Inspection on 25/03/09 for Harleston House

This inspection was carried out on 25th March 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Harleston House 11/05/07

Harleston House 24/05/06

Harleston House 28/09/05

Harleston House 16/05/05

Harleston House 11/10/04

Harleston House 07/04/04

Harleston House 25/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address:     The quality rating for this care home is:   two star good 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: Julie Small     Date: 2 5 0 3 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 32 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 32 Information about the care home Name of care home: Address: Harleston House 115 Park Road Lowestoft Suffolk NR32 4HX 01502574889 01502516638 harleston@greensleeves.org.uk 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) : Greensleeves Homes Trust care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Harleston House is a 25 bedded residential home for older people situated in a residential area of Lowestoft. The home was first registered in 1950 and has over the years been extended to provide additional accommodation. All resident rooms are offered for single occupancy. At the end of January 2004, the ownership of the home transferred from the Church Army to the Greensleeves Homes Trust, a national organisation which owns two other residential homes within East Anglia. It is the intention of the organisation to extend the service and to upgrade the existing premises. The current charges are at three levels, depending on the assessed dependency level of the resident. They are £415, £455 and £485. Chiropody, Hairdressing, Newspapers and toiletries are not included. Care Homes for Older People Page 4 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: two star good 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 unannounced inspection took place Wednesday 25th March 2009 from 10:25 to 16:00. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. During the inspection three staff recruitment records, staff training records and the care plans, medication records and needs assessments of three people that live at the home were viewed. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and two staff members, two visitors and seven people who lived at the home were spoken with. Care Homes for Older People Page 5 of 32 Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home. Staff, relative and service user surveys were sent to the home. The AQAA and one staff survey, seven service user surveys and seven relative surveys were returned to us. What the care home does well: What has improved since the last inspection? What they could do better: There were areas of the home which were in need of refurbishment which had been identified in previous inspections. The issues had not yet been addressed. However, a plan for refurbishment was underway at the time of the inspection and we were assured that they were in the process of improving the environment. Care Homes for Older People Page 7 of 32 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 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be provided with the information that they need to enable them to make decisions about if the home is the right place for them, to have their needs assessed prior to moving into the home and to have their assessed needs met. Evidence: People were provided with the information that they required which enabled them to make informed choices about if they wished to move into the home in the Statement of Purpose and the Service Users Guide. The AQAA stated full information on our fees etc. is given to residents. The service user survey asked if they were provided with enough information about the home before they moved in so that they could decide if it was the right place for them. Four answered yes, three answered no and comments included no information my (relative) informed me of the home and did not have any information just decided as I walked into the home. Eight relative surveys stated that Care Homes for Older People Page 10 of 32 Evidence: they were always provided with enough information about the home which helped them to make decisions and one commented all very satisfied and pleased. The Statement of Purpose was viewed and included details of how people could make complaints, CSCI (contact details), guidance on funding, the aims and objectives of the home, facilities and services that were provided, care staffing arrangements, the name and qualifications of the manager, the structure of the organisation, criteria for living at the home, fire safety, sizes of rooms and the residents charter, which identified how peoples privacy and dignity was respected. The Service Users Guide was viewed and it was noted that each person that lived in the home was provided with a copy, which was posted on the back of their bedroom doors. The Service Users Guide included details of the accommodation that was provided, aims and objectives of the home, day to day life, the services that were provided, how people were consulted with, the arrangements for visitors, fire safety and a summary of the complaints procedure. The records of three people that lived at the home were viewed and each held a detailed needs assessment, which had been completed prior to them moving into the home. The records also held care plans, which identified how their assessed needs were met. The AQAA stated a full assessment is carried out to ensure that we are able to meet the needs and requirements of all prospective residents. 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. People who use the service can expect to be provided with a detailed care plan which shows how their assessed needs are met, to have their health care needs met, to be treated with respect and to be protected by the homes medication procedures. Evidence: The records of three people that lived in the home were viewed and each held a detailed care plan which showed how their assessed needs were met. The care plans were regularly updated to show peoples changing needs and preferences. Each care plan had been signed by the person, which showed that they had been consulted with about the support that they were provided with. There were documents of monthly reviews in the care plans, which had been undertaken by the person and their key worker and the documents identified the persons views about the support that they were provided with. The AQAA stated the resident is at the centre of their care plan which is reviewed monthly with them and any choices, views etc. are documented and implemented Care Homes for Older People Page 12 of 32 Evidence: accordingly. Seven service user surveys said that they always received the care and support that they needed. Seven relative surveys stated that their relative was always provided with the support that they expected or agreed and comments included I am very satisfied with the care of my (relative). If there are any problems or I have suggestions, I discuss these with the manager and she deals with them and very good in every aspect of care. A staff survey said that they were always provided with up to date information about the needs of the people that they supported. People that lived at the home that were spoken with said that their needs were met. A relative of a person that lived at the home told us that they were very happy with the support that their relative was provided with and they said that their relative had told them that they were happy living at the home. The care plans included details of the support that people required and preferred such as with their health, choices in the event of their death, preferred form of address, personal care, the areas of the support that they could attend to independently, preferences in their appearance, nutrition, communication, mobility and continence. The care plans also held a life history, which provided the staff with information about the person and their experiences. Each care plan held detailed risk assessments that identified the risks in their daily living and methods of minimising the risks. Risk assessments included issues such as mobility, nutrition, manual handling and skin viability. There were also environmental risk assessments on each persons bedroom. We observed two staff members supporting a person to transfer from a wheel chair to an arm chair. They were observed to use a hoist appropriately and confidently and they clearly explained their actions to the person. We observed a staff member assisting a person to ensure that their walking frame was accessible to them. It was noted that the interaction between the staff and people was respectful, professional and caring. Daily records were viewed, which showed the support that people had been provided with, staff observations of their well being and the choices that people had made. The AQAA stated daily records are documented to promote a good quality of care. Peoples health care needs were met and the care plans clearly identified the outcomes for health care appointments that people had been provided with such as with an optician, district nurse, doctor and chiropodist. Peoples weight was regularly monitored and there were records of regular weight checks. Seven service user Care Homes for Older People Page 13 of 32 Evidence: surveys said that they were always provided with the medical support that they needed. A person that was spoken with told us that a doctor would be called if they were unwell. We observed part of the lunch time medication administration, which was undertaken using a secure trolley which was locked when the staff member left it. The staff member that was administering the medication clearly explained the medication procedure and they confirmed that they had been provided with training on the safe handling of medication, which was confirmed by training certificates that were viewed. Peoples MAR (medication administration record) charts were signed when people had taken their medication and codes were used appropriately if people refused their medication, such as with PRN (as required) pain relief. It was noted that the staff member treated each person with respect, they offered choices of if they wished to take their medication and they knocked on peoples bedroom doors before entering them. The medication was stored in a secure medication room in MDS (monitored dosage system) blister packs and original packaging where the MDS system was not suitable. Medication that needed to be refrigerated was stored in a secure refrigerator and the records of regular temperature checks were viewed of the storage room and the refrigerator, which showed that medication was stored at appropriate temperatures. The MAR charts of three people were viewed and it was noted that there were no unexplained gaps and all medication was accounted for. Controlled medication was appropriately recorded in a bound book, which was viewed. The homes medication procedures were viewed and they detailed the methods for the safe handling, storage and administration of medication. Records of regular medication audits were undertaken, which showed that issues with medication were routinely identified and addressed. Seven people that lived at the home and two visitors to the home reported that the staff were always respectful and that their privacy was respected. Comments included oh yes, definately and we respect each other, carers respect us and we respect them. It was noted that the interaction between staff and people was professional and respectful. Staff were observed to knock on bedroom and bathroom doors before entering them. The AQAA stated residents privacy and dignity are respected at all times. It was noted that peoples incontenance pads were stored discretely in their bedrooms, which showed that their dignity was respected. Care Homes for Older People Page 14 of 32 Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be provided with the opportunity to participate in activities which are of interest to them, to be supported to maintain contacts, to be supported to make choices in their lives and to be provided with a balanced diet. Evidence: People were provided with the opportunity to participate in activities that they chose to. An activities coordinator was employed at the home and they had arranged activities that people had identified an interest in. We viewed a recent survey which the coordinator had organised, which asked what peoples preferences were for the activities that were provided at the home. The AQAA stated we have a weekly activities programme (which is changeable to meet the requests of the residents). We have a notice board for all activities held in house and any outside entertainment booked. Seven service user surveys said that there were always activities arranged that they could take part in and comments included not too keen on games but like entertainment and available to all wishing to take part. Care Homes for Older People Page 16 of 32 Evidence: The activities records were viewed and they identified who had participated in activities and the observations of the activities coordinator, for example if people had said that they had enjoyed the activity. There was a notice posted on the notice board in the entrance hall to the home, which identified the activities that were provided for each day, there were also notices which showed the religious service that were provided at the home from three different organisations. The activities included slide shows, games, visiting musicians and reminiscence activities. During the afternoon of the inspection we observed the activities coordinator undertaking various activities in the lounge, such as bingo and games. It was noted that there was lots of laughter coming from the lounge from the people who lived in the home and the staff that were supporting them during the activities. The activities coordinator was also observed chatting with a person in their bedroom, again we noted laughter coming from the room. We were invited into the persons room and they told us that they enjoyed the activities that were provided at the home. A group of people were spoken with in the lounge and they said that there was plenty to keep them occupied and that they enjoyed the activities. One person said that they particularly enjoyed the sing songs and they said one starts singing and we all join in. A relative of a person that lived at the home was spoken with and said that their relative enjoyed the activities in the home and said that when they went out their relative was always keen to get back to the home so as not to miss the activities. A visitor to the home was spoken with and told us that they ran a small shop in the home where people could buy confectionery and toiletries if they chose to. They said that the money made from the shop went directly to the comfort fund. They told us that there was a library of a selection of larger print books in the home which people could read and that there was also a regular visit from the local library which people could use. The records of three people that lived at the home were viewed and each detailed the contacts with their family and friends that they chose to maintain. Two visitors to the home were spoken with and they told us that they were always made welcome and one visitor told us that they were always offered drinks and meals. People that lived at the home who were spoken with confirmed that their guests were made welcome by the staff at the home. Seven relative surveys said that their relative was always supported to keep in touch with them. The survey asked if they were kept up to date with important issues that affected their relative. Six answered always and one answered usually. Care Homes for Older People Page 17 of 32 Evidence: The menu was viewed and it was noted that people were provided with a balanced diet and that there were three choices of each meal. On the day of the inspection lunch was a choice of chicken and mushroom pie, shepherds pie or lasagne and salad and a choice of cheesecake, fresh fruit platter or ice cream. It was noted that the meal looked and smelled appetising and people that chose to eat in the dining room left little on their plates. People that were spoken with told us that they could eat their meals in the dining room or in their bedrooms and that the food at the home was very good. One person told us if you make any requests they get it specially they showed us a corner yogurt and said that they had asked for them and that they had been provided. The service user survey asked if they liked the meals at the home. Five answered always, one answered sometimes, one answered never and comments included more Italian dishes, soup very watery and I prefer thick, cant beat them and very good choice to suit all tastes. A staff member told us that people made their choices of meal each day before each meal and that if people changed their minds then they would be provided with what they wanted. A staff member was observed to take peoples choice of evening meal for the day of the inspection at 14:25. People that were spoken with said that they were happy with the arrangements for making their choices of meal each day. The AQAA stated provide a varied choice of menu. Residents have complete choice as to where they choose to have their meals. We seek residents views on menus. People were observed to be provided with regular hot drinks throughout the day and there were a choice of cold drinks, which were in dispensers in the lounge, that people could help themselves to. A staff member showed us an area in the home where relatives could help themselves to drinks if they chose to. It was noted that peoples choices and views were listened to and acted upon. We viewed the minutes from residents meetings, which confirmed that they were consulted with about the menu that was provided. The minutes also showed that people were consulted with about issues in the home, such as the extension to the home, which was underway at the time of the inspection. People were advised of the progress and they had participated in choosing the decor and furnishings. People that were spoken with had a clear understanding of the plans for the home and they confirmed that they were consulted with and that their choices were listened to. A person that was spoken with told us that they had personal items of furniture in their bedroom. Seven service user surveys said that the staff listened and acted upon what Care Homes for Older People Page 18 of 32 Evidence: they said. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be protected from abuse and to have their complaints listened to and acted upon. Evidence: The training certificates of three staff members were viewed and it was noted that they had been provided with safeguarding training, which had been updated February 2009. Two staff members that were spoken with confirmed that they had attended safeguarding training and they were aware of their roles and responsibilities regarding the protection of people that lived at the home. The homes complaints procedure was viewed and it clearly detailed how people could complain about the service that they were provided with and the actions that would be taken upon receipt of their complaint. A summary of the complaints procedure was included in the Statement of Purpose and the Service Users Guide for the attention of people that used the service. The complaints records were viewed, which included the complaint, the action that was taken to address the issue and the contacts that had been made with the complainant to explain the actions that had been taken to address the issues. It was noted that the complaints had been acted upon in a timely manner. There had been one complaint made in the last twelve months, which had been resolved within twenty eight days. Care Homes for Older People Page 20 of 32 Evidence: Six service user surveys said that they knew who to speak to if they were not happy and one commented (the manager) and (the deputy) are always wonderful and ready at all times to listen. (Staff member) gives me confidence. Six service user surveys and six relative surveys said that they knew how to make a complaint and one said that they did not. The relative survey asked if they had raised concerns had they been acted upon appropriately? Six answered always and one answered usually. Seven people that lived at the home and two visitors that were spoken with said that they knew how to make a complaint. A staff survey said that they knew what to do if a person wished to make a complaint about the service that they were provided with. We viewed several letters and cards from relatives of people that had lived at the home, thanking the staff for the support that they had provided. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be provided with a clean and comfortable home to live in and they can expect that the areas that are in need are refurbishment are addressed. Evidence: During the inspection there was building work being undertaken, which included the building of an extension to the home. There was a requirement made at previous inspections from 28th September 2005 which stated that the corridor areas within the building must be maintained to a satisfactory decorative order. This had not yet been addressed, however, a staff member that was spoken with explained the arrangements for the refurbishment of the home. It was planned that when the extension was completed people that lived in the home would move to the new extension which would allow a full refurbishment of the existing building. We were told that the extension would be completed by Easter weekend (10th to 12th April 2009) and the refurbishment of the existing building would be completed by September 2009, at this time an application would be made us to increase the registered numbers of beds in the home. The kitchen area had been removed as part of the extension and there was a temporary kitchen extension to the home. The kitchen area held the necessary equipment and hand washing facilities to minimise cross contamination. A recent Care Homes for Older People Page 22 of 32 Evidence: environmental health visit had identified that the arrangements for the kitchen and serving of food was satisfactory as a temporary measure. We were assured that people that lived at the home were aware of the plans. Seven people that lived at the home and a visitor to the home were spoken with and they told us about the plans for the refurbishment, which confirmed what we had been told. We viewed residents meeting minutes and they showed that people had been consulted with throughout the process and that they had participated in the selection of the decor and furnishings of the extension. People that were spoken with told us that they were not disturbed by the building work. A staff member told us that there was one person who had raised concerns about the noise of the building and that they had moved their bedroom to another part of the building. The communal areas of the home, such as the two lounges and the dining room were comfortable and clean and it was noted that there were fresh flowers in the lounge, which people said that they liked. The dining room provided sufficient seating for the people that lived at the home and it was noted that the tables were laid with napkins and condiments. It was noted that there were no unpleasant odours in the home. Seven service user surveys said that the home was always fresh and clean. The AQAA stated our home is clean and smells nice at all times. Peoples bedrooms that were viewed were clean and they were personalised, which reflected peoples choices and individuality. A person was spoken with and told us that their bedroom was cleaned regularly and that they were comfortable. There was a maintenance worker at the home who undertook minor repair work where required. The laundry was viewed which held two washing machines and hand washing facilities to minimise the risks of cross contamination. It was noted that the laundry was clean. A staff member told us that the laundry area had been reduced due to the building work and the drying machines were on the second floor of the home, which was accessible by the lift. The staff member said that the situation had not been ideal, however, as it was temporary they were managing the issue well. The new extension provided a larger laundry, which would be used when the building was completed. There was a sluice room on the first floor where commodes were cleansed. During a tour of the building we noted that there were several areas in the home which held disposable aprons and gloves for the use of staff to prevent the risks of cross infection. All bathrooms and toilets provided hand wash liquid and disposable paper towels. Staff were observed to use good infection control procedures, which Care Homes for Older People Page 23 of 32 Evidence: included washing their hands and wearing protective clothing and gloves when working with food and when supporting people with personal care. Staff that were spoken with confirmed that they had been provided with infection control training and they had a knowledge of the homes infection control procedures. The AQAA stated our staff are trained in infection control. The training certificates of staff that were viewed showed that they had been provided with infection control training, which had been updated February 2009. The infection control procedure was viewed and it detailed the methods of minimising cross infection, which included appropriate hand washing methods and the methods of managing infections. There was a detailed infection control risk assessment, which was viewed. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be supported by staff that are trained to meet their needs and they can expect to be protected by the homes recruitment procedures. Evidence: A staff member was spoken with and they told us that the home was fully staffed and that there were no staff vacancies. The AQAA stated we have not had to use agency/bank staff for the past two and half years. Staff turnover is minimal. Each day there was either the manager or the deputy, one senior care staff, two care staff and kitchen and domestic staff on duty to support the people that lived at the home. This was confirmed by observations of the staffing arrangements during the inspection and by the rota, which was viewed. Two staff members were spoken with they told us that they felt that there were sufficient staff on duty to support the people that lived at the home. Seven people that lived at the home and two visitors that were spoken with told us that there were enough staff on duty to meet peoples needs. They were very complimentary about the support that they were provided with by the staff that worked at the home. People told us that their call bells were answered promptly and that staff were available when they needed them, which was confirmed by seven service user surveys. Comments made in Care Homes for Older People Page 25 of 32 Evidence: the service user surveys included quite happy with staff etc. and staff very kind and listen to what you say. Staff that worked at the home had achieved the levels of the acceptable qualifications in which they were assessed as competent in their work roles. The home had met the target of 50 staff to have achieved a minimum of NVQ (National Vocational Qualification) level 3 as identified in the National Minimum Standards relating to older people. The AQAA stated that there were seventeen care staff that worked at the home, eight had achieved a minimum of NVQ level 2. Six staff were working on an NVQ level 3 and three were undertaking their NVQ level 4. A senior staff member was spoken with and told us that they had achieved an NVQ level 3 and they were working on NVQ level 4, which showed that they were provided with the opportunity to develop in their work role. The training certificates of three staff members were viewed and they showed that they had been provided with training which enabled them to meet peoples needs. Training included an induction course, safeguarding, medication, manual handling, infection control, emergency first aid, health and safety, risk assessments, food hygiene and dementia. The training programme was in the process of being updated and staff had been provided with updated infection control, manual handling and safeguarding training. Updated fire safety training was booked June 2009. Two staff members that were spoken with told us that they were provided with a good training programme which was regularly updated. A staff survey said that the induction covered everything that they needed to know to do the job when they started and that they had been provided with training which was relevant to their role, helped them to understand and meet the needs of people and that kept them up to date with new ways of working. The recruitment records of three staff were viewed and it was noted that the necessary checks had been made which ensured that people were safeguarded by the homes recruitment procedures. Each recruitment record held evidence of checks that had been made which included a CRB (Criminal Records Bureau) check, POVAfirst (protection of vulnerable adults) check, details of their work history, identification and two written references. The AQAA stated we have a good recruitment policy and practice and all our care staff are over eighteen and have all been CRB and POVA checked. Care Homes for Older People Page 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to live in a home which is managed in their best interests, to be supported by a staff team who are appropriately supervised and to have their health, safety and welfare protected. Evidence: Since the last key inspection the manager had been successful in the registered manager process with CSCI (Commission for Social Care Inspection), which showed that they were fit to be in charge of the home. The Statement of Purpose stated that the manager had achieved an NVQ level 3 in care and the RMA (registered manager award). The manager was supported in their role by a deputy manager. The AQAA stated I recently appointed a new deputy manager. (The deputy manager) and I are a very strong team and both pride ourselves on wanting the best for the home. We have the same ideas and views on the way forward for Harleston House. Staff and people that were spoken with were complimentary about the management team of the home. Care Homes for Older People Page 27 of 32 Evidence: During the inspection the manager was on annual leave, however, they arrived at the home to meet with us. They clearly explained the plans for the home and their role and responsibilities in improving the environment and the outcomes for the people that lived in the home. Staff were provided with regular one to one supervision meetings and staff meetings, which enabled them to discuss the ways that they were working. Staff spoken with confirmed that they felt that they were supported in their role and they were confident that any issues would be acted upon by the homes management team. The supervision records of three people and the supervision schedule were viewed and they showed that staff were provided with supervision meetings at regular intervals of between six to eight weeks. The AQAA stated care staff have regular supervisions every eight weeks. The minutes of staff meetings were viewed and they showed that staff were kept updated on issues in the home, future training, peoples changing needs and they were provided with guidance on the ways that they worked, such as with health and safety, manual handling and infection control. There were good quality assurance processes in the home and people that lived at the home were consulted with about the support that they were provided with. The management team undertook regular audits of records such as with complaints, care plans and medication. Monthly Regulation 26 visits were undertaken by a representative of the organisation. The Regulation 26 visit reports were available in the home for inspection and we viewed a report from February 2009, which showed that people were spoken with about their experiences in the home. Annual satisfaction questionnaires were undertaken, which provided people that used the service with an opportunity to express their views about the support that they were provided with. The results were summarised in an annual report and were provided in the Statement of Purpose. People were further consulted with regarding the support that they were provided with in monthly key worker meetings, with their care plan and in three monthly residents meetings, which are further discussed in the health and personal care and daily life and social activities sections of this report. The health, safety and welfare of people that lived at the home was promoted and protected. A staff member told us that peoples finances were not stored in the home and that their representatives were provided with invoices for transactions that they had made. The home had a fire risk assessment and the fire safety records that were viewed showed that fire safety checks were regularly undertaken which ensured that people Care Homes for Older People Page 28 of 32 Evidence: were safeguarded in case of a fire. Staff were provided with fire safety training in 2008 and we were informed that updated training was booked for June 2009. We observed certificates which showed that wheelchairs, the lift, call bell system, assisted baths and hoists were regularly serviced. Records of regular water temperatures were viewed which showed that people were safeguarded from scalds. We viewed detailed environmental and generic risk assessments, which identified the assessed risks in the home and methods of minimising the risks in areas such as COSHH (control of substances hazardous to health, security of the building, manual handling, the laundry, the garden, the medication room, all rooms in the home and infection control. Care Homes for Older People Page 29 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 30 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 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 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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