Inspection on 12/06/09 for Haylands

This inspection was carried out on 12th June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haylands 15/03/10

Haylands 26/08/09

Haylands 19/06/08

Haylands 19/07/06

Haylands 22/02/06

Haylands 29/09/05

Haylands 18/01/05

Haylands 06/07/04

Haylands 23/02/04

Haylands 23/10/03

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

Key inspection report Care homes for older people Name: Address: Haylands 93 Crofts Bank Road Urmston Manchester M41 0US     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: Sylvia Brown     Date: 1 2 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Haylands 93 Crofts Bank Road Urmston Manchester M41 0US 01617483185 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Urmston Housing Society care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Male. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 24. Date of last inspection Brief description of the care home Haylands home for retired gentlemen is registered to accommodate a maximum of twenty-four service users who require personal care by reason of old age. The home is situated within walking distance of Urmston town centre with public transport routes close by. The building is a large detached Victorian house with well-maintained enclosed gardens. There is off road parking at the front of the property. There are fourteen single rooms and five twin bedded rooms. Two of the single rooms have ensuite facilities and there are toilets and bathrooms on each floor. A stairlift provides access to all floors and there are additional toilet facilities on the ground floor with disabled access. The fees for accommodation are 250 pounds per week and the fees Care Homes for Older People Page 4 of 32 Over 65 24 0 Brief description of the care home include all meals, laundry, domiciliary chiropody and entertainment. Additional costs include hairdressing, dry cleaning and telephone calls. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service would experience adequate quality outcomes. The inspection report is based on information and evidence gathered by the Care Quality Commission (CQC) since the last key inspection, which was completed in June 2008. This was a key inspection which included a site visit to the service. The site visit was unannounced which means the manager and staff were not told that we would be visiting. For reporting purposes when referring to the Care Quality Commission(CQC) or the Inspector acting on the behalf of the CQC the term we is used. As part of the inspection process we gathered information from a number of people which included talking with and seeking the views of service users. Prior to the site Care Homes for Older People Page 6 of 32 visit we also sent out surveys to service users and members of staff. This gave them an opportunity to tell us about their opinions on the services provided at the home. Comments received are included within the report. In April 2009 the manager completed a self assessment form, which is called an Annual Quality Assessment Audit(AQAA). This document should tell us in detail what they and the registered provider have done since the last key inspection to meet and maintain the National Minimum Standards. It should also tell us what the manager and the registered provider felt they were doing well, how they had improved within the past 12 months and plans to develop in the next 12 months. The AQAA we received contained basic but sufficient information enabling us to have an overview of the service. We also gathered information from general contact with the home through their reporting procedures which are called Notifications and information we may have received from other people, such as the general public and professional visitors. We have not received any complaints about this service and have been notified of one allegation of abuse. The allegation was in the process of being investigated by the Local Authority under their safeguarding procedures. For reporting purposes the preferred term to be used for people living and receiving a service at Haylands is service users. This report is a public document and should be on display within the home and can be made available for reading upon request. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Whilst there continues to be some shortfalls in the service the registered manager and provider have continued to develop and improve parts of the service. As a consequence of listening to service users the menu have been changed and updated. The menu now includes a mid week full roast dinner and daily fresh fruit. A new supper Nite Bite menu has been introduced which means service users have a choice of food items throughout the night should they feel hungry or peckish. One service users stated within the survey that the food is good. Care Homes for Older People Page 8 of 32 Thirteen service users have received new beds and a number have received new non slip floor covering in their bedrooms. The activities programme has been developed and improved with increased outings and weekly entertainment. New light fittings have been put into place into various parts of the home including the dining room. This along with newly painted woodwork makes the dining area a more inviting place to sit. Extensive upgrading of equipment has been provided within the kitchen, this includes new ventilation systems to comply with current legislation. 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 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know that the care home can support them before they move in. This is because there is an assessment of their needs that they,or people close to them have been involved in. This tells the home all about them, what they hope for, want to achieve and the support they need. Evidence: Since the last inspection the registered manager has provided us with a statement of purpose and service users guide which had been reviewed and amended to make sure all the information was up to date. When we looked around the home we saw that each service user had copies of the documents in their rooms. Two of the three service users surveys stated that they had received enough information about the home to help them make a decision about moving in before any plans to accommodate them were made. Of the two service users we case tracked we found prior to admission both had preCare Homes for Older People Page 11 of 32 Evidence: assessment records in place which had been completed by the placing Local Authority and that the registered manager had visited both service users in their placement to complete her own assessment. Though these assessments were brief they supplemented the Local Authority information which together identified the service users needs and most of their personal preferences for care had been assessed. Service users , their family and friends are invited to visit the home and look around, talk with other service users and observe daily routines before making any decisions about moving in. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager makes sure each service user has a plan of care which they or a person close to them have been involved in making. Service users are able to make decisions about their life and how they would like to be supported, but this is not always recorded in enough detail. Service users receive support to maintain good health as far as possible, however the manner in which medication is managed, recorded and administered is not correct or safe. Evidence: Throughout the inspection we observed service users well dressed and cared for, some gentlemen wore formal clothing which included suit jackets whilst other chose to wear causal clothing, this indicated that they were able to chose their own clothing and had received support to dress as they preferred. We had the opportunity of consulting with service users during the site visit, when asked their opinions on the services and support they received they said staff are all Care Homes for Older People Page 13 of 32 Evidence: right...everything is ok and I like it here. We looked at the care files for the two service users we case tracked and found that some improvements had been made regarding the recording of information. However, there continues to be an opportunity for the registered manager to develop care plans further to make sure they reflect all the individual needs and preferences of service users. We could not always tell if the registered manager had consulted the service users about their last dental treatment, optical and hearing tests when they moved in. One service user said they had received chiropody treatment the day before the site visit. Care plans did not sufficiently detail daily oral health care support and how that applied to each service user. The registered manager should develop the care plans to make sure they include service users individual support requirements and preferences with such things as nail care, shaving, oral health, bathing and dressing etc. One file contained a waterlow chart that was incorrectly completed which meant the service user could have been at risk of having an incorrect general health assessment completed. The six weeks continence assessment charts for another service user was completed for only one week within which some days were not recorded. It is important for the registered manager to make sure all health care assessments and information are correct and reflect their current health condition. Daily care records did not reflect the rising and retiring times for service users,the individual care support they received , their individual achievements or daily routines, furthermore nighttime records failed to record what support was provided or if care staff had provided light snacks and drinks which we are told are available. Records should accurately reflect the service users daily and nighttime routines including the times when support is provided. We looked at a sample of medication administration records and found that signature omissions were evident therefore we could not be sure that service users always received their medication as prescribed. Prescribed creams were not always recorded when administered and records for those service users who self administered were unclear. We saw a member of staff administering eye creams to service users whilst they sat at the dining table with others, in one bedroom we found that a prescribed cream had the prescription details obscured and was being used for another service user. Handwritten medication records did not contain a second signature to confirm the administrations details as correct. Care Homes for Older People Page 14 of 32 Evidence: We have previously identified similar failings at the last key inspection and have concerns that the registered provider has not ensured that the management, recording and administration is not done safely. The registered manager stated that there was a full audit of all rooms had been undertaken and that as resources allow all rooms will be refurbished. The AQAA states that plans were in place to provide a new call system throughout the home. Though we have been told that improvements are to be made at the home ground floor toileting and showering facilities continue to be institutional and need modernising. Throughout the inspection the main door to the area remained open, which meant service users feet could be seen from the corridor when they were using the facilities and conversations could be heard when they were receiving support. The registered manager should make sure privacy is maintained at all times for service users. During the course of the inspection we observed service users being supported to pay their last respects and attend the funeral of a friend and service user of the home. We observed that the bereaved family were able to visit the home and commence the proceedings from Haylands. The registered manager stated that when service users are nearing the end stages of life a specific detailed twentyfour hour end of life care plan is put into place which ensures that they receive the one to one support they require and that friends and family are supported during this time. 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. Service users are able to take part in activities that are appropriate to their age and culture and are able to visit places within the local community. They are as independent as they can be and lead their chosen lifestyle and have the opportunity to make the most of their abilities. Service users dignity and rights are respected and they receive healthy, wellpresented meals and snacks at a time and place to suit them. Evidence: Service users at Haylands are able to share their opinions about the services and make suggestions for change through regualr meetings with the registered manager. We looked at three service users meeting records and found that suggestions made by service users had been acted upon. We have given the registered manager advice on ways to expand the areas for discussion within the meeings to include such things as how service users feel about the support services they receive , the conduct of staff, be involved in the selection of staff and become familiar with some policies and procedures which may affect them. Care Homes for Older People Page 16 of 32 Evidence: The registered manager and staff have improved the frequency of activities within the home. Service users have weekly events such as a Cinema like experience,games and crafts. The registered manager stated that currently staff and service users are developing teams in preparation for Wii challenges which will take place throughout each month. Service users are also given the opportunity of visiting outside places of interest within the local community and surrounding areas. However some service users have stated that the days are long when there is nothing to do and even though we go out for meals, I could do with doing a bit more. The registered manager told us she recognises that the social activities could be developed more and that plans are in place to continue developing the amount of daily activities available. In addition to service users being supported to go to local shops, for those who prefer to remain at home consideration is being given to providing a small shop within the home which is run and staffed by service users, furthermore the registered manager stated service users are to be supported to buy the supplies for the shop and consult with others about their requests for goods. As stated previously daily records did not contain sufficent information. Iin addition to what we have said daily records or the activities folder did not demonstrate service users individual participation in activities. We had the opportunity of observing service users during a meal time. Support and assistance was given correctly and service users appeared to enjoy their meals. Since we last inspected, the registered manager has developed the menu and has included a Nite Bite menu which states 3am and a little peckish....we have a choice of tasty bites to appease your appetite. Service users surveys identified that they were satisfied with the variety of meals they received, with one service user told us I am well fed. Service users are able to have a choice of full cooked breakfasts each day at times suitable to them. They are able to chose when they receive their main meal of the day and have snacks made available to them throughout the day. Most service users have friends and family who visit them , they are able to join the service user for a meal if they wish and family gatherings can be arranged at the home. Service users have ample space to receive visitors in private. Visitors to the home sign the record of visitors book so the registered manager can assure herself who is on the premises at any given time. Throughout the inspection we observed many occasions when staff supported service users. We could see that staff members and service users had formed positive Care Homes for Older People Page 17 of 32 Evidence: relationships and that service users felt at ease with members of staff. One resident told us they are nice girls another said they are alright you know, they look after us well. Care Homes for Older People Page 18 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. Service users are protected by written adult protections and complaints procedures which they are made aware of and know how to use when required. They are supported by care staff who are appropriately trained in the Protection of Vulnerable Adults procedures . Evidence: From the information we received from service users surveys and through consulting with them at the site visit, we know they have been informed about the homes complaint procedure and knew how to make a complaint or raise any issues of concern they have. Each bedroom contained a copy of the service users guide and statement of purpose, and their views about the service have been sought at some service user meetings. We have received no complaints about the service. The AQAA completed by the registered manager confirmed that no complaints had been received at the home within the previous year. There has been one allegation of abuse made at the home which was at the time of the site visit being investigated under the Protection of Vulnerable Adult. As with the complaints procedure, service users surveys confirmed that they would report any concerns they may have to the manager or someone they trusted. All service users surveys identified that they had someone with whom they could confide in. Care Homes for Older People Page 19 of 32 Evidence: During the site visit we had the opportunity of speaking with staff members , they were able to confirm they had received training or were awaiting formal training in the Protection of Vulnerable Adults and they were all able to competently explain their role and responsibilities for reporting any suspicion of abuse. The manager told us that she that all staff had received information and training in the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA DOLS) had been provided to staff and new policies and procedures implimented. . At the time of our visit no one living at the home was subject to an application being made under these requirements Care Homes for Older People Page 20 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. Service users have communal living space which is homely and inviting. Private areas are not maintained to the same standard or in a consistent manner. This has an impact on some service users and their satisfaction with their rooms. Evidence: Haylands continues to make arrangements to support those service users who prefer to smoke. Unfortunately the arrangements in place still have an affect on others within the home and the environment. Throughout the inspection the door for the designated lounge for smoking remained open, when asked staff and service users confirmed this was common practice to enable service users to freely move around the home without hindrance. Because of this there is a strong smell of smoke on the ground floor which could be smelt in the main hallway, the additional lounge and dining room. This is further increased when members of staff who smoke take their break. During the inspection it was common practice for members of staff to smoke together at the side door of the home with the door open, this door has direct access to the hallway within the home. This meant the smell of smoke increased at those times. The registered manager confirmed she has a smoking policy and procedure in place and that additional ventilation had been put into the designated lounge to reduce the affects on others. She acknowledged that staff smoking practices were incorrect and that she would take action to improve practice and amend the smoking policy and guidance. Care Homes for Older People Page 21 of 32 Evidence: Prior to the inspection service users surveys alerted us to the fact that some service users were not happy with their rooms, one told us I requested another room as the one I am in is dark with frosted glass windows, the social worker said I should be moved when a new room becomes vacant with an en suite. The room next to me became vacant ....was very sunny as it gets the sun, but they gave it to a new service user. Another said its ok but I have no window. When we looked around the home we observed that a number of rooms have frosted glass windows which means that service users cannot see out and there is less natural light. Other service users only have a sky light in their rooms which means they have no window at all to look out of. We informed the registered manager that action must be taken to ensure that all service users have windows in their rooms which they can see out of. We also discussed with the registered manager the opportunity of service users changing their rooms if they wish. She gave assurances that service users are offered alternative rooms if they make a request for a change, however she stated that often service users decline the offer when made. We could find no information to support service users had been offered alternative rooms or their response to the offer. During our inspection of the building we saw many rooms which required some improvements. Some rooms did not have bedside lights or side tables, some had an overhead light hanging from the ceiling but the cord to use this light was not within easy reach for service users. We saw furniture which was of good quality in vacant rooms whilst rooms used by service users had faulty furniture and mismatched furniture. One service users room was laid out to support them to see out of the window, however the television could not be seen from the seating area. When we checked the furniture within the room at least one large set of draws was empty, when asked the staff member explained the service user did not need it and it was left by a previous service user. There were no odours of incontinence in the home and cleaning routines appeared good, all the rooms observed were clean and tidy. The laundry area did not meet required standards for infection control. Floor and wall finishes are not sufficient to make sure they can be cleaned to the correct standards because they are of brick and stone. There was no appropriate sluicing facility and the washing machine did not have appropriate disinfectant programmes which ensures soiled linen or clothing is laundered correctly. Although the staff member responsible for laundry within the home had attempted as far as possible to make sure soiled linen and clothing was laundered to the best of her ability, practice were not correct and were not sufficient to prevent the spread of infection to the staff member when Care Homes for Older People Page 22 of 32 Evidence: laundering. When we looked at training records we identified that training in infection control was outstanding for most members of staff. Care Homes for Older People Page 23 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. Service users receive support from appropriately recruited staff who have received training and supervision. Evidence: The AQAA identified that 100 of care staff have completed a NVQ at level 2 or above. This exceeds what we require and indicates that staff are supported well to develop their practice. Since the last inspection the registered manager has improved administration systems to demonstrate her practice in respect of recruitment, supervision and training of the staff team. We were able to look at supervision records and can confirm that staff members receive regular and routine supervision and are able to attend staff meetings. When talking with some staff members they told us that they received updates on policies and procedures during staff meetings and their knowledge was tested about these at supervision. We saw a number of staff meeting minutes which confirmed what staff said. The registered manager explained that because of training in NVQs other training had not been completed at the required frequency, as a consequence she was at the time Care Homes for Older People Page 24 of 32 Evidence: of the site visit making arrangements to ensure mandatory training is completed as a priority. We have requested an up to date training matrix which identifies planned and completed training for all staff members. The service users at Haylands are supported by a stable staff team. The AQAA identified that one member of staff has left within the previous year. This means that service users are cared for by people they know, like and trust. When asked about the staff, service users told us they are all right, they do everything for us. Three service users told us that there were enough staff available and that they usually listened to them and acted upon what they said. Recruitment and selection procedures continue to be carried out appropriately. We looked at two staff files and found they contained the required information. Application forms were in place for positions applied for, face to face interviews had been completed and statutory checks undertaken. New staff had completed the homes induction and were completing the Skills for Care Common Induction Programme as required. The staffing rota continues to identify a shortage on ancillary staff at weekends. Domestics are not employed at weekends and gaps were evident for the cooks position. There are no changes to the demands on the service at weekends therefore it is expected that ancillary staff continue to support service delivery at weekends. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a home which is manage by a person fit to be in charge and who attempts to ensure their comfort and safety. Evidence: There have been no changes to the management structure since the last inspection. The registered manager has worked hard to achieve the required improvements since the last inspection, however the inspection has identified that parts of the service are not maintained appropriately which means potentially service users are at risk of harm. Health and safety records confirmed that appropriate servicing of equipment and services are carried out routinely. We are told that there are no changes to the way the registered manager supports service users with their finances. Generally service users families assist the service Care Homes for Older People Page 26 of 32 Evidence: users with their financial arrangements . Receipts for expenditure and accounting records are held on file where the registered manager holds small balances for service users. The registered provider does not conduct full annual quality assurance procedures as required. We know that service users views are sought because they told us and we read records of service user group meetings which clearly identified that their views on the service were sought. However a full quality assurance audit of the service should take place which seeks the views of all stake holders including service users, relatives, visitors and staff members. Following the audit a report should be made available to the public of the outcomes, a copy of which should be supplied to us. We also noted that the last quality audit surveys completed in 2005 were attached to the statement of purpose. The information identified service users and some of their comments made. This is not appropriate and should be removed. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) The registered manager 31/07/2008 must make sure that medication administration procedures are carried out in a safe and appropriate manner thereby ensuring that service users receive the right medication. Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The registered person must make sure that the building complies with fire safety regulations at all times and cease wedging doors open. In order to minimse the risk of smoke inhalation and the spread of fire in the event of a fire emergency. 23/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should continue to be developed to make sure they reflect the individual needs of service users and how they should be met. They should be person centred and reflect service users individual wishes for how support should be provided. Daily records should record sufficent details to idnetify the service users daily routines, health care support provides and their personal acheivements. Systems should be in place to record service users last health care checks including, dental, optical, hearing test and any future appointments planned for. Page 29 of 32 2 8 3 8 Care Homes for Older People 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 4 12 Systems should be in place to make sure that service users have daily oportunities to join in social activities and that their participation should be recorded within their own personal records. The registered person should make sure robust infection control procedures are in place and practiced at all times, including the handling and laundering of soiled bedding and clothing. For the protection of service users and staff, all staff should be trained in infection control procedures. The registered person should make sure that laundry facilities are maintained to the correct standards. Floor surfaces should be impermeable and wall finishes are readily cleanable. This should provide service users with improved natural lighting within their rooms and offer them views of the outside The registered person should make sure all bedrooms used by service have appropriate windows in place which conform to recognised standards. 5 19 6 7 19 19 8 23 9 24 The registered person should make sure all service users bedrooms are furnished to a good and appropriate standard suitable to meet their individual needs and preferences. Systems should be in place to record service users requests to change rooms and the reasons why, what action has been taken to support those requests and the outcome. To ensure that service users receive continuity of support services at all times, staffing arrangements should ensure there are sufficient ancillary staff employed to support service delivery at the home at weekend. An up to date training matrix should be provided to us which demonstrates planned and completed mandatory training for all staff. The registered provider should make arrangements to ensure Regulation 26 visits are completed monthly. Records of those visits should be recorded and made available for inspection when required. 10 24 11 27 12 30 13 31 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 14 31 To make sure the registered manager has the appropriate opportunities to run and manage the care home safely, consideration should be made to withdrawng her from the care staffing rota, making sure she is supernumerary to care support numbers. A quality audit should be completed which includes seeking the views of service users, relatives, staff and other stake holders. Upon completion a report should be published and provided to service users and us. 15 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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