Inspection on 20/04/09 for Hafod Residential Home

This inspection was carried out on 20th April 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hafod Residential Home 08/10/09

Hafod Residential Home 30/04/08

Hafod Residential Home 03/05/07

Hafod Residential Home 19/09/06

Hafod Residential Home 23/01/06

Hafod Residential Home 27/09/05

Hafod Residential Home 01/03/05

Hafod Residential Home 28/09/04

Hafod Residential Home 24/02/04

Hafod Residential Home 16/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hafod Residential Home Hafod Care Organisation 14 Anchorage Road Sutton Coldfield West Midlands B74 2PR     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: Donna Ahern     Date: 2 0 0 4 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 31 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 31 Information about the care home Name of care home: Address: Hafod Residential Home 14 Anchorage Road Hafod Care Organisation Sutton Coldfield West Midlands B74 2PR 01213556639 01213555688 hafodltd@aol.com 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) : Mr Alan Pearce care home 16 Number of places (if applicable): Under 65 Over 65 16 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 16 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 within any other category (OP) 16 Date of last inspection Brief description of the care home Hafod Residential Home is registered to provide personal care for sixteen people aged 65 years and above for reasons of old age. The Home does not provide nursing care and does not have a category to care for people with dementia. The Home does not accommodate people who require the use of wheelchairs and hoisting equipment is not available for general use. Accommodation is provided in a large adapted Victorian building situated at the junction of Anchorage Road approximately one mile from the centre of Sutton Coldfield. There are good bus links from Birmingham and Lichfield. There are 14 Care Homes for Older People Page 4 of 31 Brief description of the care home bedrooms, two of which are shared rooms however the Home utilises these as single rooms, and the majority have en-suite facilities. Bedrooms are located on the ground and first floors and a passenger lift gives access to these areas. Communal areas are available on both floors, these were spacious, attractive, well appointed and in keeping with the age of the property. A conservatory leads off the dining room looking out on to a well-maintained garden. Assisted bathing facilities are located on each floor offering a choice of bath or shower facilities and staff are available to provide assistance in these areas as required. There is limited off road parking at the front of the premises. There are notice boards located throughout the Home displaying forthcoming events and other information of interest to people who live there and their visitors in a large print format. A copy of our report was available on entering the home. Information relating to the services and facilities provided was available in individual bedrooms. Fee levels for the Home range from five hundred and forty five pounds to six hundred and eighty five pounds per week. Additional charges are made for hairdressing or chiropody. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is ONE star. This means the people who use this service experience ADEQUATE quality outcomes. One inspector carried out this inspection over one day; the home did not know we were going to visit. There were 9 people living at the Home on the day of the visit. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Care Homes for Older People Page 6 of 31 Three peoples care was case tracked and one file was partly reviewed. Case tracking involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and health and safety records were reviewed. We spoke to five people living in the Home and Four staff were spoken to and observed performing their duties. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think they are doing well and where they need to improve. It also gives us some numerical information about staff and people living at the home. We also looked at notifications received from the home. These are reports about things that have happened in the home that the Home must tell us about. No immediate requirements were made at the time of this visit. This means that there was nothing urgent that needed to be done to make sure people stayed safe and well. What the care home does well: What has improved since the last inspection? What they could do better: The pre-assessment assessments should contain sufficient information so that the Home and the person know their needs can be met. Care plans must provide sufficient and consistent information so that staff can assist people to meet all of their individual needs. Health care needs must be planned for, so people can be confident that their needs are met. The management of risks to people must be improved so people are supported to be safe. Staff must have the training they need to do their job and support people safely. Care Homes for Older People Page 8 of 31 Staff must be trained in fire safety awareness so they know how to protect people from the risk of fire. 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 31 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 31 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. People have sufficient information to enable them to make an informed decision about whether they would like to live at the home. Arrangements in place for Pre admission assessments do not fully ensure that people know their needs can be met prior to moving in. Evidence: The Home provides long term care or respite care. The service user guide was available in the entrance of the Home and in peoples bedrooms and had been updated since our last visit. It now contains details of fees and facilities so people living in the home or prospective residents have all the information they need. The certificate of registration and public liability insurance were on display in the reception area of the home, which enables anyone to view these when visiting. A copy of the previous inspection report is available in reception for anyone to read if they Care Homes for Older People Page 11 of 31 Evidence: choose to. Pre admission assessments are undertaken prior to people coming to live at the home. We looked at two assessments that had been completed recently. The Home has a standard form that is completed by the manager. Information recorded was basic. The form was incomplete in parts with section such as professionals involved left blank. One persons age had not been recorded. When we cross-referenced information with the person care plan we found that some of the information contradicted what was recorded. For one of the people it said wears hearing aids their care plan said they have one hearing aid. A comprehensive pre assessment must be in place, which ensures that people are confident that their individual assessed needs can be met upon admission to the home. The Home does not formally write to people following assessment advising them if the Home could meet their needs, which would provide people with confidence that their needs could be met. People who would like to come and live at the home and their relatives are able to visit the home. This means that people have the opportunity to sample what it would be like to live at the home, helping them to make an informed decision. One person who had lived at the home for a few months told us I am happy here. Care Homes for Older People Page 12 of 31 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. Care plans do not reflect the care required in all cases and this could result in people not receiving the care they need which may result in harm. Evidence: Each person had a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order that their needs are met. We looked at two peoples care files in detail and two files were partly reviewed. A new care plan format has been introduced since our last visit. Care plans seen provided staff with basic information about how to meet people needs. There were inconsistencies in information across documentation including pre- assessments, assessment summaries and individual care plans. This could result in needs not being planned for and met. Care plans we looked at did not provide enough information for staff to fully understand how to meet peoples needs. A care plan for personal care stated support with personal hygiene needs but gave no details about how these Care Homes for Older People Page 13 of 31 Evidence: needs would be met or how people should be supported to maintain their independence. One person had a visual impairment, another person had osteoporosis and heart problems but there were no plans in place to address these problems and so ensure that the persons needs would be fully met. We looked at peoples risk assessments and saw that these are in place for areas considered to be a risk such as fire and accessing the community. However through talking to people and looking at peoples care plans we saw that other risks had been identified such as mobility difficulties and these needed assessments in place to ensure people are supported in a safe way to maintain their independence. A risk assessment for a person accessing the community needed some further information so that the wheelchair in use is used safely and in accordance with the assessed needs of individuals. We looked at pressure sore prevention and saw that assessments had been completed. However when we checked the risk ratings calculated to assess the level of risk to the person, they did not reflect what had been recorded. The person was identified as high risk but no care plan was in place for this, which could place the person at risk of harm. Healthcare professionals including General Practitioners, social workers, chiropodists, physiotherapists visit the home to give advice for individual people as required. On the day of the visit we saw that a person who was unwell promptly received the attention of a visit from the doctor. Nutritional intake charts were kept and peoples weight is closely monitored so health needs can be monitored and responded to. We looked at the outcome of visits and interventions from professionals. It was not always easy to track this information, as it was not consistently recorded. Good record keeping must be maintained so peoples health is maintained to an optimum. People appeared to be well supported by staff to choose clothing appropriate for the time of year, which reflected individual cultural, gender and personal preferences. We saw that people were supported with personal care in a timely manner so peoples dignity was maintained. The hairdresser had visited on the morning of the inspection and several people had their hair done thus promoting peoples self esteem. People told us Staff are very good Staff are kind and look after us well We spoke to four staff who told us how peoples care needs are met and they demonstrated a good understanding of the people they care for. Although staff were busy whilst on duty interactions between staff and people living in the home were friendly caring and respectful. Care Homes for Older People Page 14 of 31 Evidence: The management of medication was reviewed and people had identity photographs to minimise the risk of a drug error. Photocopies of prescriptions are kept and this enables staff to check that the correct drug has been received into the home as prescribed. Controlled Drugs were appropriately stored and recorded. We saw some gaps on the Medication Administration Records (MAR) but the medication had been administered. We also saw for one person codes had not been entered when the person was on leave so we were unable to accurately audit their medication to ensure it had been given as prescribed. We saw that not all staff responsible for the administration of medication had received training in safe practice. When we checked staff files we couldnt see evidence that the carers competence to safely administer medication had been formally tested and recorded. There is a hands free telephone available in the home for people to use and people can have their own telephone line installed at an additional cost so that they can make and receive calls in private. Bedrooms are provided with locks on doors and lockable facilities so enhancing the arrangements for privacy. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to exercise choice regarding the activities they participate in which promotes their individuality and independence. People are offered a choice of meals, which meet any dietary or cultural needs and preferences. Evidence: The home has just appointed a dedicated activities coordinator who will work part time and this should ensure that regular in house activities are available. We were told that bingo; games, skittles and a Wii console are all available for people to use. Occasional trips out are arranged and these usually take place following discussions with people. A music and movement session takes place monthly by a visiting therapist. Each summer a holiday is planned to a hotel in Weston. This year four people will be going on the holiday, which will take place in May. A trolley shop is organised so people can make small purchases such as birthday cards to send to friends and relatives. Opportunities for worship of all faiths could be arranged and monthly church services are held so people can continue with their chosen religion. Care Homes for Older People Page 16 of 31 Evidence: The home has an open visiting policy, which means that people can maintain the relationships that are important to them. People were seen to freely access their bedroom and communal areas. The Home provides a really good choice of space and rooms for people to use. On the first floor there is a spacious lounge with lovely original features providing a comfortable relaxing room for people to enjoy. One of the people told us she loves to sit in the first floor lounge after breakfast and relax before joining people downstairs. Three main meals are provided each day and breakfast is prepared and served in the home. Lunch and evening meals are prepared at the organisations nursing home, which is near by and transported in heated trolleys. There is a four-week rotating menu with a choice of meals, which are ordered on a weekly basis. The menus reflected a choice of nutritious food that reflected the cultural preferences of people living in the home. Special diets could be catered for reasons of health, religion or taste and alternatives to the main meal options were available. Alcoholic beverages and cordial were available to accompany meals. Mealtime was calm, and music was played in the background. Staff were observed to be respectful, interacting with people to offer choice. The menu board indicated there was a choice of roast lamb or a mushroom pasta dish. We joined people for lunch and the meal was very nice. People told us: The food is nice I enjoy the meals. Care Homes for Older People Page 17 of 31 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. The complaints procedure is comprehensive and is accessible to people should they need to make a complaint. Arrangements are in place so people should be safeguarded from harm. Evidence: The complaints procedure is displayed in the home and is included in the statement of purpose and service user guide so that people know how to make a complaint if they need to. The home had received two complaints since our last visit. We saw the paper work relating to these, which explained how the concerns about care practice, had been investigated. The one complaint was still ongoing. The complaints had not been documented in the complaints log. Complaints should be documented clearly in the complaints log with details of the nature of the complaint, who had dealt with it, the date resolved and the outcomes and action taken to evidence that complaints are well managed. We had not received any complaints since the last visit. In the reception area there is a suggestion box where people can put forward their views about the service provided. The home had an adult protection policy in place and had the local multi agency Care Homes for Older People Page 18 of 31 Evidence: guidelines to follow and whistle blowing policy; this ensures that staff have guidelines to follow in the event of an allegation being made. There have been no allegations of an adult protection nature made at the home since our last visit. The training matrix showed that four of the twelve staff had received training in the Protection Of Vulnerable Adults (POVA). From talking to people it seemed that the matrix was not fully up to date to reflect all training received. We spoke to staff about safeguarding people. They demonstrated a general understanding of the actions to take to ensure that people would be protected from harm in the event of an allegation being made. Care Homes for Older People Page 19 of 31 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 are provided with a homely, clean and comfortable environment which meets their needs and their privacy is maintained. Evidence: The home is a detached three-storey building with off road parking for a small number of cars in a residential area. It was generally well maintained, clean and odour free with a homely atmosphere. The AQAA informed us that since the last inspection two bedrooms have been refurbished, one bedroom has a wet room, the first floor shower room has been refurbished and new carpets have been fitted in several rooms. Accommodation is provided for sixteen people over the ground and first floor. Communal accommodation consists of a lounge/dining room on ground and first floor plus a conservatory, which was homely and domestic in character. It was noted that there was no call bell facility in the conservatory and observations during the inspection were that people were not supervised by staff at all times. The owner agreed to action this, which should ensure that if required people can summon help from staff in an emergency. Care Homes for Older People Page 20 of 31 Evidence: There was one assisted bathing facility on each floor and the majority of bedrooms had en-suite facilities consisting of a toilet and wash hand basin. The first floor bathroom had been refurbished since our last visit, which provides people with improved facilities. We looked at the bedrooms of the people we case tracked. All had a call bell system to enable assistance to be summoned when required. Bedroom doors had locks and lockable facilities were in place, so enhancing the arrangements for privacy. Bedrooms were individually and naturally ventilated and windows were provided with restrainers for safety and security reasons. Radiators and the temperature of water from hot water taps were controlled to reduce the risk of scalding to people who live in the home. People are encouraged to personalise their bedrooms and can take their own belongings in to their bedrooms to reflect their individual tastes, age, gender and culture so meeting their needs and providing a more homely environment. There were a number of aids and adaptations provided that were fit for purpose and suitable for the needs of the people living in the home. Raised toilet seats, grab rails near to toilets and handrails in corridors were provided. Access to the first floor is by a passenger lift enabling everyone to access all areas of the home. A hoist is available if required. None of the current people had been assessed to require the hoist. Staff had received training in this area, so that they are competent to use it safely. The hoist had recently been serviced so it is safe to use. The second floor is used as offices this may impact on peoples privacy. The proprietor stated that they were planning to have an extension to the nursing home in the future and offices would be moved there. The garden area is accessible via a ramp for anyone who needs to use a wheelchair. There are seating areas and a range of flowerbeds. People told us I like the garden and sometimes like to sit outside Its a lovely garden to look at. The laundry area was tidy and measures were in place to minimise the potential risk of cross infection from soiled linen. The kitchen was clean and foods were dated and labelled so that they were discarded as required in order to minimise the risk of infection. A new sink had been fitted in the kitchen as requested by environmental health so good hygiene standards can be maintained. Care Homes for Older People Page 21 of 31 Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive some training so they have the skills to meet peoples needs. The recruitment procedure should protect people from harm. Evidence: We looked at the rota for the week of the inspection and the previous two weeks. This indicated there was two care staff on each shift during the day and the manager. In addition to care staff the home has a housekeeper who works mornings. At night there is one member of staff working between 8pm and 8am. The owner said that due to a drop in numbers of people living there the night sleep in person had been temporary removed. The owner and senior manager who live a short distance away provides support in an emergency. It was agreed by the owner during the visit that the night sleep in support would be reinstated when numbers increase. We saw that staff were busy during the visit and could see from reading records that prior to a recent hospital admission one of the people required a lot of staff care and observation. It is important that staffing levels are kept under review so there is adequate staff on duty at all times to meet peoples assessed needs. The AQAA said 4 staff have completed a National Vocational Qualification (NVQ) Level 2 in care and we were told all new staff are registered to do this. This should ensure that the staff have the knowledge and skills to care for people individually and Care Homes for Older People Page 23 of 31 Evidence: collectively. We watched the way that people interacted with staff on duty, which indicated that good relationships exist between people living there and the staff supporting them. People told us: Staff are very good staff are kind Two staff files were reviewed and these were found to contain all the required information to ensure that people employed were deemed safe to work with vulnerable adults. The AQAA informed us that there have been a lot of new staff recently. We spoke to two staff who confirmed that they had an induction when they commenced work. We saw the new induction workbooks that staff were working on which should ensure that a good induction to their role and workplace is provided. We looked at the staff-training matrix, which indicated that some staff had completed training on fire, manual handling, food hygiene, Pova, first aid, health and safety and dementia. We were told that training is scheduled to take place over the next few weeks on first aid awareness, manual handling, health and safety and food hygiene. The information on the matrix did not always match up with what was recorded on the AQAA and on other records in the Home and showed that only some staff had completed mandatory training. A training needs analysis should be completed and the matrix updated so it is clear what training has been completed and what training staff need to do so they have the required skills and knowledge to do their job. Consideration should also be given to provide training on other areas such as nutrition, diabetes, epilepsy, tissue viability etc. so staff develop their knowledge and understanding of peoples health conditions leading to improved outcomes for people. Care Homes for Older People Page 24 of 31 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 home is generally run in the best interests of the people who live there. Arrangements in place for the overseeing of systems and records that promote good care should be developed so people are fully protected. Evidence: The manager was on planned annual leave. One of the proprietors and a senior manager were available at the time of the inspection. Staff and resident/relative meetings are held. Minutes of the staff meetings were not available for us to look at as these are held on the computer, which only the manager had access to. Minutes of meetings should be accessible for staff to read and refer to. We spoke to staff and looked at the frequency of staff supervion, these provide opportunities for staff to discuss their work and receive support and advice to do their job well. Records seen indicated that regular supervision does not take place. Care Homes for Older People Page 25 of 31 Evidence: Senior managers visit the home and complete Regulation 26 visit reports which report on the quality of service being offered at the home. The Home has a number of audits in place to monitor the service provided and had sent out customer satisfaction questionnaires to people living in the Home and relatives, which had been collated into a report which was on display in the Home. This generally reported on people being satisfied with the Home. A minority of people asked for improvement around activities and care of peoples laundry. We saw that the manager had not completed the system in place for monitoring and minimising accidents and incidents. The AQAA gave no dates for the review of policies and procedures. We saw that some policies and procedures had been updated but some still required reviewing. Up to date policies and procedures need to be available to inform and update staff on what is required to safeguard peoples rights and best interests. We were told that the staff do manage money for some people who live in the home and arrangements are in place to record transactions. The owner stated that they do not act as appointee for anyone. This report has highlighted that improvements are required to pre assessment and care planning systems so that peoples need are identified and planned for so they receive the care they need to meet their assessed needs. Prior to the inspection the manager had completed an Annual Quality Assurance Assessment (AQAA) to a satisfactory standard and returned it to us. This tells us how the home think they are performing and gives us information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration when completing this inspection. We saw from the training matrix that three staff had completed first aid training and first aid training was planned for April 2009. The right provision of first aid should be decided by the home completing a first aid risk assessment. This should include the needs of the people who use the service, how likely it is that first aid will be needed, what kind of first aid will be required. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. A fire drill was due and staff training in fire safety indicated that only two staff have completed this. These must take place to ensure that staff have the knowledge to safeguard people in the event of a fire. We spoke to staff about the fire procedure and they were able to tell us what they would do in the event of the firm alarm sounding. We noted that the Home Care Homes for Older People Page 26 of 31 Evidence: had a work place fire risk assessment but this was due for review. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 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 12 Care plans must provide sufficient information. So staff can assist people to meet all of their needs. 30/06/2009 2 8 12 Health care needs must be planned for. So peoples needs are met. 30/06/2009 3 38 23 The work place fire risk assessment must be updated. So people are protected from the risk of fire. 31/05/2009 4 38 18 Staff must be trained in fire safety. So they know how to protect people living in the Home from the risk of harm. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Older People Page 29 of 31 No. Refer to Standard Good Practice Recommendations 1 3 Comprehensive pre admission assessments should be undertaken for anyone wishing to move to the home to determine if their needs can be met. Staff should write to people following a pre-admission assessment confirming if their needs can be met in line with the regulations and to provide confidence to the person moving in that their needs can be met. Arrangements in place for identifying and managing risk should be improved so people are supported to be safe and risks minimized. Arrangements for pressure sore management should be improved so that people receive the care they need. Good record keeping should be in place so monitoring of peoples health care needs takes place. Arrangements should be in place to formally test and record staff competence to administer medication. Staff should receive training in the safe administration of medication so they have the skills and knowledge to safely administer peoples medication. Medication records should be accurately maintained so people can be confident that they receive the medication they need. Arrangements for recording complaints received and their outcome should be improved so that they are well managed. A call bell facility should be available in the conservatory so that assistance can be summoned if required. A staff training audit should be completed so it is clear what training is outstanding and needs to be provided so staff have the skills to do their job. Staffing levels at night should be increased when there is an increase in numbers of people living at the home so people are safe. Staff should receive regular supervision so they have the support to do their job. A first aid risk assessment should be completed so the right provision of first aid cover is provided to keep people safe. 2 4 3 7 4 5 6 7 8 8 9 9 8 9 9 16 10 11 22 26 12 26 13 14 36 38 Care Homes for Older People Page 30 of 31 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. 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