Inspection on 12/01/10 for Farmhouse Rest Home

This inspection was carried out on 12th January 2010.

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

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

Other inspections for this house

Farmhouse Rest Home 02/11/09

Farmhouse Rest Home 12/10/09

Farmhouse Rest Home 28/09/09

Farmhouse Rest Home 19/08/09

Farmhouse Rest Home 17/08/09

Farmhouse Rest Home 09/06/09

Farmhouse Rest Home 17/06/08

Farmhouse Rest Home 02/08/06

Farmhouse Rest Home 23/01/06

Farmhouse Rest Home 15/08/05

Farmhouse Rest Home 10/11/04

Farmhouse Rest Home 10/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Farmhouse Rest Home 87 Water Lane Totton Southampton Hampshire SO40 3DJ     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: Sue Kinch     Date: 1 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Farmhouse Rest Home 87 Water Lane Totton Southampton Hampshire SO40 3DJ 02380667071 02380868865 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Richard E Kitchen,Mrs Elizabeth Kitchen Name of registered manager (if applicable) Mr John Trevor Rickman Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20 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) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Farmhouse is a registered care home providing personal support and accommodation for up to twenty older people who may have dementia. The home comprises of ten single and five shared bedrooms, eleven of which have en-suite facilities. Communal Care Homes for Older People Page 4 of 32 Over 65 0 20 20 0 1 7 0 8 2 0 0 9 Brief description of the care home space includes two lounges and a dining room. Car parking and a small, enclosed patio can be found at the front of the property. Farmhouse is situated in a residential area on a main road close to the centre of Totton. The homes fees range from £504-£520 a week. Care Homes for Older People Page 5 of 32 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: This inspection took place from 10:00 am until 19:30 pm and involved two inspectors. Information taken into account for this inspection included Annual Quality Assurance Assessment (AQQA) required to be provided by the homes manager. We spoke with people living in the home, visitors and staff on duty. We observed care practises. We viewed a selection of records required to be maintained and held in the home. We observed the shared environment and some of the private rooms. We spoke with the manager and one of the registered providers. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? The home received a statutory requirement notice after our last key inspection in respect of care plans, risk assessments and care plans needing to reflect changes in care needs. We noted slow progress when we monitored the home at random inspections in August and September 2009. However, at this inspection care plans and risk assessments had been revised, were more detailed and increasingly reflecting care needs with a system of review in place. We made a requirement about medication following our last inspection and this triggered a pharmacy inspection leading to statutory notice about medication practises. This has subsequently been monitored by the pharmacy inspector on two occasions and training and assessment of staff needed further work. On this occasion we found that the improvement in medication practises had been maintained with some minor issues to be addressed and that more staff training had been received. Some elements of competence were being assessed but this should be more detailed as addressed in the section below. We found that more attention is paid to dignity and privacy and the managers office has been moved so that access is no longer through a shared bedroom. We also noted that staff were considering dignity and privacy issues when talking to us and it is referred to in the care plans. The home is reporting more incidents to us showing an awareness of sharing information under safeguarding procedures. Records of staff training are available and show that staff have been receiving training in areas such as infection control, adult protection, food hygiene, medication, moving and handling and dementia. Evidence of Criminal Records Bureau or POVA first checks carried out before recruitment are in place and references are being obtained. Care Homes for Older People Page 7 of 32 A process of developing consultation about the service and establishing a full system of quality control has started and a short term plan of development is in place. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 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. The home has a revised policy for assessing the needs of people to ensure their needs can be met before moving in to the home. Evidence: At the last inspection in June 2009 and we had concerns about the admissions to the home due to the needs of some of the people living in the home. We found in care plans needs in relation to mental health and alcohol dependence which staff were not trained to meet. Potential risks in relation to those needs were not assessed or strategies in place to deal with emergencies potentially arising from those needs. We made a requirement that people moving into the home should be assured that their needs could be met before moving in and this was to be completed by July 2009. Since then we have been told by the home that they have been considering the needs of people before admission in more detail. The manager said that a new policy had been written and we noted on our visit that this is available in the home. Care Homes for Older People Page 10 of 32 Evidence: In the AQAA received in November 2009 the new manager told us that people would be fully assessed and only people in the homes categories of registration would be admitted. Information was missing from the dataset about movements into the home but at our visit we noted that the home had made only one new admission. An assessment had been completed identifying the persons needs although the records did not clearly identify when it was written. From our observations of records and discussions we noted that a care plan was in place identifying most care needs which, where checked were mostly met. We found one significant issue for that person that was being monitored and the owner was aware of it but we pointed out that this should also be recorded in the care plan. This is to ensure that all staff are aware of the issues. Care Homes for Older People Page 11 of 32 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. The personal, health and social needs of people living in the home are more consistently met and documented with clearer guidance in place for staff to meet those needs taking preferences into account. However, a system for continual monitoring and reviewing is not fully established to ensure that improvements are fully embedded in practise. People living in the home are protected by more accurate medication procedures followed by trained staff but this would be enhanced further by full completion of assessments staff competence, as required previously in a Statutory Requirement Notice, and ensuring that as required medication is always recorded. Evidence: We carried out a key unannounced inspection in June 2009 and made a requirement that all care plans daily records and risk assessments must be up to date with clear guidance for staff such as for when working with aggressive behaviour or meeting all short and long term health needs. The home received a statutory requirement notice after the inspection requiring the home to ensure a system in place to identify risk to Care Homes for Older People Page 12 of 32 Evidence: residents are in care plans, ensure guidance is in place to minimise risks and that changes in service users needs are identified in care plans. We have completed two random inspections on 19/8/09 and 12/10/09 to look at these issues. We found that although work was taking place we needed to repeat the requirements. On this occasion we talked with staff, residents and the manager. We observed care practises and viewed records in relation to risk assessments, care plans and day to day recording and noted that progress had been made. At this inspection there were new care plans and more risk assessments in place. We looked at four sets of records while we visited. They contain much more information than on previous visits last year including more about individual needs and preferences in a wider range of areas where support may be needed and how staff are to assist. They cover many areas of care including health, personal care, moving and handling, relationships and wishes, personal safety, continence diets and more. The care plans and risk assessments have been cross-referenced so that action in relation to risks are written in the care plan for staff to follow. These records are being monitored and updated more than before although we did find some exceptions which were brought to the managers attention. One related to the level of support needed for one person. The level of support needed for that person had decreased and this had not been reflected in the care plan meaning that independence may not be fully promoted. However, the member of staff spoken with about this was clear about the current needs.The care plan for another person had did not reflect loss of weight. However, there was written evidence that it was being monitored and the registered provider was aware of the situation and monitoring it. Staff have been encouraged to to read care plans and said that they are doing so although most have not signed to say they have read and understood the ones that were sampled. Some have signed the risk assessments. Staff said that they had been consulted about the care plans and so had the people living in the home. In a discussion about a particular issue with one of the staff they confirmed that a relative had been involved in care planning. They thought that the care plans were better and were a reflection of the needs of people in the home. Another said that it was easier to find information, that they used them and recorded information. We talked to people receiving the care and a relative, observed the care provided and talked with staff about aspects of the care they were providing. Views about the care provided were positive. Staff showed caring and friendly approaches to people and were aware of most needs of people spoken about. This included aspects of health and dealing with behaviours. We also noted that day to day recording included more Care Homes for Older People Page 13 of 32 Evidence: information about how needs were being met and followed up. Staff are being encouraged to find out more about the previous lives of people living in the home and staff member demonstrated that this was being taken into account for example,when considering why a resident may be behaving in a particular way. The manager has told us that care plans will be reviewed regularly and we noted that he has started a system to prompt monitoring of this. The manager has written the care plans and that he intends to involve the assistant manager and other staff through a key worker system. We noted that training records to do not show that staff have received care planning training and some specific aspects of care. This is addressed in the staffing section. In the report following the last key unannounced inspection we made requirements about the management of medication in the home. This included medication practises, recording, storing and to have trained staff deemed competent. Following a random inspection by a pharmacy inspector a statutory notice was issued and a further requirement made to have proper storage for controlled drugs. Progress was monitored on 28/8/09 and 2/11/09. After these visits, evidence of adequate training and assessment of competence was still not completed. On 16/12/09 the manager updated us and said that that 10 staff had attended a training session on 24/11/09 and 6 had completed three units of another course. During our visit training records supported this. However, although there is now a system in use for the management to monitor the accuracy of medication administration in the home the manager was advised that the staff needed to be individually, fully assessed,as required previously in a Statutory Requirement Notice. This is to ensure that they are competent for the tasks they are involved in. The registered provider must ensure this is completed. We sampled other aspects of the medication system in the home. We noted that appropriate storage facilities are in place including for controlled drugs. A staff member was observed carrying out administration of drugs and this was completed in line with proper procedures attending to peoples needs individually. Short courses of drugs had been recorded. As required guidelines were mostly in place but one medication was recorded as daily and given as required and needed to be checked. One medication needed to be returned to the chemist. However administration charts were otherwise being fully completed and regularly checked for accuracy. In June 2009 at the Key Unannounced inspection we also made a requirement about the promotion of privacy and dignity. We had noted at the random inspection on 10/12/09 that the managers office, previously only accessed through a shared bedroom, had been moved meaning that the people using that room had more Care Homes for Older People Page 14 of 32 Evidence: privacy. In conversation with staff during this visit they spoke of promoting privacy and dignity and these issues were reflected in care plans viewed. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are offered an increased range of activities for mental stimulation based on assessed needs and interests. They are provided with a menu that they have influenced and like but more visual aids in the home would increase the potential to orientate people. Records are not held in enough detail to reflect that people are provided with a nutritious diet and special diets are catered for. Evidence: There are activities arranged each day in the week for people to join in. Staff spoke about the variety and were seen to assist people to enjoy a music session with external entertainers when we visited. We noted that several people joined in with the singing and playing of instruments. Others chose not to join in and staff were seen to check with those they thought would enjoy it before it started. A record of those who participate in activities has been started and a staff member said this is taken into account when reviewing what has happened for each person monthly. Other staff said that they are being encouraged to find out more about the residents previous interests and hobbies to find out more about what will stimulate them. Regular visits to a local club for those able to go are being planned. Care Homes for Older People Page 16 of 32 Evidence: We noted that social needs and interests are being assessed in the care planning process and in examples given support was being given during our visit. This included for example, people spending time together, or being supported to have a cigarette. People were choosing where they wanted to be and some chose to be in their rooms. One person was reading. At various points in the day staff had time to sit and talk with people. A visitor told us that they had been asked about the previous history and interests of their relative and saw this as positive. Positive comments were received from people living in the home and the staff about food. Improvements were commented on and the new chef is well received. A visitor said that the food had improved and was more varied. The manager said that the menus had been revised with residents wishes taken into account. The chef has a 4 week menu and offers alternatives. The main meal was written on a board in the dining room although this did not state that it was the main meal, the time of it or what other meals would be provided that day. This was the only information provided in the lounge and there was no clock to help orientate people. Staff spoken with and the chef were aware of special diets and food prepared to meet those needs although no records were kept to reflect this or of food provided to demonstrate that people are offered a nutritious and balanced diet. The menu does not reflect the variety of food offered and the range of fresh fruit and vegetables available. The manager agreed to address the records. The weight of people is being monitored. Changes have been made to the dining room which now has new tables and chairs and provides seating for 16 people at four tables in an attractive setting for meals. Another table is provided to the rear of the home where a further four people can eat and if they wish, share with visitors. All of the dining furniture is new. Fruit and crisps were on tables around the home for people to help themselves. Staff spoke about various visitors to the home who are made welcome and this was confirmed by a visitor. We were also told of families being invited to a Xmas party and made welcome. Meals are also offered to them. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training in safeguarding and the reporting of incidents have improved so that the risk of incidents not being addressed have been reduced offering greater protection to people living in the home. People are able to raise issues and are aware of how to make complaints. Evidence: After our inspection in June 2009 we made a referral, through safeguarding procedures, to social services due to issues in the health and personal care section of that report. We made further referrals for example about aggressive behaviour that the home had not followed up effectively after a random inspection on 19/08/09. We also made another requirement about reporting incidents following that inspection and referred to our ongoing concerns after the random inspection on 12/10/09. Since the new manager has been at the home we have had an increase in incidents reported to us by the manager who has also been refering to social services if it has been a safeguarding matter. The home has been involved in local safeguarding procedures and has worked to improve the care provided at the home in response to issues raised. In the records that we viewed at this inspection we noted that care plans have included more details of how to support people with particular needs although some more work is needed to ensure that they are fully person centred. Progress in relation to safeguarding issues were still being monitored by social Care Homes for Older People Page 18 of 32 Evidence: services at the time of the inspection. In report dated 16/12/09 the manager updated us and said that all incidents are now reported, staff were trained in safeguarding on 30th November 2009 and are aware of incidents needing to be recorded. We sampled some of the records for people living in the home and did not view any further details of incidents that should have been reported. Training records showed that eight of 13 care staff had received training in safeguarding in 2009 and one in 2007. The manager is still checking old records for evidence of other training. We spoke with two staff during our visit and they confirmed that they had received the training and they were aware of what to do if they were concerned. There is a complaints procedure in the home and this has been recently distributed to all rooms in the statement of purpose. A visitor to the home was aware of this and of how to complain. The manager told us that he did not currently have a log book but would be establishing one. He told us that he had not recently received any complaints. In conversation, one of the people living in the home volunteered in answer to a question about what it was like in the home, that it was fine and that they had no complaints. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with a comfortable environment to live in but more attention is needed to ensure that infection control procedures are monitored to minimise any risk of cross infection in the home. Evidence: There are ongoing improvements to the environment as found at the last inspection and we were made aware of new carpets, some redecoration, refurnishing of the dining room, some replacement windows and plans for some new curtains. We viewed the shared areas of the home and a sample of bedrooms with en suites. All areas were pleasantly decorated, fresh and clean with the the exception of one or two pieces of equipment such as an extractor fan. The staff told us that they do any necessary cleaning when the cleaner was not available. The home felt warm and people told us they were warm. Decorated boxes and notice boards have been provided in peoples rooms. Staff told us there is a maintenance book for repairs and the maintenance person visits weekly. If the repair is urgent then staff contact him and he responds quickly on the same day. There were two missing light bulbs in the lounge when we visited but otherwise the home looked well maintained. Staff told us all residents require help and assistance to get into the bath. The shared Care Homes for Older People Page 20 of 32 Evidence: bathroom is only used for those residents that do not have an en suite bath. Bath seats were provided in the rooms viewed. In the report of the key unannounced inspection in June 2009 we noted that records of infection control training were not accessible to give us a clear overall view. We did not make a specific requirement but it was included in one made in respect of staff training. The records now held by the home indicated that 11 of the 13 care staff have now received some training, ten of them in 2009. Infection control procedures were discussed with some of the staff and aspects of the practices in the home considered. We found that there were a few risk points in need of attention. These included a toilet with a bin without a lid, provision of a bar of soap and a nail brush putting people at risk of cross infection. Paper towels had also not been provided in this area. This information was fed back to the manager and provider. The provider told us of plans in the home to improve the system of infection control. We have made a requirement to ensure the system of infection control is sufficiently monitored to minimise risks and that any improvement is sustained. Care Homes for Older People Page 21 of 32 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. People living in the home are supported by caring and friendly staff who have received some training in key areas of care but a training plan, including meeting more specific needs, is not in place. The recruitment process has improved in ensuring the people are vetted before working with people living in the home although some further attention to recording will make it fully robust. Evidence: After the inspection of June 2009 we made an immediate requirement that the manager must have evidence of a POVA first check or a fully completed CRB check before people start working in the home. We received confirmation that this had been completed by the manager at the time and further confirmation that this had been addressed in an update from the manager on 16/12/09. At this visit we found in the evidence viewed that this had been followed up. We also made another requirement that the manager must ensure that there is full evidence of employment checks available in the home including written references, employment gaps, and testimonials about why people left previous care employment.We checked records for three people at this inspection and found that there were references for them but that not all of them were dated to show that they were obtained before the date of employment and we were told that those for one person had been submitted with the the application Care Homes for Older People Page 22 of 32 Evidence: and not obtained directly from the referees. During the visit we were told that there are two or three staff usually working in the mornings, two in the afternoon and evenings,one staff awake and one asleep and on call at night. In the week the manager is additional to this. There is a part time domestic and a chef works on six days a week. These hours were all reflected on the rota and staff confirmed this reflected what happened in the home. Those asked thought that it was enough with the current 13 residents in the home. During conversations with staff we noted positive and helpful attitudes towards the people living in the home and this was demonstrated in the support that they gave while we were there. They were aware of their roles and peoples needs in the examples talked about although one person was not aware of the needs of people with Parkinsons disease or of side affects of some medication. However, they were aware of their role to monitor their well being and report changes. Staff said that they were now having supervision and regular support. We saw a record of this in the office. We had positive comments from one staff member about working together more as a team. The assistant manager is pivotal in change overs between shifts as she works across both shifts on week days. Following the last key inspection in the report we said that the manager must have clear records to show that staff are trained in relevant skills including infection control, adult protection, and specific needs such as mental health and alcohol dependence. At this visit we were shown records of training that staff had received in the autumn of 2009. This was provided to most of the 13 staff with one or two staff still needing the training in each area. The topics included moving and handling, health and safety, safeguarding, food hygiene, infection control, medication and dementia. Staff confirmed that they had been given training in the autumn and where asked about specific training such as safeguarding they confirmed that they had received it. Nine of the staff in the home are recorded as having had some first aid training and four in challenging behaviour. We were told that alcohol related training was not needed as the person this related to was no longer in the home. The manager said that he still needed to check through other records that had been held by the previous manager to find more evidence of other training that he has been told staff completed. Currently, for example, records show that three staff have had NVQ assessments, that one has done continence care, reminiscence, depression and equality and diversity. He also is aware of the need for ongoing training including to meet more specific needs such as dementia training and mental health but currently does not have plan of training in place. He also said that the induction programme Care Homes for Older People Page 23 of 32 Evidence: needs to be reviewed. We have made a requirement for the home to ensure that there is a rolling programme of staff training which is kept under review and includes care planning and meeting more specific and individual needs of current residents such as Parkinsons disease. This is to ensure that staff have the skills to meet peoples needs. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is not yet registered with the Care Quality Commission. There remain some areas of concern such as, assessment of staff competence in medication administration, infection control, no clear staff training plan and insufficient food recording. The system of quality assurance in the home has not yet been developed sufficiently to embed recent improvements into practise to provide a service which is well organised with consistent outcomes for people. Evidence: Since the last key inspection,after a period of temporary management by one of the owners of the home, a new manager with previous experience of managing residential services was appointed from October 2009 and has submitted an application for registration with the commission. During the initial period following his appointment, other managers within the organisation and one of the owners, shared some of the responsibility for the management tasks. However, at this inspection the manager said that he was now fulfilling all management tasks including staff recruitment, training and supervision, quality assurance and admissions. An assistant manager has also Care Homes for Older People Page 25 of 32 Evidence: been appointed and is in post. Positive comments were received from staff about feeling consulted, supported and said that the management were approachable. An AQAA completed by the manager was received in November 2009 before our inspection. The manager said that some of the information was not to hand for the data set at the time of completing the AQAA and therefore it was incomplete. The update on 16/12/09 did not provide all this information although some of it was available at the inspection. The registered person had not ensured that the AQAA was fully completed to demonstrate that peoples needs are met. After the key inspection in June 2009 we made a requirement that the manager must review information received in the quality audits of the home through consultation. We required that it informed a plan for development which was made available to people living in the home or their representatives by 9/10/09. Progress was discussed with the manager who said that consultation with people was in progress and he showed us that some forms had been returned but he was waiting for a fuller response. He also told us that a surveys had been done with resident participation on menu choice leading to a change in menus. Staff told us that they felt consulted. A development plan had not yet been made available for people in the service or relatives to know how the home would be developing. A short term plan was provided by the manager to CQC on 16/12/09. The need to provide a full plan for the homes development was discussed with him and he agreed to address it. We required regulation 26 reports to be sent to us after a random inspection in August 2009. In those received, we noted that progress in the home has been monitored in relation to the improvement plan we had also required from the service. The manager demonstrated that he has been auditing aspects of the service although some areas are still in need of further work such as staff training, recruitment recording, and health and safety. However, there are systems in place to monitor the reviews of care plans and risk assessments and entries on the forms and records viewed showed that this had begun. A monitoring form for staff supervision is also being completed and some medication practises are being monitored. Records showed that staff training is being audited and staff appraisals were planned for January 2010. A review of the homes fire risk assessment was also reported to be underway. We checked a sample of records held for people who have money held for them in the home and noted that these were accurate. The manager was advised to record management checks of entries which he agreed to do. Care Homes for Older People Page 26 of 32 Evidence: We considered aspects of health and safety and were told in the AQAA that checks of systems and appliances were regular. We sampled the records in for this and these had been completed except for a Legionella check and adequate records of monitoring hot water temperatures in the home. The manager agreed to follow these matters up. Fire checks are taking place a fire risk assessment was completed in September 2009 and a fire audit was to take place by the fire authority on the day after our inspection. Fire training had taken place in March 2009 and had been included in induction but the record was needed for one person. Staff are being trained in health and safety related issues as identified in the staffing section. A matter regarding infection control is to be addressed as detailed in the environment section of this report. Care Homes for Older People Page 27 of 32 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 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that a detailed system for monitoring care plans and risk assessments is regularly followed. This is to ensure that monitoring is ongoing and effective in ensuring that needs are met. 12/03/2010 2 9 13 The registered person must ensure that a system of reviewing individual staff competence in medication practises is more detailed and carried out regularly . This is to ensure that staff medication practises are accurate and people living in the home receive their medication correctly. 24/02/2010 3 15 17 The registered person should ensure that records of the food provided are in sufficient detail to demonstrate that the diet is 24/02/2010 Care Homes for Older People Page 29 of 32 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 satisfactory in relation to nutrition and special diets. This is to ensure that individual needs are met. 4 26 13 The registered person must ensure that periodic monitoring of infection control procedures are in place to ensure that risks of cross-infection are minimised. This is to ensure the safety of people living in the home. 5 30 14 The registered person must 24/03/2010 ensure that there is a rolling programme of staff training which is kept under review and includes meeting more specific and individual needs of current residents. This is to ensure that individual needs are met. 6 33 24 The registered person must ensure that the quality assurance system is broad enough to ensure that peoples needs are consistently met. This is to ensure that monitoring systems are in place to identify action required to maintain standards of care provided. 12/03/2010 24/02/2010 Care Homes for Older People Page 30 of 32 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 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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