Inspection on 28/01/10 for Greensleeves

This inspection was carried out on 28th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greensleeves 17/03/10

Greensleeves 07/07/09

Greensleeves 08/07/08

Greensleeves 02/05/06

Greensleeves 28/09/05

Greensleeves 24/06/05

Greensleeves 28/09/04

Greensleeves 19/04/04

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

Key inspection report Care homes for older people Name: Address: Greensleeves 19 Perryfield Road Southgate Crawley West Sussex RH11 8AA     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: Edward McLeod     Date: 2 8 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: Greensleeves 19 Perryfield Road Southgate Crawley West Sussex RH11 8AA 01293511394 01293513680 greensleeves19@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Jean Thompson Kennedy Gisbey care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users that can be accomodated is 41. The registered person may provide the following category/ies 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 categories: Dementia (DE) Date of last inspection Brief description of the care home Greensleeves is a care home providing accommodation and personal care for up to forty one older people who suffer from dementia. The owner is Mrs Jean Gisbey, and there was not a manager registered for the service at the time of our visit. The home is situated in a residential area of Crawley, being close to the town centre, local amenities and transport links. Greensleeves consists of two linked houses and a large purpose built extension. There are two units, and each unit has a sitting room and dining area. Bedrooms are on the ground and first floors, with a lift serving most rooms on the first floor. There is off-road parking for staff and visitors. Fees range from GBP 439.25 per week to GBP 585 per week. Care Homes for Older People Page 4 of 32 Over 65 0 0 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 inspection visit was arranged to assess compliance with previous requirements made, and to make an assessment of compliance with the key national minimum standards for care homes for older people. In preparing for the visit we looked at all the information that we have received or asked for since the last key inspection or annual service review. This included: - The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. Care Homes for Older People Page 5 of 32 - Surveys returned to us by people using the service and from other people with an interest in the service. - What the service has told us about things that have happened in the service. These are called notifications and are a legal requirement. - The previous key inspection. - Relevant information from other organisations and what other people have told us about the service. The site visit was attended by a regulatory inspector and a pharmacist inspector, and was conducted over a period of six and a half hours on the 28th January 2010. During our visit we spoke with the manager Mrs Gisbey, with five people living in the home and six members of staff. We sampled care and support records for four people living in the home. We sampled recruitment and training records for three staff working in the home. Other records sampled included records relating to pre-admission assessments, staff supervision, complaints, and health and safety. We visited the main communal areas of the home, and five bedrooms. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? 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 7 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 8 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. 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. Evidence: We looked at two sets of assessments carried out on peoples needs before they were admitted to Greensleeves. We found that these were assessing the support the person would need, including social and communication support. We spoke with a member of care staff who is involved in carrying out pre-admission visits and assessments, who told us when doing pre-admission assessments we look at mobility, ability and behaviour and assess if the home can meet their needs. The home does not provide intermediate care. Intermediate care is defined as dedicated accomodation which is provided together with specialised facilities, Care Homes for Older People Page 9 of 32 Evidence: equipment and staff to deliver short term intensive rehabilitation and enable service users to return home. Care Homes for Older People Page 10 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. Peoples health, personal and social care needs are not always being met. The plan of care is not always setting out in detail the action which needs to be taken by care staff to ensure that all aspects of health and social care needs of the service user are met. The home is not always supporting people with managing their medicine in a safe way. Evidence: We sampled the care plans and records for four people living in the home. We found that there have been improvements to how care plans are recorded, and each person living in the home has a copy of their care plan in their bedroom. Records sampled indicated that care plans are being reviewed at least monthly. We talked with staff about how individual people wished their care to be provided, and what staff had learned about how best they could support a person with dementia. Care Homes for Older People Page 11 of 32 Evidence: Staff told us that, for example, one person who is deaf responds well to care being provided if staff speak into one ear quite loudly and explain to her what they are doing. This helpful information was not recorded on the care plan. For one person living in the home, a number of incidents of aggressive and violent behaviour had been recorded. A member of staff we spoke to said that when she tells the person that what shes doing is wrong, that will often calm her down. The member of staff noted that not all the staff take this approach, and that for example some less experienced staff do not know how to manage a resident who is becoming abusive. Information in the care plans should include the particular strategies agreed for managing a persons needs and behaviour, to assist staff in providing a consistent approach to caring for the person and therefore improve the care provided. The care records for another person note that they are prone to breakdown of skin in groin due to urine and lack of washing. The records note a number of recent occasions when the person was not moved from a wet bed and had wet clothes or pads changed because they were not co-operative. A requirement has been made concerning the need for care plans to include advice to staff which will help provide more consistent care for individuals living in the home. The AQAA advises us that key workers are reviewing care plans at least monthly. The eight people living in the home who sent written responses to our Care Quality Commission survey form told us that they always or usually receive the care and support they need and that staff always or usually listen to them and act on what they say. Four relatives of people living in the home returned questionnaires to us. They told us that the believe the home is always or usually meeting the persons needs, and that peoples diverse needs are being met. We received survey forms from eight people living in the home and four relatives of people living in the home who all indicated that they believed the persons healthcare needs were being addressed in the home. Healthcare records which we looked at indicated that people were being assisted to access the healthcare they were in need of. Care Homes for Older People Page 12 of 32 Evidence: At our previous visit a requirement was made that the registered person ensure that arrangements for the recording, handling, safekeeping and disposal of medicines received in the home are safe. This visit was attended by a CQC pharmacist inspector who found shortfalls including incomplete medication records and some medicines being out of stock. We found that there were some gaps in recording on the Medicine Administration Record [MAR] chart when there should some initials. On checking the medicines stock for two people whose MAR charts had not been completed on a particular date and time we found the medicine dosage to be missing. We were unable to assess whether this medicine was given to the resident or not. We found that some medication that had been prescribed and supplied for external use had not been recorded on the MAR chart. We found that some of the medication prescribed for three people living in the home had not been obtained before the stock had run out, and therefore had not been available for administering to them. It is the homes responsibility to ensure supplies of regularly prescribed medicine are ordered in a timely manner so that there is continuity of prescribed treatment. We found that the cupboard used to store controlled drugs was not compliant with the 1973 Misuse of Drugs (safe custody) regulations. The previous requirement concerning safe medication administration was found not to have been met. An additional requirement concerning the need for controlled medicine storage to comply with current regulations was made. There was evidence that peoples dignity and privacy are being respected. For example, one person living in the home told us in their survey form that residents are treated as individuals and not just as elderly ladies. Also a relative of a person living in the home wrote to us that the standard of the care is quite good and I get the impression mum is being treated fairly by the staff there. The care records for one person we sampled however indicates that arrangements for their continence care were not always best ensuring their dignity. Care Homes for Older People Page 13 of 32 Evidence: Care Homes for Older People Page 14 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. Each person is treated as an individual, and they are a 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. They have nutritious and attractive meals and snacks at a time and place to suit them. Evidence: At our previous visit a requirement was made that the registered person consult service users about the programme of activities arranged by the care home and provide facilities for recreation having regard to the needs of service users. At this visit we found that that equipment such as hoops, bean bags, mats and arts and crafts materials have been obtained, and photographs of people taking part in activities such as quizzes, dancing, arts and crafts and special events were displayed around the home. On the day of our visit staff were doing exercises in the main lounge with a group of 5 Care Homes for Older People Page 15 of 32 Evidence: residents, which was followed by some dancing to music. Staff told us that recent activities had included baking cakes, making Christmas hats and cards and dressing the Christmas tree. A member of staff told us that they have found that using play dough helps people with stiff hands or arthritis. We were told by staff that local 6th form students visit twice a week, which on the last occasion gave two of the residents an opportunity to talk about holidays they had been on. Recent events celebrated in the home have included Remembrance Sunday, Burns Night, and there was a Christmas party. The home has begun sending a newsletter to families to let people know whats going on and events that have happened. We asked staff what entertainment people enjoyed, and staff said people especially like singing along to old songs and the entertainers who visit. One person said to us that she liked singing and a little dance. We found that the activities taking place were the kind of things people wanted and had asked for. We found that the previous requirement concerning activities had been met. Staff were also taking time for one to one time with people - for example one member of staff was observed reading a postcard to the person that they had just received. Survey form feedback from relatives indicated that they feel welcomed when they visit the home. On the day of our visit the lunch served was loin pork chops, gravy with vegetables and mashed potato, followed by rice pudding. Staff told us one person sometimes has lunch in their bedroom, but had come to the dining room today. People who needed help with cutting food or other help were receiving this. The lunch was unhurried and atmosphere was calm. We discussed options provided with the cook who said that alternatives such as eggs, toast, or sausages could be provided. The cook told us that one person doesnt like beef so chicken is prepared for them instead. Peoples likes and dislikes and specialist diets are listed on a board in the kitchen which the cook refers to. Care Homes for Older People Page 16 of 32 Evidence: Two people we talked to said they had very much enjoyed lunch. Seven of the eight people living in the home who responded to our survey questionnaire told us they always or usually like the meals. One relative wrote to us that my mother is especially complementary about the variety and taste of food provided. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. There is more that the care home could be doing to ensure that people are always being safeguarded from abuse and neglect. Evidence: The AQAA advises us that there is now a monthly accident and falls audit. The eight people living in the home who responded to our questionnaire told us they had someone they could speak to if they had a concern or complaint. At our visit we looked at the record of complaints. No complaints have been recorded since our previous visit. Relatives who responded to our survey questionnaire told us that the service responds appropriately if they or the person living in the home have raised concerns. At our visit we sampled the homes policy and proceedures for whistleblowing, restraint, and what action would be taken in the event of a safeguarding incident. Care records we sampled indicated that a number of incidents in which staff have to Care Homes for Older People Page 18 of 32 Evidence: deal with aggressive or violent behaviour have occurred. One member of staff we spoke to told us that less experienced members of staff sometimes do not have the skills to manage these kinds of incidents. We discussed this with the deputy care manager, who acknowledged that training for staff had not been recently provided in dealing with aggressive behaviour. A requirement concerning this has been included in the Staffing section of this report. Mrs Gisbey advised us that as one of the offices was being rearranged, a copy of the local safeguarding procedures couldnt be located on the day of our visit. Mrs Gisbey advised she would ensure a new copy was obtained. We discussed with Mrs Gisbey and the deputy care manager that a West Sussex County Council safeguarding conference on 14/5/09 had found that the service had failed to notify them of a safeguarding incident and had dealt with the incident as an employment issue instead. Mrs Gisbey and the deputy care manager advised us that since then staff had been provided with a training session on raising alerts by West Sussex County Council. It was not evidenced at our visit that staff left in charge of the home undertake training or briefings which the local authority provides to ensure managers know their role in reporting safeguarding incidents and contributing to safeguarding investigations. Mrs Gisbey and the deputy care manager advised us that they are taking appropriate action when safeguarding incidents occur or allegations are made. For example, a disciplinary process with two members of staff concerning the recording of a safeguarding incident was carried out. At the time of our visit there were safeguarding investigations which had not yet been completed. Subsequent to the visit we attended a West Sussex safeguarding case conference on the 3rd February 2010 at which we were advised that all substantial safeguarding allegations received had been found to be not substantiated. 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 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. Evidence: We are told in the AQAA that improvements to the premises have included the upgrading of the fire panel and new flooring in some bedrooms. We found that the home is being maintained to a good standard, and arrangements are in place for repairs to be carried out if needed. The garden and exterior areas are being well maintained. There are two main communal areas in the home, which are arranged so that small groups of people who enjoy spending time with each other can get together. We visited five bedrooms and found them to be homely, clean and tidy. Furnishings and decoration were of a good standard. People had personalised their rooms by Care Homes for Older People Page 20 of 32 Evidence: puting up photographs or pictures and bringing in some of their possessions or items of furniture. The eight people living in the home who completed our questionnaire told us that the home is always or usually fresh and clean. One person living in the home told us in their CQC survey that their bedroom was always lovely and clean. 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 have safe and appropriate support as there are enough competent staff on duty at all times. Staff recruitment arrangements are not ensuring that staff are safe to work with people living in the home because the required references and checks are not always being obtained before staff commence work in the home. Not all staff have received the training and support they need to ensure that they can meet the needs of people living in the home. Evidence: On the day of our visit it was our observation there sufficient staff available to meet the needs of the people living in the home. Two staff working in the home responded to our questionnaire. They told us that there are usually enough staff on duty to meet peoples needs. Their comments included I am happy with the home and love my job and that they look after and care for the residents on a high level. A member of staff we spoke to told us that staffing levels have been improved in that more staff are on duty at busier times, for example during mornings. Care Homes for Older People Page 22 of 32 Evidence: We are told in the AQAA that the home has 21 full time carers, 12 of whom have obtained at least level 2 of the National Vocational Qualification (NVQ) in care. On the day of our visit an assessor for the NVQ qualification was visiting the home, and advised us that two staff would be completing NVQ in care at level 4 on that day. The AQAA tells us that all staff employed in the home in the past 12 months have undergone the required recruitment checks before starting. At our visit we sampled the recruitment records for three members of staff who had commenced work in the home in September 2009. We found that required checks and references had not been in place for any of them before they commenced work. Where this had happened, there was not a written record to advise what steps were taken to ensure that the person did not work unsupervised with any person living in the home. Some of the checks and references referred to had been obtained a number of days or weeks after the person had commenced working in the home. A requirement concerning the need for recruitment checks has been made. We discussed the induction training undertaken by new staff with the deputy care manager. She said that the staff induction training was not fully being completed by the previous manager, and that this they were beginnning to do. We looked at the induction training records for two care staff who had commenced work in the past four months, and found that these were being fully recorded and checked by senior staff. We spoke with a member of care staff who told us they had supported one of the new members of staff through their induction and common induction standards, and this was evidenced by records seen. The carer said that the new member of staff also had meetings at agreed times with the manager to monitor their induction and induction training. We are told in the AQAA that 22 staff have undertaken control of infection training, 2 Care Homes for Older People Page 23 of 32 Evidence: staff have undertaken malnutrition care training, and 2 catering staff and 3 care staff have completed food hygiene training. This indicates that some staff who are not up to date in their food hygiene training may at times be preparing and handling food which is served to people living in the home. It also indicates that some of the staff caring for people in the home for whom nutritional intake needs to be monitored have not received this training. The deputy care manager advised us that an Environmental Health Department inspection in November 2009 had identified that the food hygiene training being provided was not of a high enough standard. The deputy care manager said that providing new training in food hygiene was one of the homes present training priorities. Mrs Gisbey advised that she had asked for an independent review of all training being provided for staff to ensure training provided is of the necessary standard. Care records we sampled indicated that there have been a number of recent incidents in which people suffering from dementia living in the home have been aggressive or violent. A member of care staff we spoke to told us some girls dont understand how dementia works. They get frightened when people become aggressive. We discussed this with Mrs Gisbey and the deputy care manager, who acknowledge that there has been no recent training provided for staff in dealing with aggression. The care manager said they believed there was a need for more staff to undertake training in dementia, care planning, and food hygiene. We looked at the training record for one experienced member of staff, and found that there was no record of them having undertaken recent training in required topics such as safeguarding, health and safety, and food hygiene. There was also not a record of them having recently completed training in dementia or managing aggressive behaviour. The deputy care manager advised us that no training in dementia had been recently provided, but that 5 senior staff would be doing dementia training. She said that no training had taken place in dealing with aggression but that this is something they would like to do in the future. A requirement has been made concerning staff training. 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. People have confidence in the care home because it is led and managed appropriately. The environment is safe for people and staff because appropriate health and safety practices are carried out. Evidence: The manager registered for the service resigned in September 2009, since when the owner Mrs Gisbey and the deputy care manager have been in day to day charge of the service. At the time of our visit there was not a manager registered for the service, and a requirement has been made concerning this. The relative of one person living in the home wrote to us that they seem far more approachable and warmer in their approach to both residents and visitors than the previous management. My mother also seems calmer and more settled now. Care Homes for Older People Page 25 of 32 Evidence: Mrs Gisbey said to us that staff are getting more support, more leadership. Residents (are) happier, (more) smiley faces. Relatives tell us things have improved and the house is relaxed, friendlier. Feel they can approach us. The management of the service has therefore gone though a period of difficulty and change, and there is now a need for consistent management of the service to be established and embedded in good practice. During our visit we found the atmosphere in the home to be good, and staff told us that they appreciated that the new management team were more hands on and this was having a positive effect on staff and residents. During our visit the manager and staff provided examples of suggestions made by people living in the home or their relatives which have been acted upon. This indicates that the home is listening to the views of others on the service provided and implementing changes accordingly. At our previous visit a requirement was made that the registered person ensure that people working in the care home are appropriately supervised and that for the duration of a new workers induction training a member of staff who is appropriately qualified and experienced is appointed to supervise the new worker. As indicated in the Staffing section of the report, there was evidence that structured induction and induction training is now in place in the home. Asked about sit-down staff supervision a member of staff told us that this wasnt really taking place but that staff can approach (the manager and deputy manager) at any time. We asked to look at the supervision records for the three staff employed in the home in the past six months whose recruitment records we had sampled. Mrs Gisbey advised us that no supervision records were available for those members of staff. Mrs Gisbey told us she had not been able to locate records for supervision undertaken in the time of the previous manager who resigned in September 2009. The previous requirement concerning the provision of staff supervision was found not to have been met. As indicated in the Staffing section of the report, not all staff are up to date with Health and Safety related training such as food hygiene and health and safety. A Care Homes for Older People Page 26 of 32 Evidence: requirement concerning this was made in the Staffing section of this report. We are advised in the AQAA of the most recent services and checks which have been undertaken on equipment in the home. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 36 18 The registered person shall 19/10/2009 ensure that persons working in the care home are appropriately supervised. There are not arrangements in place for staff to formally and regularly sit down with a senior member of staff or manager to talk about all aspects of practice, the philosophy of care in the home, and their career development needs. This formal supervision should aim to assist staff in meeting the needs of the people receiving care and support. 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 provider must ensure that the service users health, personal and social care needs are set out in an individual plan of care which sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the persons care are met. The complex needs of people living in the home are not being satisfactorily addressed in the individuals plan of care. 30/04/2010 2 9 13 The provider must ensure that arrangements for the recording, handling, safekeeping and disposal of medicines received in the home are safe. We found some medication records to be incomplete and some medicines prescribed were not in stock. 30/04/2010 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 3 9 13 The provider must provide a 30/04/2010 controlled drugs cupboard to store controlled drugs. The cupboard must comply with the Misuse of Drugs [safe custody] 1973. To comply with the law. 4 29 19 The registered person shall 30/04/2010 not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2, Care Homes Regulations 2001. The home is failing to protect people living in the home by commencing staff before the required checks and references have been obtained. 5 30 18 The registered person shall 30/04/2010 ensure that people employed to work at the care home receive training appropriate to the work they are to perform. Not all staff have received all the training they require to provide safe and appropriate care - for example training in safeguarding, dementia Care Homes for Older People Page 30 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 care, managing aggression, and food hygiene. 6 31 8 The registered provider shall 30/04/2010 appoint an individual to manage the care home. There is not a manager registered to manage the service at present. 7 36 18 The registered person shall 30/04/2010 ensure that persons working in the care home are appropriately supervised. We found a lack of recorded evidence that staff are receiving the recommended levels of supervision to support them in providing good care to people living in the home. 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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