during the morning to sit with some individuals and have a talk about current affairs which the individuals enjoyed. Staff also have the time to support individuals out to walk locally and when indoors to assist individuals to write letters to loved ones. Staff have received training in Seniorcise which is a programme designed to support older people with gentle exercises. All the individuals spoken with during the inspection said they were happy living at the home and the home was comfortable and the manager and staff kind and attentive. The homes communal facilities promote individuals to live in a homely atmosphere Care Homes for Older People Page 17 of 36 Evidence: with a variety of areas where they can continue to take part in leisure and hobby activities. One individual told the inspector that they liked to do their painting when they felt like it and used the conservatory area whilst others said they enjoyed the new plasma television and particularly liked watching the news, Catchphrase, Countdown and reading the daily paper. A piano has been purchased and a group had been arranged to visit the home and have a sing along which was enjoyed by some individuals. There were a variety of books and, board games, jigsaws and music available for individuals to choose from if they wished to and it was observed that some individuals had made strong friendships in the home and helped each other during the course of the day. One care staff member told the inspector that board games like dominoes and connect 4 are enjoyed by individuals and the AQAA advises that external companies visit the home to provide entertainment which includes Music for Life and ceramic painting sessions. The home have a cat called Lady who enjoys the pampereing she receives from the individuals who like cats. The registered manager advised that a newsletter is currently being developed and will be available to people in the home and their friends and relatives to inform them of specfic events and topics of interest. People are encouraged to be part of the local community and attend local fairs and events, bonfire evenings, and some individuals attend a local day centre. One individual attends step dancing which they enjoy. A hairdresser and manicurist visit the home to offer beauty therapy and the newly landscaped garden has a small green house which is available for individuals wanting to potter about making hanging baskets or potting plants. People were seen to move around the home freely and the atmosphere in the home was was quiet and relaxed. Two visitors were seen in the home but the inspector did not have the opportunity to meet with them. It was observed that staff were friendly and welcoming to visitors and during the morning the staff kept in telephone contact with an individuals relative in order that they were included and informed of the persons well being. The registered manager confirmed that a member of the Christian clergy visit the home to offer spiritual and religious support to individuals. The breakfasts and midday meal served were well presented. People were offered choice if they wished to have their breakfasts in their rooms or in the dining area and most people had their breakfasts in their rooms. Some people were choosing to have their breakfasts at a later time and staff were flexible to adjust to the persons choice Care Homes for Older People Page 18 of 36 Evidence: which indicated the service was led by the individuals living in the home rather than by the homes procedures. The registered manager showed evidence to support that people had been asked about their views about the meals provided at the home and several of the suggestions had been implemented within the menus. The home are in the process of recruiting a chef and there was evidence to support that the homes menu was being reviewed and individuals living at the home had been asked their views about their likes and dislikes which were being incorporated within the menu which was available in the home. There was evidence to support that individuals with specfic dietary preferences for example vegatarian diets were catered for and a choice of cereals and food at breakfast and lunch time was available. The breakfast and the midday meals were served in an efficient manner. The dining area contained small tables which had been had been set with appropriate condiments, crockery, tablecloths and napkins. People were observed during the midday meal and staff were on hand to support anyone who needed assistance. Care Homes for Older People Page 19 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not fully protected by the homes complaints and safeguarding adults procedures which need to be strenghenned. Evidence: The home has a complaints procedure dated 2002 which was sampled within the complaints folder and indicated that it would be updated in 2003. There was no evidence to support that it had been updated yet the AQAA received by the commission indicates that the procedure was updated in June 2008. It has been required that the current complaints policy is updated and includes the current details of the Care Quality Commission. The registered manager confirmed that no complaints had been received by the home and any complaints received would be fully investigated and that records would be kept by the home to evidence this. Several people told the inspector that they would talk to the staff or their family members if they had any concerns or were unhappy. Several letters of compliment and thanks were evident in the homes office which reflected favourably on staff and the care they had provided. The registered manager demonstrated some knowledge regarding peoples human rights with regard to the Mental Capacity Act and Deprivation of Liberty and the home have access to an advocacy service as required. It was noted during the inspection that the home use a listenning device in an individuals bedroom and as previously documented administer Care Homes for Older People Page 20 of 36 Evidence: covert medicines in order to ensure the individuals safety and wellbeing. It has been required that any actions by the homes staff that may constitute deprivation of liberty of individuals living at the home be referred to the local authority in order that appropriate advise is sought and assessments undertaken if necessary by the appropriate parties to ensure any deprivation of liberty is lawful and the individual is protected. The registered manager confirmed that a letter from a doctor dated 2007 and related to the use of covert medicines at another registered care home was being referred to as authorisation for the administration of covert medicines in the home. It was confirmed that the individuals family and GP were aware of the use of the covert medicines yet there was no indication that the home had sought up to date documented authorisation to safeguard the individual or the staff adminstering the medicines. The registered manager was proactive to contact the pharmacist assigned to dispense medicines to the home in order to ascertain if the current medicines could be dispensed in an alternative medium and assured the inspector that she would contact the individuals general practitioner to discuus the persons medication, confirm and seek up to date authorisation regarding the use of covert medicines. The homes Abuse Guidance Policy dated August 2008 was sampled and evidenced that it did not comply with the local authorities multi agencies safeguarding vulnerable adults protocols. The copy of the Surrey County Council multi agency Procedures for Safeguarding Vulnerable Adults in the home were dated 2005 and had not been updated to the 2008 version. It has been required that the home obtain the current local authority multi agency procedures for the safeguarding of vulnerable adults and the homes policy and procedure regarding safeguarding vulnerable adults is updated to comply with the local authority protocols in order to ensure the protection and safety of individuals in the home. The registered manager when questionned was clear in detailing the process of reporting alleged harm or abuse and two staff records sampled indicated that staff had attended safeguarding vulnerable adults training. One safeguarding vulnerable adult referral has recently been made and remains ongoing. The home has a whistle blowing procedure in order that staff are aware of their duty of care to report any safeguarding incidents. Staff files sampled evidenced that Criminal Record Bureaux checks had been obtained. Care Homes for Older People Page 21 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout supports individuals to live in a safe, well maintained and comfortable environment. Communal and private areas in the home are are of a high comfortable standard, well furnished and comfortable for individuals. The control of the spread of infection in the home and cleanliness is robustly managed. Evidence: A site visit was carried out on the 12th March 2009 by a representaive of the commission in order to gain information to approve the major variation that the commission had received regarding the proposal to increase the occupancy of the home from 10 individuals to 15. The variation was granted and the certificate of registration within the home was an up to date document. The five new rooms have been provided by renovation of the registered managers former living accommodation and the registered manager has moved to a bungalow adjacent to the service. The five new bedrooms meet the National Minimum Standards for Older People and all rooms have ensuite toilets and and hand wash basins. Individuals spoken with said they liked their bedrooms which were viewed during the tour of the premises to be clean, well decorated, and furnished to a high standrd. Some individuals confirmed that they were encouraged to bring their own items of Care Homes for Older People Page 22 of 36 Evidence: furniture and personal effects if they choose to which made it feel more like home. Bedroom furniture consisted of divan beds on legs so that a hoist ccould be used if required, chest of drawers, wardrobe, bedside cabinet, arm chair, bedside lamp and small bedside table. All rooms had a call bell and there are smoke alarms in each room and radiators were covered to reduce the risk of burns. It was confirmed during the registration site visit that one of the ten existing bedrooms did not have an en suite however, this was rectified so all fifteen rooms have en suite toliet and hand wash basin. Four of the existing rooms have been redecorated and refurbished and the registered manager confirmed that the other existing rooms are to be refurbished as they become vacant. The communal lounge has been enlarged and as previously documented was evidenced as spacious and individuals in the room said how homely it felt. During the tour of the premises it was noted that there were suffcient bathrooms and toilets to cater for the current needs of individuals in the home. A walk in shower has been installed in the new part of the home and there is an existing bathroom with hoist in the old part of the home. A new laundry room has been provided and contains one washer and one dryer. Sluice areas in the home were viewed as clean and orderly. Staff were observed to wear protective clothing, including aprons and gloves and hand washing facilities were available throughout the home in order to promote the control of spread of infection in the home. There are two stair lifts in the home enabling individuals who use the service easy access to the first floor. The home was clean throughout with no malodour present and and all areas of the home were well maintained. Care Homes for Older People Page 23 of 36 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. Staff in the home are in sufficient numbers to support the people who use the service. The home does not have a robust system for the safe vetting of staff and management of recruitment practices must be strengtenned to protect the welfare and safety of indivduals at the home. The induction and training development practices of the home currently ensure staff receive training to ensure peoples needs are appropriatly met. Evidence: The home currently employs 12 permanent care staff 8 of whom have achieved their National Vocational Qualification NVQ Level 2 or above. Staffing levels at the home during the inspection were two carers, and one staff member who was on their indcution to the home. During the site visit regarding the major variation of the home it has been reported that the registered manager confirmed that she uses the Residential Care Home Staffing level forums document to determine the level of staff required in the home and that staffing levels will be monitored and reviewed in accordance with the needs of people in the home. The home have a waking night staff member and a sleep in staff member, a housekeeper and a dedicated chef will commence work when fully recruited. As previously documented the manager had undertaken the waking night duty the night Care Homes for Older People Page 24 of 36 Evidence: before the inspection and wished to be present throughout the day of the inspection to represent the service. The registered manager advised that she works hands on in order to mentor good practice and maintain contact with the individuals and staff in the home. The general atmosphere was quiet and orderly and staff were observed to undertake their duties in an efficient and professional manner. Staff relationships with individuals were professional and the use of terms of endearment supported trusting relationships between the individual and the staff member. Peoples preferences on how they like to be addressed were documented in peoples care plans. The homes recruitment and selection policy was not sampled during this inspection. The inspector sampled two care staff files. The documents regarding the safe recruitment and vetting of new staff were not robust in order to ensure the safety and protection of people in the home. One file did not contain an application form, the registered manager advised that the staff member had previously worked in another registered care home but the 3 references within the staff members file were two personal references and a reference of a past employer. There was no recorded evidence of why the person had ceased to work with vulnerable adults and the photograph of the staff member had been photocopied from their passport and thus may not have been a recent photograph. The other staff file contained an application form that was scant of information about the staff member, there was no statement regarding the persons mental or physical health, and no reason given why they had left their last place of work. The registered manager advised that the home employ on an ad hoc basis a hairdresser, chiropodist and beautician and no documented evidence was available to support that they had been vetted prior to working in the home. There was documented evidence that a CRB clearance had been obtained for care staff. It has been required that arrangements must be made for the safe vetting of all staff working in the home in order to ensure the safety and protection of individuals in the home. The managers confirmed that the home is committed to the ongoing training and development of staff and the staff files sampled evidenced that staff had attended induction, statutory training and specialist training including dementia training to support them to care for individuals with specfic needs. The AQAA advises that one staff member has achieved their NVQ Assessors award and will be able to undertake NVQ assessments at the home. Continence management training and updating the induction programme are to be undertaken in the near future. Care Homes for Older People Page 25 of 36 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 homes administration needs to be strenghtenned. The home is run in the best interests of individuals and their views and opinions and those of others associated with the home are sought and acted upon. Peoples general safety and welfare is promoted yet improvements need to be made regarding some managerial aspects of the home. Evidence: The management of the home is based on openess and respect. The registered manager, who has managed the home for fifteen years, demonstrated throughout the inspection a knowledge and understanding of the day to day running of the service for the benefit of the people living at the home. The registered manager has attained the Registered Managers Award and NVQ Level 4 in Care and continues to offer leadership and stability in the home. It was evident during the inspection that the homes staff have open and professional relationships with individuals living in the home, their visitors and peoples views about the care and support their friends and relatives receive is listenned to and acted upon by the homes manager. Care Homes for Older People Page 26 of 36 Evidence: As previously documented throughout the report the registered manager represented the service during the inspection despite having been on night duty the previous night. It was acknowledged throughout the inspection that the home has recently been granted registration to provide care and accmodation to fifteen individuals and this has caused some upheaval in the management of the home with regard to reviewing supporting new people into the home, reviewing staffing levels, employing new staff, updating activities programmes and menus and incorporating new medication procedures. The home has an internal Quality Assurance process and there was evidence to support that the views from people living in the home had been instrumental in changing some of the aspects in the home which have included changes in the menu choices to include more exciting recipes and increased number and type of activities. The fridge, freezer and pantry were well stocked. Fresh fruit and vegetables were available for individuals. Records of food temperatures, storage of food in the fridge and pantry was in compliance with food hygiene standards to ensure peoples health and safety. The storage of chemicals in the home were appropriate to ensure the safety and welfare of all people in the home. Fire safety measures were in place and fire doors linked into the fire alarm system so that should the fire alarms sound fire doors close automatically. One room not linked to the system has a door guard fitted and during the site visit for the major variation the registered manager confirmed that when the fire alarm sounds the door guard is activated shutting the fire door in order to ensure the safety and protection of the individual. A new fire risk assessment has been documented and is stored within the homes office. The homes fire procedures sampled confirmed that records were kept of fire tests and equipment checks and signage was available within the home to show people fire exits. No finance policies or procedures were sampled at this inspection but the previous inspection in June 2007 states that the home do not have responsibility for individuals money and relatives safeguard individuals financial interests. This standard will be fully assessed at the next inspection. The home have a current certificate of registration and insurance indemity certificate displayed within the home. Care Homes for Older People Page 27 of 36 Evidence: Accident and incident records were sampled which indicated that not all events which affect the wellbeing and welfare of individuals are reported to the commission. There was evidence of individuals falling within the home which had not been reported to the commission in line with Regulation 37 notifications. It has been required that all events which affect the well being and welfare of individuals must be reported to the commission without delay. As recorded throughout the report there are several aspects of the homes management which are potentially putting the health, safefty and welfare of individuals and staff at risk and have affected the overall quality rating of the home. The shortfalls include the lack of robust medication procedures, lack up robust risk assessments where hazards have been identified in peoples lives, lack of robust safeguarding and recruitment procedures and shortfalls in the updating of the homes policies and procedures. During the inspection the registered manager acknowledged these shortfalls and it is recommended that during this time of transisition that the registered manager have the time to consolidate the changes within the home in order to improve the current quality of service. It has been required that the home must forward to the commission an improvement plan detailing how the home intends to improve the services provided to ensure the safety and well being of individuals in the home. Care Homes for Older People Page 28 of 36 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 29 of 36 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 8 13 Arrangements must be made that where hazards are identified in peoples daily lives for example falls, and behaviours which test the service, risk assessments are documented. To evidence that measures are in place to reduce the hazards as far as reasonably practicable to ensure the safety and well being of the individual and others in the home. 10/08/2009 2 9 13 Arrangements must be 10/08/2009 made that all household remedies administered by staff to individuals must have been authorised by the individuals general practitioner and the practice reviewed appropriately. Care Homes for Older People Page 30 of 36 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 In order to safeguard the individual and promote their welfare and well being. 3 9 13 All medication must be 10/08/2009 administered directly from the orignal labelled container to the individual and not placed into any secondary container for later administration by another carer. In order to ensure that individuals receive their prescribed medicines and their safety is ensured. 4 9 13 Arrangements must be made that clear and comprehensive policies and procedures for the receipt, recording, storage, safe handling, administration, self administration and disposal of medicines, specfic to the home, must be produced. In order to ensure that robust procedures are in place to safeguard the individuals in the home with regard to their medication needs. 10/08/2009 5 9 13 A documented policy and 10/08/2009 procedures on handling self administration by individuals Care Homes for Older People Page 31 of 36 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 must be produced. This should cover risk assessment, storage, a record of prescribed medicines for the individual, the supply of medication and monitoring of the health of individuals. In order to ensure that individuals who choose to self administer their medicines are supported to do so safetly. 6 9 13 An accurate record must be kept of all medication administered to individuals and medication administration charts must be signed immediately after the medication has been administered not at a later date. In order to ensure that medicines are administered at the frequency prescribed by the doctor. Arrangements must be made that the complaints policy is updated. In order that any person wishing to raise a concern or complaint about the home has up to date information. 10/08/2009 7 16 22 08/07/2009 Care Homes for Older People Page 32 of 36 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 8 18 13 Any actions by the homes staff that may constitute deprivation of liberty of individuals living at the home must be referred to the local authority. In order that appropriate advise is sought and assessments undertaken if necessary by the appropriate parties to ensure any deprivation of liberty is lawful and the individual is protected. Arrangements must be made that the home obtain the current local authority multi agency procedures for the safeguarding of vulnerable adults and the homes policy and procedure regarding safeguarding vulnerable adults is updated to comply with the local authority protocols. In order to ensure the protection and safety of individuals in the home. 08/07/2009 9 18 13 08/07/2009 10 29 19 Arrangements must be made for the safe vetting of all staff working in the home. 10/08/2009 Care Homes for Older People Page 33 of 36 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 In order to ensure the safety and protection of individuals in the home. 11 38 37 Arrangements must be made that all events which affect the wellbeing and welfare of individuals are reported to the commission without delay. In order to ensure the safety and well being of individuals in the home 12 38 24A Arrangements must be 14/09/2009 made that the home forward to the commission an improvement plan detailing how the home intends to improve the services provided. In order to ensure the safety and well being of individuals in the home. 08/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 It is recommended that the format of care plans be designed and updated to further develop a more person centered approach. It is recommended as good practice that a recognised malnutrition universal screening tool be documented as part of the individuals care plan in order to ascertain the 2 8 Care Homes for Older People Page 34 of 36 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 individuals nutritional state in order to ensure the wellbeing and welfare of the individual. 3 9 It is recommeneded that the home obtain the guidance document from the Royal Pharmaceutical Society named The Administration and Control of Medicines in Care Homes 2003 when updating the homes policies and procedures relating to the handling of medication. It is recommended that as good practice that when it is necessary to handwrite a medication administration record chart in the home that the member of staff writing the chart signs the chart and that a second carer checks the entry for accuracy and then initials the chart. It is recommended that during the current period of transisition that the registered manager have the time to consolidate the changes within the home in order to improve the current quality of service. 4 9 5 38 Care Homes for Older People Page 35 of 36 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. 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