Inspection on 25/11/09 for Hadrian House

This inspection was carried out on 25th November 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hadrian House 09/01/08

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

Key inspection report Care homes for older people Name: Address: Hadrian House Garden Street Blaydon on Tyne Gateshead Tyne and Wear NE21 4AG     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: Alan Baxter     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Hadrian House Garden Street Blaydon on Tyne Gateshead Tyne and Wear NE21 4AG 01914143330 01914143332 hadrian.house@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross OPCO Ltd care home 63 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 63 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling wtihin any other category - Code OP, maximum number of places: 43 Dementia, over 65 years of age - Code DE(E), maximum number of places: 20 Date of last inspection Brief description of the care home Hadrian House is a modern, purpose built care home that is situated in the Blaydon area of Gateshead. The home is registered to provide care for up to 63 older people, including 20 places for people who have dementia. The home can provide personal care but cannot provide nursing care. Bedrooms and communal facilities are situated over 4 floors. The 1st floor is an 8 Care Homes for Older People Page 4 of 32 Over 65 20 43 0 0 Brief description of the care home bedded residential unit, the second floor can accommodate up to 20 people with dementia, the 3rd and 4th floors offer 19 and 16 residential places respectively. All bedrooms have en suite toilet and shower facilities. Throughout the home there are six lounges and four dining rooms. A lift is provided to take people to each floor of the home and an emergency call bell system is fitted in all bedrooms and communal areas. The entrance has level access and the well laid out garden has a paved walkway that residents may use. There is a car park to the side of the building offering parking facilities for visitors to the home. The home is situated close to a number of local facilities and amenities such as shops, GP surgeries, Health Centres and pubs and the public transport system runs nearby. It is owned and operated by Southern Cross. A Service User Guide has been developed and this informs residents and other interested parties about the services the home offers and a copy of the most recent inspection report is available to read. Fees charged by the home range from £432 - £541:20 Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is an overview of what the inspector found during this inspection. The quality rating for this service is 1 star. This means that people using this service experience adequate quality outcomes. Before the visit we looked at information we have received since the last key inspection on the 9th January 2008. We looked at how the the service has handled any complaints or concerns since the last visit, and whether there have been any changes to how the service is run. We looked at the providers view of how well they care for people, and also the views of people who use the service, their families or representatives, and of the staff. An unannounced visit was made to the home on the 25th November 2009 by two inspectors. The total inspector hours for this inspection was 17 hours. During the visit Care Homes for Older People Page 6 of 32 we talked with the people who live in the home, the staff, the deputy manager and several senior representatives of the company, and visitors. The manager was away on a training course on this day, and was unable to give her response to the issues raised. We looked at information about the people who use the service and how well their needs are met. We looked at other information that must be kept. We checked that staff have the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to see if it was safe, clean and comfortable. We checked what improvements have been made since the last inspection. We told the deputy manager what we found (the registered manager was unavailable for this inspection). Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: All identified needs are to be covered by a relevant care plan, including personal care issues such as denture and hearing aid care. Care Homes for Older People Page 8 of 32 The failure to ensure that the home is always fully staffed means that people living in the home do not always get the degree of personal attention that the staff like and wish to give them, and may have lead to poor practices such as getting the majority of residents up well before breakfast, and not providing them with hot drinks. Menu choices should be ascertained at meal times wherever possible. Complaints are not being fully recorded, nor always responded to appropriately. Staff need to be given training in a number of areas, including the safeguarding of vulnerable people, fire safety and the care of people with Dementia. The management ethos of the home needs to be improved and made more inclusive. Supervision and appraisal should be at the frequency advised. Some aspects of health and safety management need to be improved. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 10 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. Assessment information is clear and provides sufficient information to ensure that people are only admitted to the home when it is clear it can meet their needs. Evidence: The home conducts a wide range of appropriate assessments of need before a person is accepted as a new resident. In addition to an assessment of physical and social needs, the home carries out assessments of risk, dependency, nutrition, continence, falls, skin integrity and manual handling needs. There was also evidence of the home referring a service user on for more specialist assessment, such physiotherapy, where necessary. There is a review of each persons needs at least every six months after admission. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social and health needs of the people living in the home are well understood and are met using detailed care plans. They are treated with respect and their dignity protected. Evidence: Care plans had been drawn up for most, but not all, of the needs identified in the various assessments. The companys assessment documents usually specify the level of assessed need that should trigger a care plan, but this was not always happening in practice (one service users pressure sore assessment indicated the need for staff input, but no care plan had been drawn up). Other omissions were the failure to describe several peoples denture, spectacle and hearing aid care, and the lack of social and spiritual care plans for some people. Nevertheless, care plans were generally drawn up in good detail, and showed that staff have a good knowledge of the people they care for. Care plans were also sensitive and demonstrated an person-centred approach by staff. Care Homes for Older People Page 12 of 32 Evidence: Draft care plans are drawn up before admission, to make sure that the basics of care are in place when a person comes into the home, and this gives staff time to get to know the person before the ongoing care plans are put into practice. There was some evidence that care plans are updated in the light of new information or changes of need. Where there are significant changes, there was evidence that at least some care plans are completely re-drawn to reflect this. Care plans are evaluated regularly, but the detail of the evaluation varied between key workers, and some needed to be better focused (for example, one evaluation noted that a person had gained weight, but failed to say how much, and whether it was significant). Some evaluations were more overviews of the care given, rather than a robust examination of whether the care plan was working, or whether changes were needed. Staff who returned surveys said that they are given up to date information about the people they care for. A comprehensive range of health assessments was in place, and most needs identified had been met with a care plan. There was evidence of appropriate re-referral to specialists such as the falls team, where necessary. Good records are kept of when a person has had input or attention from any health professional, and the daily information records record health or medical issues in good detail. Service users are asked to sign their consent for flu jabs, etc. Assessments of oral health needs are now in place. There was evidence of improvements to the health of various people living in the home, including appropriate weight gain and improved skin integrity. There is a seperate drugs trolley on each floor of the home, and a seperate storage space for each. The Medication Administration Record (MAR) contains a list of staff trained and authorised to administer medicines, and photographs of residents to guard against drugs being given to the wrong person. There were no gaps in the MAR. The deputy manager said that seniors check regularly Care Homes for Older People Page 13 of 32 Evidence: and follow up any omissions. The people living in the home said that they are treated with respect by the staff at all times. This was observed during the inspection. Bedroom doors are kept open only at the residents request. The home has two in-house dignity champions. 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. Individual lifestyle and preferences are generally considered and people continue to be part of their local community, with good opportunities to take part in group and individual activities. However, routines in the home are not always flexible and may mean that staff prioritise completing tasks before individual choice. Evidence: A total of 37 of the people living in the home were up at 7:15am when this inspection started. Care plans did show that some people do choose to get up early or have disturbed sleep patterns that mean they get up early. However, such large numbers (almost two thirds of the total number of residents) indicate that this is routine practice, rather than individual preference or person-centred care. Those people who were up early did not get offered a drink until breakfast was served over an hour later. The home has an activities organiser in post. She displays great imagination and huge energy and commitment in providing a wide range of social stimulation. In-house, there is a wide range of activities on offer to residents, including crafts, games, film shows, quizzes, beer making, reminiscence and pampering sessions, and seasonal activities such as Christmas card making. Care Homes for Older People Page 15 of 32 Evidence: There are a number of clubs, including a ladies club, a club for the gentlemen, a gardening club and a take away meal club. There is a residents social committee, that directly influences the way social activities are provided (for example, the committee asked for the organiser to go to each floor in turn, rather than all the residents gathering on one floor for an activity). There are regular trips out to places of general and, on request, of personal interest. Recent trips include Beamish Museum and regular trips to watch Newcastle United at St James Park. The residents also have a big input into their environment within the home, and have worked with the activity organiser to develop a shop, staffed by residents; a bar area, with a range of soft and other drinks available; a Magpie corner for Newcastle United fans; and an indoor gardening area. There is a visiting entertainer every month. The home has pleasant gardens, and has plans to develop the grounds further, hopefully with the help of local schoolchildren, as the home is keen to foster relationships with local schools. The organiser keeps clear records of all the activities within the home, including who has joined in and what the response was. Although she works on weekdays, only, she leaves equipment out for staff to use for activities over the weekends. Visitors are welcomed at all reasonable times. Staff will accompany residents out of the home, but this is not always possible, due to staffing levels. Similarly, there seems to be a general commitment amongst the staff to promoting residents autonomy and choice in their daily lives, but again, staffing levels hamper this ethos. Nutritional assessments are carried out on admission to the home. The kitchen was well stocked with fresh and canned foods, fresh fruit, frozen and fresh meat and vegetables, and there was evidence of home baking of scones, buns, cakes and Christmas cake. Menus are prepared using the Nutmeg menu planning system on a three monthly Care Homes for Older People Page 16 of 32 Evidence: cycle. Residents are asked to make their menu choices a week in advance. This creates difficulties for people who have memory problems, who may well have forgotten what they ordered over such a prolonged period of time. Staff said that residents didnt get regular fresh fruit, but the cook advised that this was available in the kitchen. Communication channels should be looked at. Residents were seen to enjoy a cooked breakfast in the morning, and the meal was relaxed and unhurried. The main meal, taken at lunch time, consisted of stewed steak or quiche with broccoli, carrots and potatoes. Meals were taken with residents in two of the homes dining rooms. Tables were pleasantly set, with tablecloths, condiments, a flower in a vase, and paper napkins. Hot and cold drinks were offered with the meal. The tea meal was home made lentil soup, a choice of sandwiches, macaroni cheese and home made drop scones. Trolleys of drinks were taken around mid-morning and mid-afternoon, but there did not appear to be any jugs of water or juice available in lounges for residents to help themselves. Residents confirmed that they have monthly meetings with the manager and the chef, and that their comments are acted upon. They said that they get good portions at mealtimes, and that they can have seconds on request. 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. While complaints handling and organisation should improve, safeguarding procedures are clearly understood and referred appropriately to protect people from risk of harm. Evidence: The complaints folder was not well organised and it was difficult to see how or whether complaints had been well handled. The home had stated, in its Annual Quality Assurance Assessment (AQAA), that it had received 12 complaints in the past year. However, the complaints folder recorded only 3 complaints, suggesting that the recording systems are poor and are not reflective of the overall volume of complaints received. Outcomes were not being recorded and any lessons learnt from complaints received do not appear to be considered, recorded or fed back into the Quality Assurance system. However, as the AQAA states that none of the 12 complaints were upheld by the home, it is questioned whether the management is seriously looking to learn from complaints. After this inspection, the manager wrote to say that all the complaints were in a file along with the relevant correspondence, and that a complaints register is kept which records in brief each complaint received. These had not been made available on the day of inspection. Complaints are not always signed and dated. Care Homes for Older People Page 18 of 32 Evidence: Looking at the managers written responses to complaints, they were open to different interpretation. A more measured and less defensive tone is advised, especially as two relatives have seperately contacted the Commission in the past year, with concerns that their complaints to the home had not been responded to properly by the management. Only 18 of the current staff group have received safeguarding/protection from abuse training in the past year, and 21 staff (nearly half the total staff group, and including staff who have worked at the home for up to seven years) have never been given this training. This must be speedily addressed. However, where concerns have been identified, appropriate safeguarding referals had been made, and the deputy manager demonstrated a good knowledge both of the companys internal procedures and those of Gateshead Safeguarding team. 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 who live in the home enjoy a safe, well-maintained, warm, clean and comfortable environment. Evidence: The home is a four storey design, built into a hill, and allowing access from the street at three different levels. Residents have good view of whats happening in the local community. There are good links with the local primary school, with visits both ways. As noted above, great imagination has been used to make the interior of the home interesting and stimulating to the people who live there, and they are actively encouraged to have an input into the homes activities. There is a garden, which residents can safely access and sit in, and there are plans to improve this feature in the coming year. Residents are encouraged to personalise their bedrooms. Several people who live in the home commented on the good quality of the domestic staff, and said that the home is kept very clean at all times. There were no odours in Care Homes for Older People Page 20 of 32 Evidence: the home. Domestic staff obviously work very hard to keep the home clean and fresh. The manager has contacted South Tyneside PCT to arrange more infection control training for staff. 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. Staffing levels are good overall but sickness is not always covered and this could impact negatively on care delivery for people using the service. Staff training needs are not being fully addressed. Evidence: The normal staffing levels for the home are 9 carers between 8am and 8pm, and 6 carers at night. Staff sickness over recent months has been high, and the rota showed that on a number of occasions, the number of care staff has dropped to as low as 5 during the day and 5 at night. This has been where staff who were sick or on holiday had not been replaced. The manager needs to be more proactive about covering staff holiday and sickness absences. Agency or relief staff must be provided, if necessary to maintain minimum staffing levels. The manager must also advise the Commission when the home is being run under-staffed. The concern is that having less than the minimum staff on duty will impact on the ability of the home to meet the care needs of the people living there, especially with regard to their degree of choice and control over their daily living routines. The fact that 35 of the 57 people in the home were up, dressed and sitting in the lounges at 7:15 in the morning does not usually indicate that this is the personal choice of all. Nor had they been given hot drinks whilst they waited a considerable time for their breakfast. Care Homes for Older People Page 22 of 32 Evidence: Several staff commented, in surveys, about how well staff support each other, and that they work well as a team. However, they also said that there was only sometimes enough staff to meet the individual needs of the people in the home, and that they needed more stafff. A visiting professional commented that the staff always seem busy and overworked, and suggested that more staff should be provided. Another professional said that staffing levels are insufficient at peak times of the day. Staff said that they frequently had to work through their breaks, in order to provide the necessary care, but that the company still deducts their break times from their wages. A relative said that the staff are caring and dedicated. Staff recruitment records were generally completed in good detail, and the processes covered all the necessary elements to protect the people in the home. Staff surveys confirmed that they had had the appropriate checks carried out before they were employed, and said that their induction training covered what they needed to know about their jobs. Twenty staff have achieved at least level 2 at National Vocational Qualification level 2 in care; another 7 staff are currently studying for this award. nine staff hold level 3. The training matrix showed that , although all staff have taken part in a fire drill in recent months at least 14 had not had certificated fire safety training. Also, the regularity of internal refresher fire safety training was not being specified or met. The manager is advised to consult with the local fire service regarding this important issue. There were gaps in other areas of mandatory training, also, including moving and handling, food awareness, infection control, health and safety, and COSHH. Only ten members of staff (22 ) have been given Dementia Awareness training. Staff commented that it seems harder to get training since all training was taken inhouse. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management approach of the home is failing to create an open, positive and inclusive atmosphere, and cannot fully demonstrate that the home is run in the best interests of the speople living in the home. Evidence: The registered manager holds the Diploma in the Management of Care Services, the Registered Manager Award, and is a member of M.C.M.I. She has undertaken the Yesterday, today and tomorrow Dementia care training. Surveys received from staff, relatives and visiting professionals identified a range of concerns about the management of the home. Staff surveys identified a perceived lack of support of care staff from the manager. They also identified a failure to always deal with issues in an appropriate and professional manner, and some issues of breaches of confidentiality. Care Homes for Older People Page 24 of 32 Evidence: Professional visitors surveys highlighted a managerial style prone to be dictatorial, to be unable to motivate staff, and not to always deliver on promises made. Relatives surveys and other feedback from relatives questioned the effectiveness of the manager, identified a failure to deal properly with complaints, and indicated that some relationships with relatives were strained to the point of breakdown. The manager was away on a training course on the day of this inspection and was not available to give her response to these issues. There is a nine-part quality management system in place, that meets BS EN ISO 9001:2000. There is a weekly managers surgery. Seven visits to the home under Regulation 26 of the Care Homes Regulations were recorded in the past 12 months. They are well-recorded reports that show the visits are taken seriously. Details of discussions with residents and staff are recorded, omissions in the care records identified, and environmental issues addressed. However, there does not appear to be a record of any remedial work carried out. A free advocacy service is advertised on the notice board. One person had had a Deprivation of Liberty assessment. The proper procedures had been used and an appropriate referral made for assessment. The home is subject to the Personalized Quality Standards framework for residential and nursing care in Gateshead. Service users money is properly accounted for with a new computerised system recently installed. There is quarterly external audit. Staff supervision records show that six sessions per year are planned. However, the homes policy is that up to two of these sessions can be used as full team supervision sessions. This needs to be in addition to, rather than replace, the formal individual supervision of staff. Supervision sessions are recorded in reasonable detail. There was evidence of annual appraisal for some, but not all, staff. There is a comprehensive health and safety quality manual in place. This includes a six-monthly health and safety audit, health and safety procedures, risk assessments, and emergency contingency plan (blank). Care Homes for Older People Page 25 of 32 Evidence: No health and safety training has been given to the large majority of staff. The homes maintenance and servicing records were up to date. The fire log book does not show that staff are receiving regular in-house fire safety instruction. The manager was advised to contact the local fire service to agree the necessary frequency. The accident log has a format that does not allow for detailed recordings. There is a monthly audit. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 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 needs of people who require help with dentures, spectacles, hearing aids and other sensory aids must be clearly met in their personal care plan. This is to make sure that staff do not neglect these important areas of personal care. 31/12/2009 2 14 14 The home must demonstrate 31/12/2009 that each person living in the home has the opportunity of exercising their choice in relation to the routines of daily living by consulting them (and, where appropriate, their representatives) regarding their preferred times of rising and retiring; keeping this information on their personal file and regularly evaluating whether this choice is being is being respected. Page 28 of 32 Care Homes for Older People 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 This is to make sure that personal choice is being respected. 3 15 16 Fresh fruit must be prepared 31/12/2009 and offered to residents on a daily basis. This is to make sure that residents health needs are being met. 4 16 22 All complaints and concerns 31/12/2009 expressed to the manager or staff must be fully recorded, with details of any investigations, outcomes, and degree of satisfaction of the complainant clearly set out. Any lessons learnt from such complaints or concerns must be considered, recorded and fed back into the quality assurance system. This is to improve the overall quality of the service being delivered. 5 18 13 All staff must be given 31/01/2010 training in the homes internal safeguarding policy and procedures, and those of the relevant local authority. 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 This is to improve the level of protection gien to the people living in the home. 6 27 18 The registered manager 31/12/2009 must inform the Commission should the home ever be staffed at lower than the minimum staffing levels. This is to make sure that the Commission is able to respond promptly to the situation. 7 27 18 A robust system must be introduced to ensure that all staff sickness and holiday absences are covered. This is to make sure that the care of the people living in the home does not suffer through a reduction in the number of staff available to meet their needs. 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 31/12/2009 1 7 Care plans should be robustly evaluated to ensure that the plans are achieving or working towards the stated goals, or whether the plan needs to amended. Residents should be asked their meal preferences as close as possible to the meal in question, and sufficient quantities provided for individuals to change their minds and request 2 15 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations the alternative meal. 3 4 5 15 15 16 Jugs of water and juice should be available in the lounges for residents to help themselves. Where a person chooses to rise early they should be offered a hot drink before breakfast. Complaints files should be better organised, with a clear index, and seperation into seperate years and into current and archived sections. Complaints and concerns should be treated as opportunities to improve the service being given and, as such, a more measured and less defensive tone is advised in writen responses to complainants. All staff should receive training in the care of people suffering from Dementia. All care staff should be given formal individual supervision at least six times each year, in addition to any group supervision sessions held. The registered manager should consult with the local fire service regarding the required frequency of in-house fire safety instruction to staff. 6 16 7 8 30 36 9 38 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. 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