Inspection on 28/01/10 for Haven Rose Rest Home

This inspection was carried out on 28th January 2010.

CQC found this care home to be providing an Adequate 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

Haven Rose Rest Home 28/10/09

Haven Rose Rest Home 04/08/09

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Haven Rose Rest Home 33 Landguard Road Southampton Hants SO15 5DL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nick Morrison     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Haven Rose Rest Home 33 Landguard Road Southampton Hants SO15 5DL 02380322999 02380366228 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Haven Rose Residential Care Home Limited Name of registered manager (if applicable) Mrs Shahnaaz Joommun Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 16 The registered person may provide the following category of service only: Care home only (PC)to service suers 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) Mental disorder, excluding learning disability or dementia (MD) Dementia (DE) Date of last inspection 0 4 0 8 2 0 0 9 16 16 0 Over 65 0 0 16 Care Homes for Older People Page 4 of 30 Brief description of the care home Haven Rose is a large detached property situated in Languard Road in Southampton. It is located in a quiet residential area and is close to local shops and amenities. The registered provider is Haven Rose Residential Care Home Limited and the registered manager is Mrs Shahnaaz Joommun. There are 8 single rooms and 4 double rooms and the home is registered to provide accommodation for up to 16 older people both male and female who have mental health and dementia problems. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 28 January 2010 and lasted from 12:00am until 6:30 pm. During this time we toured the premises, looked at six service users files and spoke with two people living in the home. We also met with the Manager and spoke with two other members of staff. All records and relevant documentation referred to in the report were seen on the day of inspection visit. We have also referred to the Providers Annual Quality Assurance Assessment (AQAA) and written responses to our survey from nine people who live in the home, four members of staff and two healthcare professionals. The previous Key Inspection for this service occurred on 4 August 2009. Since that time we made a further Random Inspection of the service to ascertain whether or not the requirements made in August 2009 had been addressed. The Random Inspection took place on 28 October 2009. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 30 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. Service users benefit from having their needs assessed by the home prior to admission. Evidence: We looked at the files of six people who live in the home, referred to the homes Annual Quality Assurance Assessment (AQAA) and also to the written responses to our surveys. The AQAA told us that the home enables people to visit the home and to stay for the day or overnight before they make a decision about whether or not they want to move into the home. The files showed that assessments were undertaken prior to people moving in so that the home could determine whether or not they could meet the persons needs. These assessments were undertaken with input from the service user where possible and from their relatives and relevant other professionals. The assessments were comprehensive and covered all aspects of potential needs the person may have. Care Homes for Older People Page 9 of 30 Evidence: Eight of the nine service users who responded to our survey told us they were asked if they wanted to move into the home and seven of them told us they had sufficient information about the home before moving in. Both of the healthcare professionals who responded to our survey told us the home assesses people well prior to admission. Care Homes for Older People Page 10 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place, reflect peoples current needs and are kept under regular review, but are still not specific enough about how staff are to meet peoples needs. Risk assessments are in place, but do not all reflect peoples current needs. There are concerns that these areas remain outstanding despite the service receiving support from Adult Services. Medication is generally well managed but records do not detail exactly how much medication each person has received on each occasion. People living in the home benefit from having their privacy and dignity respected. Evidence: We looked at the files of six people who live in the home, referred to the homes Annual Quality Assurance Assessment (AQAA), written responses to our surveys, the previous inspection reports and information we had received from other professionals. We also looked at medication records, observed staff administering medication, spoke with two people who live in the home, spoke with the Manager and observed how staff supported people throughout the day. Care Homes for Older People Page 11 of 30 Evidence: There had been a requirement from the previous Key Inspection on 4 August 2009 that care plans must be in place and record action for staff and must be kept under regular review. At the Random Inspection on 28 October 2009 we found that progress had been made in addressing this requirement. At this current inspection we found from service users files that care plans were in pace for people and that they were being regularly reviewed and updated as necessary. Staff working in the home had signed the care plans to indicate that they had read and understood them. We saw that each persons care plans related to the initial assessment the home had done for the person. Other professionals told us they thought there had been some improvement to the care plans in the home and that they now gave a clearer picture of how care was to be given to each person. However, the care plans we saw on the day of the inspection visit need to provide information to staff on how care is to be undertaken for each person and we found that some of the plans we looked at did not contain specific enough information. Examples of this were needs full assistance to get washed. and needs all assistance of one carer with dressing and undressing. These examples are not descriptive enough about what staff members actually need to do in order meet peoples needs. This may result in inconsistency of care because different staff may interpret these in different ways. They may also result in service users becoming less independent because they do not acknowledge which parts off the task the person is currently able to do for themselves. There has been some progress in relation to the previous requirement but there are still concerns as to the effectiveness of the care plans. The home keeps daily records in relation to the care provided to each person and to identify any other issues the person has. Previously this had been just been done by staff writing in the files, but the Manager has recently introduced a more structured process for recording this information. There is now a recording sheet for each service user and the staff on each shift have to record observations on this form, so it is completed twice a day. The form contains prompts so that information is relevant. The prompts are what time the person got up, personal care, physical and emotional well being, nutrition, activity and other issues. There had been a requirement from the previous Key Inspection on 4 August 2009 that service users must be protected from avoidable risks. At the Random Inspection on 28 October 2009 we found that progress had been made in addressing this requirement. At this current inspection we found that risk assessments were in place. The home uses a screening tool for assessing risks for each person. Documentation in service users files showed that these were being reviewed on a monthly basis. We also found evidence that where peoples needs changed, in between the monthly review of risk, further risks were considered and measures put in place to address Care Homes for Older People Page 12 of 30 Evidence: them. One example of this was additional risk assessments put in place where a person had fractured their knee and was therefore prone to more risk. There was also evidence that risk assessments regarding peoples food and fluid intake did not reflect peoples current needs (see below). There had been a requirement from the previous Key Inspection on 4 August 2009 that medication must be given as prescribed, records must kept up to date, risk assessments must be in place for people who selfmedicate, care plans must be in place for medication prescribed on an as required basis, staff must receive training and controlled medications must be stored correctly. At the Random Inspection on 28 October 2009 we found that this requirement had been met, with the exception that the home still did not have secure storage for controlled medication at that time. By the time of this current inspection an appropriate storage cupboard had been purchased and secured to the wall. At this current inspection we saw that the home had purchased a cabinet for controlled medication and that all controlled medication in the home was being stored appropriately within it. Information we had received from other professionals told us there had been some improvement in the management of medication in the home but that there had been a recommendation for them to change their medication system. The home is now in the process of beginning to use a different chemist to provide its medication and this will include improvements to the system and further training for staff involved in administering medication. The medication records we saw on the day of the inspection were clear, accurate and up to date. The records included what medication had come into the home, what had been administered and what had been returned to the pharmacy. The records also contained photographs of each person living in the home to decrease the likelihood of medication being given to the wrong person. The medication file contained information for staff on the mediation used in the home and the homes medication policy. The Manager has begun auditing the records and the medication in the home on a daily basis to decrease the likelihood of any errors occurring. One person living in the home needed Insulin injections and training records showed that staff involved in administering these had received training from qualified staff at the local surgery. One person had been prescribed ointment which they preferred to keep in their own room and a risk assessment was put in place to demonstrate that this could be done safely. One persons care plan stated that staff needed to contact the Community Psychiatric Nurse if the person was refusing their medication and we found that this had been done on the occasions it was necessary. Some people living in the home had been prescribed paracetemol or Cocodamol if they Care Homes for Older People Page 13 of 30 Evidence: required it for pain. This mediation was prescribed as one or two up to four times a day and no more than eight in any twenty-four hour period. It was clear for one person how staff decided whether one or two tablets were required, but for other people it was not. This information should be on their care plan. The records did not show whether one or two tablets had been administered on each occasion the person had the medication. This means that if a person asked for more of this medication because of pain they were experiencing, the member of staff would not now whether or not they had already received eight tablets in the previous twenty-four hour period. In looking at how the home addresses the healthcare needs of people living there we found evidence of good practice but also some evidence of ineffective practice. Service user files showed that staff in the home referred to healthcare professionals when necessary in relation to some concerns such as urine infections, mobility, eyesight tests and communication difficulties. There was also good evidence of liaison with healthcare professionals over specific health problems individual service users had. There was also some positive feedback from healthcare professionals about the ability of the home to manage issues and liaise with other professionals. In addition, the home kept information on individual conditions, such as Diabetes, that affected people living in the home so that staff had knowledge of the issues involved. There was other evidence in service users files and daily records that showed the home did not monitor healthcare well. One persons care plan said they were prone to urinary tract infections as they sometimes do not drink enough and that staff need to ensure they are drinking plenty. The risk assessment for this person stated that staff needed to encourage drink and monitor whether or not they finish their drinks. The lack of clear and effective monitoring in relation to this shows that the risk assessment was not being followed. The home did not have any clear records of how much fluid this person was consuming. The daily records we saw for this person contained statements such as ate well all food and drinks given and drank well. This is insufficient to monitor a persons fluid intake and where there are concerns about the amount of food or fluid a person is consuming there should be clear monitoring records in place that provide accurate information on the actual amounts the person has had. Another persons care plan said that there was a need to contact the GP if the person had not had a bowel movement for more than three days. The records showed that from the third to the eighth of January 2010 inclusive there had been no bowel movement, yet staff had not contacted the GP in relation to this (although they had contacted the GP in relation to a different matter for the same person within that time). The homes AQAA told us that they ensure people living there have choices about how Care Homes for Older People Page 14 of 30 Evidence: they spend their time and that privacy and dignity is maintained for people at all times. All nine of the service users who responded to our survey told us that staff in the home listen to and act on what they say and seven of the nine people told us that staff always treat them well. One of the healthcare professionals identified that one of the things the service does well is that they respect privacy and dignity. Initial assessments had information on each persons preferred form of address and we observed staff using these throughout the day of the inspection visit. We also observed that staff respected peoples privacy. Care Homes for Older People Page 15 of 30 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 living in the home benefit from support to maintain contact with their relatives and support to retain control over their own lives. There is not a plan of activities in the home which reflects the assessed needs and preferences of people living there. People living in the home benefit from varied and nutritious meals that suit their preferences. Evidence: We looked at the files of six people who live in the home, referred to the homes Annual Quality Assurance Assessment (AQAA) and written responses to our surveys. We also spoke with two people who live in the home, looked at menus, spoke with the Manager and observed how staff supported people throughout the day. The AQAA had identified that the home needs to improve the range and regularity of activities provided for people living in the home. One of the healthcare professionals who responded to our survey also identified that one of the things the home could do better was to ensure there was a social activities structure. At present there are few planned activities and there is no plan of when different activities will take place. The homes initial assessments do include information on peoples social and recreational interests but it is too brief and does not inform a plan of activities. The activities that Care Homes for Older People Page 16 of 30 Evidence: do take place are listening to music and playing ball games and these take place at times when members of staff feel they are able to lead the activities rather than at planned times. The AQAA told us that some activities had been arranged for people living in the home and that these were supported through a local voluntary scheme. We observed on the day of the inspection visit that one person was supported to go out to the cinema. We spoke with the person before they went and they were really looking forward to going. When they came back they told us they had had a good time and that they valued the opportunity to be able to go out of the home to do activities. Risk assessments were in place to support some people living in the home to go out without staff support. This included going to the local shops and going to the Post Office to collect their money. The home arranged transport for some people who went out on their own and there was also support for other people living in the home to attend church services when they wanted to. Staff in the home had recently supported someone to go and visit their sister, who lives in another care home and who the person had not seen for a long time. Another person was supported to keep in touch with their family through letters and postcards which staff helped them write. The homes visitors policy states that people are able to visit friends and relatives who live in the home at any time that is convenient to them both. All nine of the service users who responded to our survey told us they were able to choose how they spent their time at the home. A healthcare professional told us that what the home did well was to provide a family environment and promote freedom of choice. Our observations throughout the day of the inspection showed that staff in the home were skilled in being able to offer choices to people, give them time to choose and respect their decisions about what they wanted to do. Menus in the home showed that a wide range of food was on offer to people and that different alternatives were always available. Specific diets were catered for, for example where people were diabetic, and the home also catered for peoples ethnic needs and preferences. One person living in the home had a preference for West Indian cooking and the chef was able to source the ingredients for this and cook them appropriately. This person had their own menu in place, although they were able to choose things from the main menu on the occasions they wanted to. People we spoke with told us they thought the food in the home was of good quality and served in adequate portions. Care Homes for Older People Page 17 of 30 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. Service users benefit from having information on how to make a complaint and are protected by the homes safeguarding policies and practices. Evidence: We looked at the homes complaints procedure, spoke with the Manager, referred to the homes Annual Quality Assurance Assessment (AQAA) and to responses to our survey. We also looked at staff training records and referred to information given to us by other professionals. The complaints procedure in the home had been reviewed in March 2009 and staff had signed to say they had read and understood it. Information on how to complain was given to service users and their families when they moved into the home and a copy of the complaints procedure is available in the building. The Manager also told us that residents meetings are used to remind people living in the home about the complaints procedure. All nine of the service users who responded to our survey told us they knew who to speak to if they had a problem and eight of the nine told us they knew how to make a complaint. Since the previous inspection the home had only received one complaint and this was from a Consultant who had concerns over the way a service user was dressed when they turned up for an appointment. Information on the service users files demonstrated that the home had responded to the complaint in writing and had taken Care Homes for Older People Page 18 of 30 Evidence: action to address it. At the time of this inspection the home did not have a complaints log in place for recording complaints and how they were responded to. Safeguarding concerns had been raised in the home in July 2009 relating to medication recording and care planning. As a result of this Southampton Adult Services placed a suspension on the home, meaning that they would not fund further people to live in the home while the issues were being monitored. The home also voluntarily agreed not to accept referrals from other authorities or from privately funded people while the suspension was in place. This was followed by a Key Inspection from the Care Quality Commission in August 2009, at which time the service was rated as poor. In the meantime Southampton Adult Services have continued to monitor and support the service and the Care Quality Commission undertook a Random Inspection in October 2009 to monitor the extent to which the service had met requirements made in August. We understand from Southampton Adult Services that they still have a suspension in place. In discussion with the Manager on the day of the inspection visit we found that she was able to demonstrate an understanding of the local safeguarding reporting procedures and how to use them. Staff had received training in protecting vulnerable adults and, in their responses to our survey, four of the four people who responded told us they were aware of what to do if they had concerns about practices in the home. There had been no further safeguarding issues identified in the home since July 2009. Care Homes for Older People Page 19 of 30 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. Service users benefit from living in a well-maintained home but would benefit further from the home being kept cleaner. Evidence: We walked around the building, spoke with the Manager, referred to the homes Annual Quality Assurance Assessment (AQAA) and to responses to our survey. We also referred to previous reports and our own observations on the day of the inspection. There had been a requirement from the previous Key Inspection on 4 August 2009 that the hot water boiler in the kitchen must be securely fixed to the wall. By the time of the Random Inspection on 28 October 2009 we found that this requirement had been met. The boiler had been removed and a new boiler had been put in place in the laundry room. As part of this process the central heating system in the home had been replaced. The new system has individual controls on the radiators in each room so that people living in the home are able to adjust the temperature in their own room to suit their own preferences. Five of the nine service users who responded to our survey said the home was always fresh and clean. Three said it usually was and one said it sometimes was. In their response to our survey one of the healthcare professionals told us that improvements Care Homes for Older People Page 20 of 30 Evidence: in quality of furnishings, decor etc was something that the home could do better. The homes AQAA told us they intended, at some point, to redecorate some of the rooms in the home to make them more pleasant and also intend to replace some of the carpets. In discussion the Manager told us this had not yet taken place due to the suspension placed on the home and the effect that was having on their income, resulting in them having no money available at this time to make those improvements to the building. On looking around the home we found that some parts of the building were not clean. This included dusty surfaces and tea or coffee stains on some of the paintwork. When we discussed this with the Manager she acknowledged that some parts of the building ought to be cleaner than they currently are. There had been a requirement from the previous Key Inspection on 4 August 2009 that the laundry must have surfaces that are easily cleaned. By the time of the Random Inspection on 28 October 2009 we found that this requirement had been met. At the time of this current inspection we observed that laundry area was being kept clean. There had been a requirement from the previous Key Inspection on 4 August 2009 that procedures must be in place for the washing of soiled items. By the time of the Random Inspection on 28 October 2009 we found that this requirement had been met. There had been a requirement from the previous Key Inspection on 4 August 2009 that hand washing facilities must be available in the kitchen. By the time of the Random Inspection on 28 October 2009 we found that this requirement had been met. We observed hand washing facilities throughout the building, along with alcohol gel dispensers which staff, service users and visitors were encouraged to use. The home has infection control procedures in place and staff have received training in infection control practices. Care Homes for Older People Page 21 of 30 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 living in the home benefit from being supported by adequate numbers of trained staff and are protected by the homes recruitment policies and practices. Evidence: We looked at the files of four members of staff, spoke with the Manager, referred to the homes Annual Quality Assurance Assessment (AQAA) and to responses to our survey. We also referred to the homes training plan. Staff files showed that all necessary checks were undertaken prior to people being employed in the home. Good records were kept of these. In responses to our survey, all four of the members of staff who responded said they had not been able to work in the home until their pre-employment checks had been received by the Manager. At the time of the inspection the home was relying on staff from agencies to address the shortfall of staffing numbers. This was due to some care staff having recently left, the Deputy Manager having left and the Secretary being on long term leave. The Manager said she was aware that a reliance on agency staff can affect the consistency of care in the home but said she was addressing this by only using one agency and also by recruiting more permanent staff. She also explained that some of her own duties had not been undertaken fully while she has had to cover for the Deputy Manager and the Secretary. One aspect of her role that has been affected is providing Care Homes for Older People Page 22 of 30 Evidence: staff support and supervision on a regular basis. In response to our surveys one member of staff said there was always enough staff on duty, one said there usually were and two said there sometimes were. On the day of the inspection visit we did not observe anything that suggested there were insufficient numbers of staff to meet peoples needs. There had been a requirement from the previous Key Inspection on 4 August 2009 that staff must have training relevant to the role they are carrying out with particular attention paid to medication, safeguarding and mental health. By the time of the Random Inspection on 28 October 2009 we found that this requirement had been met. Training records seen on the day of the inspection visit demonstrated that staff had received training in medication, safeguarding and mental health. The home has a training plan in place which it produced in response to a requirement made at the previous Key Inspection. Since that time further training has been provided and the training plan now needs updating. All four of the staff who responded to our survey told us they thought the training they received was relevant, helped them understand how to do their job, kept them up-todate and provided them with enough knowledge. Care Homes for Older People Page 23 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager has not undertaken appropriate training for managing the service and staff do not receive regular support and supervision. The Providers cannot currently meet the needs of people who live there without external support. The quality assurance system in the home needs further development and the home needs to implement its own policies and procedures to inform effective service delivery in the home. Environmental health and safety is generally well managed, but the individual health and safety of individuals is compromised by the ineffective management of risk. Service users benefit from the way the home looks after their financial interests. Evidence: We looked at the management processes in the home, spoke with the Manager, referred to the homes Annual Quality Assurance Assessment (AQAA) and to responses to our survey. We also looked at health and safety records, quality assurance records, the safekeeping and records relating to service users money and staff support and Care Homes for Older People Page 24 of 30 Evidence: supervision records. The Manager told us in the AQAA and in discussion that she had previously begun working towards a qualification in managing care homes and was looking at restarting the qualification with another training provider. She had spoken with the new provider on the day of the inspection visit to plan an initial meeting. The home has some of its own policies and procedures in place, which have been devised as issues have arisen in the home. Other policies and procedures in the homes file are merely draft or guideline documents produced as examples by a care association. The home needs to introduce and implement its own policies and procedures. There had been a requirement from the previous Key Inspection on 4 August 2009 that the home must not keep service users personal monies in the homes bank account. By the time of the Random Inspection on 28 October 2009 we found that this requirement had been met. At this current inspection we looked at the records of service users money and checked them against the amount of money the home was looking after for each person. The records matched the amount of money each person had. Receipts were kept to demonstrate expenditure where possible and the records were clear and up-to-date. The home has some quality assurance systems in place including sending out questionnaires to service users, residents meetings and monitoring of service provision by the Manager. At present these are not coordinated into an overall quality assurance process where information is gathered from a wide range of sources, analysed and then used in producing a development plan for the service which can be implemented, monitored and reviewed. In discussion, the Manager was aware of the need to do this in order to ensure that the service itself was able to identify and respond to aspects of the service that needed improvement rather than have to respond to improvements required by outside agencies such as purchasers or th Care Quality Commission. The service provided in the home is currently monitored by Southampton Adult Services who have told us their monitoring will continue until they feel it would be safe for them to withdraw from this. All nine of the service users who responded to our survey told us they thought the staff in the home listen to and act on what they say. One healthcare professional told us they thought the Manager was keen to improve the service. The AQAA told us that workplace risk assessments are carried out on a regular basis and action taken, where necessary, to ensure the safety of people who live and work Care Homes for Older People Page 25 of 30 Evidence: in the home. It also told us the Manager undertakes regular inspections of the building to identify any new hazards. On the day of the inspection visit we looked at the workplace risk assessments and found they were up to date and that they were amended where necessary, for example where a new carpet had been fitted. We also saw records demonstrating the Managers weekly checks of the building. These were up to date and it was possible to see where issues had been identified and responded to. Staff files showed that staff were not receiving support and supervision sessions on a regular basis. In response to our survey two staff said they received adequate support and supervision from their Manager and two said they sometimes did. In discussion with the Manager she acknowledged that support and supervision had not been occurring as regularly as it should and said this had been largely due to her increased workload while there had been no Deputy Manager and no Secretary working in the home. Staff working in the home must have regular supervision in order to ensure safe and effective outcomes for people living in the home. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must describe the 23/04/2010 support each person requires. So that their needs can be met consistently. 2 8 13 Where there are concerns about peoples healthcare needs the home must monitor effectively and contact healthcare services as necessary. So that peoples healthcare needs can be met 23/04/2010 3 9 13 Medication records must accurately record how much medication has been administered on each occasion. To ensure people receive medication safely. 23/04/2010 4 12 16 The home must fully assess the social and leisure needs of people living there and provide a programme of activities that reflects these. So that people have the benefit of stimulation and activities they will enjoy. 23/04/2010 5 26 23 The Manager must ensure that there is a cleaning schedule in place which is closely monitored. So that people live in a clean environment. 23/04/2010 Care Homes for Older People Page 28 of 30 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 6 31 9 The Manager must undertake 21/05/2010 appropriate training. To ensure that the home is managed effectively 7 33 24 The quality assurance 21/05/2010 system in the home must be further developed. To demonstrate that there is a plan of development for the service based on the views of people living in the home. 8 36 18 Staff working in the home 23/04/2010 must receive regular support and supervision. So that people can be managed effectively, service delvery can be monitored and training needs identified. 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 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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