Inspection on 04/06/09 for Glengariff Residential Home

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

Glengariff Residential Home 18/06/08

Glengariff Residential Home 05/06/07

Glengariff Residential Home 06/06/06

Glengariff Residential Home 02/02/06

Glengariff Residential Home 17/03/05

Glengariff Residential Home 24/11/04

Glengariff Residential Home 10/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Glengariff Residential Home 45 Freeland Road Clacton On Sea Essex CO15 1LX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Bushell     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Glengariff Residential Home 45 Freeland Road Clacton On Sea Essex CO15 1LX 01255220397 01255220880 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Glengariff Company Limited care home 55 Number of places (if applicable): Under 65 Over 65 15 55 dementia old age, not falling within any other category Additional conditions: 0 0 Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 15 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 55 persons) The total number of service users accommodated in the home must not exceed 55 persons Date of last inspection Brief description of the care home Glengariff is a care home for older people accommodating a maximum of 56 service users. The property is a three-storey converted hotel close to the town centre and seafront. The upper floors are accessed via a passenger lift. Most bedrooms are single occupancy and all have en-suite facilities. There is a choice of communal areas and a large garden at the rear of the building. Care Homes for Older People Page 4 of 36 Brief description of the care home The home provides written information about the service to prospective service users. Inspection reports are displayed on notice boards and in the managers office. 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 focus of the inspections undertaken by the Care Quality is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 18th June 2008. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. Care Homes for Older People Page 6 of 36 We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors to the service. The visit took place between 9:00am and 17:00pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the manager. Fees for this home, at the time of the inspection, ranged from £365.00 - £460.00 per week. Hairdressing, chiropody, personal items and outings are an additional cost. What the care home does well: What has improved since the last inspection? The recruitment of staff follows robust procedures where a full range of information is gathered about them prior to the individual commencing employment. The service is completing an ongoing re decoration plan. A number of new carpets have been replaced in bedrooms and bedrooms repainted. The service has erected a large gazebo in the garden with chairs available for all to sit. Care Homes for Older People Page 8 of 36 There is a new kitchenette area in the willow view room over looking the garden for relatives and individuals to access, with support as required. A new stable efficient management team is in now post and has the right skills and abilities to move the service forward as required. 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 set out 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people wishing to use the service can be assured that their basic care and support needs will be assessed. However shortfalls in recording may mean that some areas are not explored in great detail. Evidence: The admission of new people to the service aims to involve the individual as much as possible. The AQAA tells us that pre admission assessments, where possible, we try to involve both the resident and family to gain as much information as possible. The service has sufficient policies and procedures regarding assessment of need and moving into the service. Part of the inspection process involved case tracking two people. Case tracking is a method used to review a persons care package and reviews the person from the assessment stage to the current stage in their lives, including assessments, care Care Homes for Older People Page 11 of 36 Evidence: planning, risk management and health issues. Where possible the people case tracked are also visited to gain their views directly. Indirect and direct observations also occurred in order to establish if the care being provided was as per the care plan. Two people were case tracked as part of this inspection process. The assessment process sets out each separate area of need and how the service is able to meet the needs of the individual. The service also has internal documents in place to ensure that each of the records are completed to a standardised approach, ensuring that the full needs of the person are accurately recorded. Of the two people case tracked one of the pre assessments formats was completed well. The other was found to have a number of minor gaps identified. For example there was no photo of the individual, identifying them to staff, the form titled records to be kept in respect of each service user was also blank. The pre admission assessment does explore some areas off difference and diversity and identifies the persons preferred name, religion, age, ethnic group and wishes in the event of death or a terminal illness. The form also explores marital status but does not prompt or identify civil ceremony and partnerships. This was brought to the attention of the manager and the deputy manager, who agreed they would be reviewing this document and exploring other methods of addressing cultural needs and diversity issues. The manager and the deputy manager at the service are new to post and have recently been reviewing the internal systems and have been pro active in identifying areas within the service where minor shortfalls have been found. The new management team are suitably skilled to improve areas of assessment and relevant documentation and spoke during the inspection of their intensions. The service consults the assessment information to see if they can meet the prospective individual needs before they make the decision to accept the application for admission and offer a place. For most of the individuals the service has received copies of the summary and care plans from the assessments carried out through care management arrangements. For individuals who are self funding the service is able to demonstrate how they have undertaken the assessment. They are generally undertaken satisfactorily. Staff have the necessary specialist skills and ability to care for individuals who are admitted, although a number areas of training need have been identified. Individuals are provided with a statement of terms and conditions or a contract before admission to the service. It gives basic information on what people who live in the home can expect to receive for the fee they pay, and sets out terms and conditions of occupancy. The contract is normally reviewed when the persons circumstances change. Care Homes for Older People Page 12 of 36 Evidence: The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service users guide, which provides basic information about the service and the specialist care the home offers. The guide is made available to individuals in a standard format. These documents, although available upon request were not on display within the service. Discussions occurred with the new management team about how to improve information availability for all. The Statement of Purpose, although reviewed in December 2008, still contains some out dated information in relation the contact details for the Care Quality Commission. Discussions with a persons relative identified that they had been provided with information about the service prior to moving in and also had an opportunity to visit and ask questions about the service. They had participated in an assessment of their needs and felt that the service had sought to understand them before they agreed to the admission. One relative commented I have been coming here now for over a year, its very clean and very nice. We were told everything we needed to know and had all the information we needed, if I ever needed to know anything I would ask the manager as they are very approachable. The service does not provide intermediate care. Care Homes for Older People Page 13 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. People using the service can not be assured that their full care and support needs will be met due to lack of detailed care planning, risk assessments and reviewing systems. Evidence: The care plans of two people living at the service were read to determine how the service supports the needs identified in the persons initial assessments. All the plans seen were completed and followed a format that provided information about the persons abilities and how staff should support these. The care planning format followed the information obtained during the assessment process. Each area of need was identified in a separate care planning tool and covered items such as a safe environment, eating and drinking, personal hygiene, elimination, dressing, communication, mobility, sociability, oral / mouth care and foot care. Each of the care plans detail the identified need for the individual person followed by the individuals need and outcomes for delivery of the care and support. Each of the care plans seen, followed the same format, however varied in how informative the information was as in some instances a more general instruction was given. Examples of this include Care Homes for Older People Page 14 of 36 Evidence: under the section on eating and drinking the care plan stated occasional swallowing difficulties / unable to manage solids and unable to chew properly. Whilst the care plan then went onto explore the specific needs of the person it did not refer to any associated risk assessments with regards to the management of possible choking for this individual. Additional examples include under the care planning section relating to a safe environment the care plan details that the needs of the individual requires the person to be turned two hourly and how this is achieved. However the care pan did not refer the staff member or the reader to the manual handling risk assessment. This information would help staff to understand how the persons abilities can best be supported to promote their independence and develop an understanding of them as an individual. One person using the service commented Its lovely here, I have fun with the friends I have made. The staff are always really kind to us. Additional examples were observed with reference to a care plan regarding continence management of an individual. The need was identified as needs to be physically taken to the toilet. The inspector discussed this with the managers of the service and a care worker on duty throughout the inspection, who confirmed that the person is now bed fast as is not transferred to the toilet any more. Whilst one of the care plans reviewed was last reviewed on the 20th May 2009 the other care plan had not been reviewed since March 2009. This was brought to the attention of the new management team. Following discussions with the management team it was determined that they have highlighted the shortfalls of the service, however both of these people have only been confirmed in post since the beginning of May 2009 and there has physically not been the opportunity to implement new initiatives, monitoring and ideas. It was established that the manager and the deputy do have the skills and abilities to correct these issues as identified and implement suitable management systems to rectify these shortfalls. A relative at the service during the day of the inspection commented I can come and see X when ever we want. I stay quite along time. the care staff are very caring and really help X eat and drink. In addition this a person using the service commented the staff are very good and my favourite is always lovely. They come and go but they certainly do all they can. The care practices observed throughout the day were respectful and caring at all times. It was pleasing to find that the care plans, although at times laking in detail did focus on the specific needs of the person. It was observed that one care plan detailed the true preferences of a person and stated appears to relax if Rose based / scented products are used. Care Homes for Older People Page 15 of 36 Evidence: Overall the plans do give instruction to staff in meeting the majority of peoples needs, and from observation and discussions with people living at the home and the staff group there was evidence of knowledge of the individuals and their needs. However if the information in care plans was more detailed and responded to all the information staff demonstrated that they knew about the person, it would provide an increased level of consistency in the delivery of the staff support and improve the outcomes of people living at the service. The files also contained risk assessments relating to the moving and handling needs of people living at the service. These gave an indication of the persons strengths and weaknesses that affect the outcome of their movements. The conclusion of these are incorporated into the mobility element of the persons care plan and inform staff in the safe way to support someone when moving them around the home. There were no risk assessments in place for other issues raised in initial assessments or daily records. These included falls assessments, nutritional screening, weighing individuals, choking and allegations. Risk assessments identify and support the service in determining a proportionate response to risks presented in peoples daily living whilst recognising their rights to live their life in as independent a way as possible. Without the process of risk assessment the service is unable to ensure these rights and protection of an individual are supported. Discussions occurred with the new management team regarding internal processes for the completion and implementation of appropriate risk assessments for all people. The service maintains some records that monitor peoples health and wellbeing such as regular checks on their weight and fluid intake. This provides tools that give indications of changes in the persons wellbeing which may require action by the service. The service uses a number of recognised tools to identifying deterioration in a person specific health area, which in turn alerts the service to other possible health issues associated with the deterioration. However during the inspection it was noted that these were not being consistently reviewed. Visits made by medical professionals such as GPs or District Nurses were maintained on peoples files, and included the reason and outcome of the visit. Changes made as a result of these visits to the individuals support or medication were transferred to their care plan and medication records. This helps staff understand how the persons changing medical needs are to be met. The management of medication administration was reviewed as part of this inspection visit. This included the indirect observation of staff administering the lunchtime round, checks on documentation and discussions with staff. Care Homes for Older People Page 16 of 36 Evidence: A number of areas were highlighted during the inspection conducted on the medication systems with the new manager. Whilst in general, a sound system is in place its was the services ability to deploy the systems, which failed and identified shortfalls. The shortfalls included none of the current medication being appropriately booked into the Medication Administration Record (MAR). This would therefore make it difficult to review the stock balance and complete internal audits on the processes and management of medication by the manager and the staff team. The bottles and boxs that were in use did not have a date of opening on them, no temperatures were taken where medication was being stored, there was no sample signature sheet of the staff in place and where a code was needed to be entered onto the MAR this was missing and therefore did not give clear information as to the reasons for omission of medication. In addition to this it was identified that a number of medication was prescribed showing as required, however, there were no additional guidelines in place for staff, as to what circumstances the person is to receive the medication. Care staff are the people applying peoples creams as prescribed but the MAR did not show that this had been administered as the staff had not signed. The manager discussed a new system where by care staff are to sign a sheet upon administration and then this can be transferred to the MAR for record purposes. The manager referred to an internal audit system that was previously in place, however this had not been completed recently. There was one occasion identified where a drug being stored as a controlled drug was being administered as prescribed but due to an error of the MAR the instructions were different from those detailed. This was checked and confirmed to be accurate and the person had been receiving the correct dosage however the records had been incorrectly completed. This was discussed and brought to the attention of the manager who took immediate action to rectify. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The variety of activity and social stimulation available at the service could be further improved ensuring that the needs, wishes and preferences of the people using the service are acted upon and implemented. Evidence: Generally staff are aware of the need to support people to develop their skills, including social, emotional, communication, and independent living skills. Some people are consulted or listened to regarding the choice of daily activity, but this process could be improved. The service currently provides a total of thirty eight hours activity provision per week spread over a Monday to Friday period. The hours are covered by two activity workers who work part time on separate days, except for a Wednesday where they work together to review the programme and meet. People using the service are given the opportunity to take part in a number of activities both within the service. Where possible, staff gather information on community-based events and try to make individual arrangements for people to attend. However due to the number of people residing at the service, the frequency of community base trips is minimal. The service has a standardised activity programme Care Homes for Older People Page 18 of 36 Evidence: with general activities available split between the morning and afternoon session. The service benefits from a separate large activity space, linked with the garden and newly refurbished kitchen facilities available. During the inspection this area was not accessed at all by either staff or the individuals. When the inspector asked if people are able to access this area the staff member stated yes, but only with staff as they may fall or slip. There was an activity notice board with the schedule of activity on an A4 size piece of paper. There was no date or time or location of the activity and appeared to be tokenistic. This was raised with the new management team who discussed improvements they are aiming to introduce with regards to activities. A person using the service commented I dont know who the activity person is, but the staff are very kind. A further person added the other day some one came to do movement to music and I really enjoyed it, I wish we could do that more. The service has a basic understanding of human rights and how this impacts on people using the service. There is little documentary evidence to support this approach, but staff were directly observed to be respecting and dignifying personal choices and opinions. The service does not document on the person care file restrictions that are imposed upon the person. The initial assessments held on the persons care plan detailed some references to a persons life style and interest, although this is sometimes not fully completed. The plan also details a section where information is obtained regarding the persons family, working life and what the individual enjoys. It was not apparent that the activity schedule had been completed with the specific interest of the people using the service at all times. There were care plans relating to the social needs of people there were not specific details of how the assessed needs and abilities of people shaped their choices and how staff should support these. Care plans contained an activity sheet used by staff to record the activities which people had participated in. The records although completed were at times rather sparse. Discussions occurred with the new management team regarding this. The manager commented that this was more than likely due to the staff not accurately completing the record, rather than the provision of activity not occurring. The manager reported that there was not a specific budget in place for activities, however she had confidence in the proprietors willingness to give financial support to any activity project. The AQAA detailed that over the next twelve months its aims to hold more regular meetings with both residents and relatives and possibly set up an Care Homes for Older People Page 19 of 36 Evidence: in house committee with both residents, relatives, activity organisers and carers. The AQAA also identifies that they could improve by involving care staff more in activities as some feel this is not their area. Activities are under review at present. To improve what is already offered. Visitors spoken with during the visit said they were made to feel very comfortable during their visit and were welcomed at any reasonable time. During the inspection the inspector spent some time in each of the communal lounge areas observing from a distant. On one occasion in a small lounge where seven women were sitting relaxing was a radio station not suitable to their individual age or preferences. This was brought to the attention of the manager. People who live at the home said that they felt they were given opportunities to exercise choices during their day. One person spoke about how they enjoyed spending time in their room and actively chose not to take part in activities provided or outings. They felt that this was respected although staff never forgot to offer the opportunity to take part. One person using the service commented we like it here really, when the man comes to sing to us, hes such a good singer. The staff are so caring they really are. Another person spoke about the choice of meals and felt confident that if they chose something else from the offered menu this would be not be a problem, they said the foods not bad, I like shepherds pie and there is always two choices. . The menu is planned in advance and people are asked for their choice for the following days meals. The menu includes at least two choices at each meal and provides a nutritious and balanced diet. The inspector sampled the food during the inspection and found it to be well presented and tasty. The observation of the lunchtime meal indicated that there was generally a congenial atmosphere where people were given time to eat in a relaxed manner. The staff moved around the dining room serving the meal, encouraging people to eat and offering assistance if required. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust systems, polices and procedures are in place in order to ensure that the people who use the service are supported and protected. Evidence: The service has an open culture that allows people to express their views and concerns in a safe and understanding environment. Individuals and others involved with the service say that they are happy with the service provided, feel safe and well supported by an organisation which has their protection and safety as a priority. One relative commented that I have no complaints at all, if I did I would always report any problems to the manager. The service has a complaints procedure that is clearly written and easy to understand. The procedure is available to in the the Statement of Purpose and is on display in the foyer of the building. However the procedure is out of date and requires the revised contact details of the Care Quality Commission to be added. The AQAA tells us that the service has received five complaints in the last twelve months and it reports that eighty percent of these have been managed within a twenty eight day period. Individuals and others involved with the service understand how to make a complaint and are clear about what will happen if a complaint is made. The service keeps a full record of complaints and this includes details of the investigation and any actions Care Homes for Older People Page 21 of 36 Evidence: taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The manager has responded in the AQAA that the service learns from complaints made and the AQAA has detailed that documentation in regards to concerns and complaints has improved, the use of manual handling equipment and staffs use of personal protective equipment and general awareness has improved. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. The service did not have a copy of the Local Authority policy and procedure relating to the safeguarding of people. There is a clear system for staff to report concerns about colleagues and managers. Staff confirmed that they are aware of how to report bad practice and one staff member stated I feel confident in talking to the manager about anything that I think is not right or bad practice. I have only be here four weeks and I have started my induction, it makes you take a step back , think and evaluate what you are doing, its very interesting. The home understands the procedures for safeguarding adults and will always attend meetings or provide information to external agencies when requested. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. The outcomes from any referral are managed well and issues resolved to the satisfaction of all involved. Training of staff in safeguarding is regularly arranged by the service and the manager reported on the day of the inspection that a further training session on safeguarding adults is scheduled. The Commission monitors the outcomes of safeguarding referrals and considers how the findings of any investigation indicate the services compliance with the Care Homes Regulations 2001. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to relax and be cared for in an environment suitable to meet their communal and individual needs. Evidence: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The environment provides specialist aids and equipment to meet their needs. The home is a pleasant, homely, safe place to live and the bedrooms and communal rooms meet the NMS or are larger. All bedrooms that were seen, were very personalised to the individuals own taste. All the services fixtures and fittings meet the needs of individuals and can be changed if their needs change. One person using the service commented I am very pleased with my room, its quite spacious. In addition to this one person commented I enjoy going to my nice room. Most bedroom doors have the name of the person on a plaque, however the service does support a number of people with Dementia. No additional memory aids were being used at the service. The lay out of the service attempts to encourage people to socialise and engage in small clusters rather than all in one area. The service has many different seating areas available with books and music available to all. The design of the building allows people to move freely throughout with a lift available to move between floors. The Care Homes for Older People Page 23 of 36 Evidence: environment promotes the privacy, dignity and autonomy of people. This was directly observed during the inspection, where people where seen to be supported to their rooms for personal care and support tasks. Staff were also seen to knock an wait on bedroom and bathroom doors. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The service also has an additional wing available for staff, relatives and the people that use the service to use. This area has a newly fitted kitchenette where drinks and soft drinks can be accessed. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and are in sufficient numbers and of good quality. The service is well lit, clean and tidy and smells fresh. The management has a good infection control policy. They seek advice from external specialists, such as NHS infection control staff, and encourage their own staff to work to the services policy to reduce the risk of infection. Discussions occurred with a member of staff working in the laundry. The member of staff confirmed the completion of an Infection Control course and discussed the management of soiled laundry. Gloves and aprons were being used and were visible throughout the building with easy access at all times. A relative commented Its always clean and tidy here. The AQAA tells us that improvements have been made to the garden with large patio area and covered gazebo, new chairs and decoration carried out to both the main and first floor lounges. New kitchen area within willow view room for residents and relatives. Some rooms have had new carpets. Discussion with the maintenance person determined that redecoration is ongoing and within the year he anticipates the entire building to have undergone some redecoration. Care Homes for Older People Page 24 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. People who use the service are supported by a workforce that have received basic training to meet their needs, however additional training will ensure that the changing needs, risks and rights of the person are greatly empowered in the persons best interest. Evidence: People are generally satisfied that the care they receive to meet their needs. One person using the service stated I like the staff. The manager confirmed that there are eight care staff working throughout the day with four people covering the waking night duties. In addition to this the manager is supernumerary, with the deputy manager having some supernumerary shifts available to support the manager in her role. In addition, there are catering, housekeeping and activities staff on duty in the waking day. The manager stated that the numbers of staff required are arrived at by a calculation of individuals needs, discussions with staff about how they work with people living at the service and an allowance of time for the tasks to be undertaken. The rota was also arranged to provide increased staffing levels for the periods where Care Homes for Older People Page 25 of 36 Evidence: people living at the home require the most support from staff such as early in the morning when people wanted to get up and late in the day when people wanted to go to bed. The recruitment records of the four staff contained documents that supported the employment of people who were suitable to work with vulnerable adults. This included full application forms, references, proof of their identify and CRB checks. In each case the staff had commenced their employment with a POVA first request while the full CRB report was waited for. Discussions with staff verified that they undertook a robust recruitment process and were asked to provide supporting documents before they were offered a post. One staff member commented I was working as an extra carer when I started for two weeks, I was very impressed with this two week induction. I am also completing the skills for care induction programme. The training programme included items such as health and safety, food hygiene, fire safety and manual handling as having being completed so far this year. Further scheduled training included dementia care, medication, infection control and safeguarding. Staff spoken with said they had enjoyed the training they participated in and felt that there was plenty of training on offer. The AQAA tells us that all the senior staff have undertaken National Vocational Qualification (NVQ) level III. It also adds that staff are undertaking dementia care, infection control and nutrition distant learning. Currently there is no provision for training in care planning and risk assessment. However the AQAA tells us that the service is planning to improve and provide this training to staff. There are enough qualified, competent and experienced staff to meet the health and welfare of people using the service. Staffing rotas take into account the needs and routines of the people using the service. The manager is aware that there are some gaps in the training programme and plans to deal with this. The service has not provided training in the Mental Capacity Act or Deprivation of Liberty and Safeguards. All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. There is acceptable use of any agency or temporary staff which doesnt adversely affect the quality of the individual care and support that residents receive. The manager stated that the service is currently completing a large recruitment drive to fill Care Homes for Older People Page 26 of 36 Evidence: vacant positions. Care Homes for Older People Page 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a safe, well managed and maintained service, that enables people to live in a safe environment, However extra measures must be implemented to ensure that people can evacuate the service as required. Evidence: The manager and the deputy manager were only confirmed in their new roles in May 2009. Both have obtained or are in the process of obtaining suitable qualifications relevant to the role. Time was spent with both the manager and the deputy manager, they are aware of and work to the basic processes set out in the NMS. The managers are aware of the need to keep up to date with practice and continuously develop their management skills. The service focuses on the individual, takes a basic account of equality and diversity issues, and works in partnership with families or close friends, as appropriate, and professionals. The service has a Statement of Purpose that sets out the aims and Care Homes for Older People Page 28 of 36 Evidence: objectives of the service. The management team have already identified a number of shortfalls within the service and has shown a pro active approach to its review and implementation. The management team discussed the ways it will be improving and developing systems that monitors practice and compliance with the care plans, policies and procedures of the service. Whilst there is significant improvements required to be made by the service, it is felt that once the new management team are stable within their roles that the development of the service will continue with supportive, motivational leadership offered by the new managers. Staff spoken with during the inspection spoke highly of the manager and the new deputy manager. They said they felt supported by the management team and knew that they could speak to them at any time. This was endorsed by the people who live at the service, who said that they thought the service was well run and that they knew they could speak to the manager or deputy manager at any time. The manager reported that the consistent provision of staff supervision had not yet been achieved although all staff were going through their annual appraisal at the time of the inspection. The manager was aware of the shortfall and although all the staff have taken part in supervision training the consistent application of carrying out the sessions had proved difficult to fit into work arrangements. There have been arrangements made to set up a spread of line management supervision responsibilities across the senior staff in each area of the service and the service needs to consider how it will support these staff to monitor and meet their supervision programme. The service does manage some peoples monies on their behalf. The system in place for management of monies includes individual finance sheets detailing all withdrawals and deposits of monies and the reasons for the action. The record includes receipts for monies that are spent and the staff countersigns the withdrawal. The cash is kept in individually named plastic wallets, in the services safe only accessible by the manager, the deputy and the administrator. This provides a robust and safe account of peoples monies. The service has a quality assurance system in operation that consists of the consultation of people who live at the home and their families through the distribution of surveys at the end of the calendar year. The manager reported that they are awaiting a return of all the surveys in order for feedback and analysis to occur. Discussions occurred with the management team regarding the quality assurance system place and how they intend to report the findings back to the people that use the service and their families, friends or representatives. Care Homes for Older People Page 29 of 36 Evidence: The service held certificates in relation to the safe operation and maintenance of equipment according their legislative responsibilities. The certificates that demonstrated this were considered at this inspection and included electrical installation, gas safety soundness test, lift maintenance, moving and handling hoists, water regulations, portable appliance testing, fire extinguishers and emergency lights and fire alarms. Further discussions with the maintenance person confirmed completion of all required tasks. The service carries out monthly visual check of the fire safety systems and there was a fire risk assessment in place. The records included the monitoring of staff attendance at fire drills. It was observed that the service does not currently provide any equipment aids to support people in zone evacuation or total evacuation of the building. This was discussed at length with the manager and the maintenance person who agreed to review the risk assessment and the process used. Care Homes for Older People Page 30 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 31 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 1 3 14 Assessments must be fully completed and provide detailed information holistically to meet all needs of the person. To ensure that the service is able to meet all needs. 31/08/2009 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 13 Risk management processes 31/07/2009 and identification must be in place. To ensure that all people using the service have suitable and relevant risk assessments in place where a need has been identified. 2 7 13 Risk assessments for the control and management of choking must be implimneted where a need has been identified. To ensure that the welfare of the person using the service is maintained at all times. 30/06/2009 Care Homes for Older People Page 32 of 36 3 7 15 All care plans and screening tools must be reviewed monthly. To ensure that the changing needs of the people using the service are identified and care practices reviewed to meet the persons needs. 31/08/2009 4 7 15 completed care pans must be in place addressing all needs of all individuals. To ensure that the full care and supports needs of a person can be met. 31/08/2009 5 9 13 Temperatures must be taken 31/07/2009 and recorded where medication is being stored. To ensure that all medicines are being stored within environmental conditions as specified by the manufacturer. 6 9 13 All medication must be administered as per the prescription details. To ensure that people are supported to take their medication correctly. 31/07/2009 7 12 16 An activity programme to meet the choices and preferences of the people using the service must be in place. To ensure that the social needs of people are acknowledged and activities implemented to meet that need. 31/08/2009 Care Homes for Older People Page 33 of 36 8 14 16 People using the service must be consulted about their choices of activities and a meaningful provision made. To ensure that the social needs of the people using the service are being met. 31/08/2009 9 18 12 The service must obtain a copy of the Local Authority agreement and protocol for safeguarding. To ensure that the people using the service are protected from abuse. 10/07/2009 10 36 18 Staff must receive recorded 17/07/2009 supervision at least six times per year. To ensure that staff are suitably supported and supervised. 11 38 13 The service must review their fire safety risk assessment. ensuring that measures are identified to remove people to a place of safety in a phased or partial evacuation of the service. ensuring that measures are identified to remove people to a place of safety in a phased or partial evacuation of the service. 31/08/2009 12 38 13 Fire safety equipment must be in place to support people is a phased or full evacuation from the building. 31/08/2009 Care Homes for Older People Page 34 of 36 To ensure that the people using the service are appropriately supported to evacuate the service as required. 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 2 3 4 5 6 7 1 3 7 9 9 9 9 The information available to people using the service should be on display and up to date. The assessment should further explore an individuals cultural and diversity needs. People who use the service and or their representatives should consent to their care plans. All bottles and boxs should have the date of opening added to them. All medication should be booked and and stock checked appropriatly. A sample signature sheet should be in place. An appropriate code should be used on the Medication Administration Record when medication has not been administered as per the prescribers instructions. Where medication has been applied by care staff a system for checking and recording should be in place. Music and radio stations chosen should reflect the peoples choices who reside at the service. The complaints procedure should be reviewed in the Statement of Purpose and the complaints procedure. The service should consider having memory boxs and memorabilia within the service to meet the needs of those people with dementia. 8 9 10 11 9 12 16 23 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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