Inspection on 07/08/09 for Heronswood

This inspection was carried out on 7th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heronswood 30/09/08

Heronswood 12/09/07

Heronswood 10/07/06

Heronswood 05/12/05

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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: Heronswood Heronswood 51 Harestone Hill Caterham Surrey CR3 6DX     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: Jane Jewell     Date: 0 7 0 8 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 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: Heronswood Heronswood 51 Harestone Hill Caterham Surrey CR3 6DX 01883344645 01883341232 gurl_red19@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: S.E.S Care Homes Ltd care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 21 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Heronswood is a converted domestics detached property, which is registered to provide care and accommodation up to twenty-one older people. The home has been a care home since 1986 with the current owners purchasing the property in 2005. The organisation also own and operate three other registered care homes in the South East. The home is in an elevated position on the outskirts of Caterham and its amenities being a short journey away. The home is presented over three floors with the upstairs accommodation accessed by a shaft passenger lift. Due to the layout of Care Homes for Older People Page 4 of 30 3 0 0 9 2 0 0 8 21 0 Over 65 0 21 Brief description of the care home the building the home is not suitable for residents who have a permanent restricted mobility. Communal space consists of two lounges, a dining room and a small conservatory. There is a rear sloped garden with a patio area, the front area of the home is paved to provide parking. Residents accommodation consists of nineteen single bedrooms with the vast majority providing en-suite facilities. The home provided long and short term placements The fees for residential care are currently in the range of £662 to £574 per week, depending on room and the funding arrangements. Extra such as: newspapers, hairdressing, chiropody, toiletries are additional costs. Refer to the homes literature for the actual amounts charged for any additional costs. 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: The information contained in this report has been comprised from an unannounced inspection undertaken over five hours and information gathered about the home before and after the inspection. The home had completed an Annual Quality Assurance Assessment (AQAA). This contained only limited information about the home, which was fedback to the person who completed it. This is the second key inspection within twelve months. An improvement plan had been submitted by the home following the previous inspection which highlighted the actions being taken to address the previous shortfalls. Part of this inspection involved confirming whether that these shortfalls had been addressed as well as looking at the experiences of people living at the home. The inspection was facilitated by the Ms Devianni Dinand (the person appointed by the provider to manage the home and hereafter referred to as the person appointed to Care Homes for Older People Page 6 of 30 manage. The inspection consisted of being shown the communal areas, and being invited to view some residents bedrooms, examination of the homes documentation and observations of residents daily routines and in their interactions with staff during lunch time and over the afternoon period. Seven residents, two staff and two relatives were interviewed as part of the inspection process. Feedback surveys were sent to the home for distribution, in order to obtain the views on the quality of the services and facilities being provided. Three were returned in total, one from a resident, one from staff and one from a relative. Their feedback is included in this report. There were seven residents living at the home at the time of the inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? All of the previous shortfalls noted at the last inspection have now been addressed or are in the process of being fully addressed. This has significantly improved residents safety through improved risk and fire safety management and residents quality of life through increased opportunities for occupation and stimulation. . Although the home has remained without a registered manager since 2006, positive steps have now been taken to ensure that a suitable competent manager has been appointed by the provider and who now provides a clear sense of leadership and direction enabling staff to provide good quality care. A relative commented improvements made under the current manager as she is there all the time and she talks to us and lets us know what is happening. A staff member commented good always helpful instructs us on how to do things she is very knowledgeable she is training us well very good with residents who all like her. Care Homes for Older People Page 8 of 30 Although there have not been any new admissions to the home since the previous inspection, new assessment documentation has been developed which will enable a range of information to be obtained about a prospective residents needs to enable management to make an informed decision as to whether their needs could be safely met by the home. Care plans now provide staff with the guidance they need to provide consistent and individual care to meet the needs of residents Although work is still needed to the environment to ensure that it is fit for purpose and fully meets the needs of older people who have mobility restrictions, progress has been made towards identifying the adaptations needed. Managements understanding of the restriction the building imposes on being able to meet residents needs has increased with mobility now a significant factor in the Homes admission criteria and residents moved internally around the home to ensure a more suitable accessible environment. Standards of cleanliness and hygiene have improved, with more robust management of malodours. A resident commented the place is always clean nowadays and does not smell. New staff have been recruited who have experience in working with older people combined with the training has helped improve staff competency and skills. This has ultimately led to improved practices at the home. A relative commented staff at the moment are fine much improved of late. 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 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 10 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. The home provides both prospective and existing residents, with a range of information about what services are provided and what to expect when living at the home. The way in which prospective residents would be assessed helps ensures that the home admits only those residents whos needs can be met by living at the home. The home is able to identify and meet most needs of the residents living at the home through a quiet gentle relaxed lifestyle provided at the home. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, provide a range of information about the home. These are made available at the home and given to prospective residents, representatives and other interested Care Homes for Older People Page 11 of 30 Evidence: parties. The manager said that there have not been any new admissions to the home since the previous inspection. In line with the previous requirement, needs assessment documentation has been developed which would enable a range of information to be collated about a prospective residents needs. This would then help the person appointed to manage make an informed decision whether their needs could be safely met at the home. The person appointed to manage showed a clear understanding of the admission criteria for the home and the level of residents needs that could be met and the restrictions that the building places on the level of needs the home could safely meet. There is a range of needs being accommodated at the home this includes the majority of residents who have developed dementia including some who also have physical needs and mental health conditions. The majority of residents have lived at the home for several years and are assessed as having medium levels of assessed needs. Through observation, looking at records and speaking to residents, staff and relatives, there was evidence that the home is meeting the needs of residents and offers a quiet relaxed gentle lifestyle. However, further work is needed to the environment to ensure that residents who have restricted mobility needs can be met. This is discussed under standard 19 of this report. All persons consulted regarding the home largely spoke positively about their experiences. Resident said I like it here they are kind to me and it has a caring family atmosphere all of the staff are friendly caring and at the same time professional I feel very well care for and my medical needs are also attended to promptly. A sample of comments by relatives included For me the most important thing is that he is safe and well cared for at the home and small friendly home mixture of clients not all have dementia needs of all seem to be taken into consideration. A staff member felt that the best bit about the home was the good standard of care which was provided. The person appointed to manage confirmed that residents are provided with a written contract of terms and conditions of residency with the home with copies maintained in their personal files. This enables residents and their families to be informed of the placement arrangements and to clarify mutual expectations around rights and responsibilities. The person appointed to manage confirmed that any new residents would be provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Care Homes for Older People Page 12 of 30 Evidence: The first six weeks of occupancy is looked upon as trial occupancy. Where social services are the placement authority it is usual practice that within this period a review be undertaken to determine whether the residents wishes to stay permanently or not. Intermediate care is not offered at the home therefore this standard is not assessed. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the care planning process means that they now provide staff with the necessary guidance to provide safe, consistent individual care. The health needs of residents are well met with evidence of regular input from a range of health care professionals. Medication practices are well managed promoting good health. Personal support is offered in ways, which promotes and protect residents privacy and dignity. Evidence: Much work has been undertaken to improve the standards of care planning and risk assessments. This includes the inclusion of person centred information, for example food preferences, hobbies, interests and cultural needs, which has been collated with the help from relatives. Five care plans were viewed and these showed that staff had a range of guidance on the needs and preferences of residents, including any risks residents face and pose. The information included in the care plans would enable staff Care Homes for Older People Page 14 of 30 Evidence: to deliver consistent support to residents based on their individual needs and preferences. The home maintains a daily record for each resident on events and occurrences, which are now recorded individually making it easier for staff to retrieve information. The tone of language used was respectful and linked to residents care plans. The home works closely with a range of health care professionals including GPs, dieticians, district and specialist mental health nurses, chiropodists, opticians and dentists to ensure residents receive a range of health care intervention. An example was noted whereby prompt health care support had been obtained for a resident. A resident also confirmed that when they have asked to see a GP then an appointment has been made quickly. None of the residents accommodated are assessed as safe to administer their own medication. Residents are on stable medication regimes with few changes noted. Annual medication reviews were reported to be undertaken. The medicine administration practice observed was seen to be safe and the records demonstrated that systems are in place to ensure staff are appropriately trained and records are accurate and provide a history of what was given by who and when. Good practices were noted in the management of As prescribed medication which provided staff with some guidance on when they should be administered. Staff consulted with showed a clear understanding of good practices in preserving residents rights to privacy and dignity. Staff were able to give examples of how they promote these rights in their every day care practices. This was supported by the inspectors own observations of residents personal appearance and interactions between staff and residents. A resident said that staff knocked on their door before they entered. A relative spoke of how important personal appearance was to their relative and that their relative was presented well in accordance with their personality and preferences. 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. Residents are treated as individuals and are able to exercise some choice and control over their lives with flexible routines being part of daily practice at the home. Links with families and friends are valued and supported by the home. Residents lives are enriched by the home providing various opportunities for occupation. The meals are good offering both choice and variety. Evidence: Much effort has been undertaken to improve opportunities for residents to participate in meaningful occupations. This includes identifying residents individual preferences in their care plans and developing a monthly plan that informs residents and their families what activities will be available. Residents spoke of participating in bingo, gentle exercises and quizzes. Residents said they particularly enjoyed listening to music and nail painting. Consistent feedback was received with regard to the need to create opportunities to go out on outings. The person appointed was aware of this and was in the process of arranging suitable transport to be able to take residents into the community. Care Homes for Older People Page 16 of 30 Evidence: Without exception, all residents and relatives commented positively on how welcome they or their visitors were made to feel when visiting. A relative commented No restrictions I can visit whenever I want always made to feel welcome always offered refreshments. A resident spoke of being able to use the homes phone to keep in contact their family. Positive feedback was received on the good communication between the person appointed to manage and relatives with a relative commenting I am always informed of any changes in my mothers care straight away. Observation of the daily routines and discussion with staff confirm that staff accommodate residents personal wishes with regard to meal times, going to bed, rising and bathing. A residents said I just tell them what time I would like to go to bed. For a few people living at the home, exercising their choice was more difficult. The staff were seen to use their acquired knowledge of a person to help them make choices with regard to their dress, food and drink. Care plans now record a range of residents personal preferences including food, beverages and occupation. Consideration has also started to be given to new legislation (Mental Capacity Act) which affects residents rights to make decisions in their lives. Staff spoke knowledgeable about the individual cultural and religious needs and preferences of residents. . The inspector observed part of the lunch time meal which was presented well with individual preferences respected. Menus were reported to based on residents likes. Residents who required supported received largely discrete assistance from staff. However, to further promote good practices, when assisting residents to eat, staff should be sitting at the table when assisting residents rather than standing or kneeling over residents. The majority of residents eat their meals in a pleasantly decorated environment conducive to providing a relaxed environment which also helped to promote orientation for people who have dementia. Residents feedback on food included food very good they get me something else if I do not like it and food all very good. A resident did comment food not too bad no cooked sweets more or less ice cream or bought puddings which was fedback to the person appointed to manager to address. In between meals residents confirmed that they are offered drinks and snacks. 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. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents. Evidence: There is an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. All residents and relatives consulted said that they felt able to share any concerns they had with the person appointed to manage. The manager reported that there have been no formal complaints to the home since previous inspection. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted said they had received formal training in safeguarding adults and prevention of abuse and showed an understanding of their roles and responsibilities under safeguarding adults guidelines. There has been no safeguarding referral made to social services since the previous inspection. Care Homes for Older People Page 18 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant improvements have started to be undertaken to ensure that the building is fit for purpose and can meet the needs of older residents with mobility restrictions. Parts of the environment remain poorly decorated and maintained which does not create a pleasant and safe environment in which to live. Improvements to hygiene standards now means that residents live in a clean environment. Residents personal accommodation is individualised with their personal effects around them. Evidence: The home is in an elevated position on the outskirts of a town centre, access to local facilities involves a short journey or walk that involves a steep inclines. Variable standards of maintenance and repair were again observed throughout the home. The person appointed to manage confirmed that there is a maintenance and redecoration plan. However, due to significant problems in recruiting suitable maintenance staff, much of the work that should have been undertaken to date has not yet been completed. Relatives commented environment its an old house so there are many restrictions on it but it is quiet and clean could do with a lick of paint and Care Homes for Older People Page 19 of 30 Evidence: environment ok I suppose pleasant enough bedroom no unpleasant odours always kept clean. A staff member commented environment it could be better in places but on the whole it works we keep it clean. The outside of the building appears extremely unkempt and uninviting with stored road works equipment on the drive way and pigeon excrement around the building, steps and pathways. The person appointed confirmed that they are awaiting a new sign for the home following the vandalism of the previous sign and have obtained quotes for pest control to manage the pigeon population. Communal space consist of a lounge, dinning room and small conservatory, much effort continues to be made to create a homely feel to these areas. There is a rear sloping garden, which is set to lawn with flower beds and a paved pathway leading to small patio area which is not accessible to residents to use safely and independently. The garden area was currently uninviting and was not a nice area for residents to look out upon or use. It has been required for some time that the external security arrangements be reviewed to ensure the safety of the residents. A wire fence has been put around parts of the garden but there remains a need for a gate in order to fully secure the garden. The person appointed to manage confirmed that a gate is due to be fitted in the near future, and that efforts will be made to make the garden more inviting. They spoke of the long term plan to level out the garden in order to make it more accessible and safe. The home is presented across three floors with the vast majority of residents accommodation above ground level. The stairs to the second floor were noted to be particularly steep and required considerable mobility to use them safely. It was reported that no residents use the stairs, all use the lift and have to be accompanied by a member of staff. Consideration has now been given to residents with mobility restrictions in the event of fire and have moved to bedrooms to the ground floor. Corridors above ground floor are narrow and in some parts dark and do not enable ease of access. Residents confirmed that their bedrooms provided everything they needed and that they could individualise their bedrooms with personal effects. A resident said that there is always plenty of hot water when they needed it. Two vacant bedrooms were noted to be without window restrictors to prevent the risk of accidental falls. Before these rooms can be occupied, windows must be risk assessed and any measure put into place to ensure residents safety. One bedroom door could not be opened fully due to the radiator fitted behind the door. There is sufficient number of toilets and bathrooms located around the home, including the majority of bedrooms providing en-suite facilities and assisted bathing Care Homes for Older People Page 20 of 30 Evidence: facilities. It was previously required that the premises be suitable for the purpose of achieving the aims and objectives and the physical design and layout of the premises meets the needs of the people for whom the service is intended. The person appointed to manage was much more aware of restrictions the building imposes on being able to meet the needs of residents with restricted mobility and residents have moved bedrooms in order to enable their needs to be better met. Furthermore, the restrictions of the building would now form part of the admission criteria to the home. In line with a previous requirement the home initiated for an assessment of its facilities by an occupational therapist to be undertaken. This was comprehensive and highlighted many areas of improvement and adaptations that could be undertaken. This included the fitting of hand rails and ramps to exterior steps, widening of door ways, improved pathways and accessibility in the garden to meet the needs of people with permanent restricted mobility. The person appointed to manage confirmed that they have started to undertake some of the minor improvements suggested which included the repair of call bells, bedroom door numbering and pictures of toilets displayed to help with residents orientation. It was previously required that robust procedures are put into place to ensure effective cleaning standards. Consistent feedback was received of the improved standards of hygiene and odour management. A resident commented the place is always clean nowadays and does not smell. Systems were in place for the control of infection and staff said that they have been trained in this area and were observed to be working in ways that minimised the risk of infection. 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. Staff make a positive contribution in residents lives, as residents benefited from a trained and enthusiastic staff team that know them and who are safely recruited and who are employed in sufficient numbers as is necessary to meet their needs. Evidence: Staff, relatives and residents felt that there was always sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed when they wanted it. Following the previous inspection, there has been some turnover of staffing. All care staff were observed to have a good rapport with residents, this promoted a relaxed atmosphere in the home. Staff were observed initiating conversations with residents who clearly recognised them and showed positive body language towards them. This included eye contact smiling and touching. Staff were observed providing gentle and affectionate support to a resident who clearly responded to this approach. Humour was effectively used in communicating with one resident. Residents comments about staff included they are very kind to me they seam to chop and change a bit but not a problem and staff very good indeed. A relative said staff they are doing a good job best they can they are attentive. However, the language barrier on a few occasion can be difficult and staff at the moment are fine much improved of late. Care Homes for Older People Page 22 of 30 Evidence: The person appointed to manage said that they are now purposely recruiting staff with National Vocational Training (NVQ) qualifications. Staff recently recruited are trained overseas nurses. The personal files of three staff were viewed and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing to help ensure that only staff who are suitable to work with vulnerable people are employed Staff consulted with said that they had undertaken all of the mandatory areas of training such as moving and handling, medication, first aid, food hygiene and fire safety in order to work safely with residents. The person appointed to manage has recently obtained training DVDs on a variety of subjects to enable them to provide the mandatory areas of training when needed. Staff have undergone some dementia care training since the previous inspection. New staff now undertake the recommended Induction standards. The person appointed also has some specialist areas of training planed for in the near future including the Mental Capacity Act. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home has been without a registered manager for some time, the current person appointed to manage has significantly improved practices at the home and provides a clearer ethos and values of the home that enables staff to provide good quality care to residents. Staff are being appropriately supervised and given direction to ensure good practices and the homes policies and procedures are being followed. The home has reviewed aspects of its performance through a good programme of selfreview and feedback. A range of regular health and safety checks and practices helps to promote the health and safety of residents and staff. Evidence: The home has been without a registered manager since 2006. It was previously Care Homes for Older People Page 24 of 30 Evidence: required that a manager be appointed and an application to register a manager be made to the Commission. There have been several people appointed by the provider to manage the home since 2006. A relative said manager a bit confused as to who it currently is as there have been a few in the last few years. Following the previous inspection another manager was appointed who worked at the home for three months before leaving. The current person appointed to manage was previously the deputy manager and facilitated the previous inspection. They confirmed that they were imminently about to make an application to become the registered manager. The person appointed to manage has obtained the recommended managers qualifications and has clearly made a positive contribution towards addressing the areas of shortfall noted at the previous inspection. All persons consulted about the home spoke positively about them and their comments included she is lovely very helpful always keeps us updated improvements made under the current manager as she is there all the time and she talks to us and lets us know what is happening. A staff member commented good always helpful instructs us on how to do things she is very knowledgeable she is training us well very good with residents who all like her. The person appointed to manage has significantly improved their personal knowledge and understanding, since the previous inspection, of the running of a care home for older people. They continue to receive support from the area manager and an external training body and have accessed care professional websites to keep themselves updated in changes in practices and legislation. There was evidence of a much clearer leadership and direction now being provided at the home. There are several mechanisms in place for the home to obtain feedback on the quality of the services provided and whether it is achieving its aims and objectives. This includes residents and staff feedback surveys and annual placement reviews. The person appointed to manage said that changes to cleaning practices and menus have occured as a result of such feedback. Staff consulted confirmed that they receive formal supervision and records of these sessions are maintained. It was clear that these sessions are used to effectively identify staff training needs and to discuss work practices. The person appointed to manage also works directly with care staff who said that they also provide informal direction and feedback when they work together. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible persons external to the home. The person appointed to manage confirmed they do not hold any monies for residents. Care Homes for Older People Page 25 of 30 Evidence: Written guidance is available on issues related to health and safety. Records submitted by the home prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The person appointed to manage reported that a fire risk assessment had been completed which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. The person appointed to manage confirmed that in line with the previous requirement a fire safety officer was contacted regarding the fire safety arrangements at the home. They confirmed that the recommendations they made have been actioned which includes the fitting of acoustically activated door guards to bedroom doors. Accident records seen showed that there were very few recorded accidents at the home. There is a monthly monitoring process in place to help identify any potential patterns of residents falls. An example was noted whereby prompt action was undertaken to eliminate further falls for a resident, which included contacting health care professionals for advice. Staff were observed using appropriate moving and handling techniques which helped to promote the safety of residents and staff. The area manager undertakes the required monthly audit of services and facilities and completes a written report on their visit. This is in accordance with the organisations responsibilities under the National Minimum Standards. Copies of the record of their visits must be maintained at the home, as several months were missing. The person appointed to manage confirmed that visits were undertaken and would ensure that copies were retained. 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 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 That all parts of the home are decorated and maintained to a good standard and are fit for purpose. 12/10/2009 To ensure a consistently pleasant and safe environment in which to live. 2 22 23 That suitable adaptations 12/10/2009 have been made to the building to ensure the needs of service users accommodated who have mobility restriction can be met safely. To ensure that the needs of service users who have mobility restrictions can be safely met and to promote independence. Care Homes for Older People Page 28 of 30 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. 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