Inspection on 29/07/09 for High Dene Residential Home

This inspection was carried out on 29th July 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Dene Residential Home 17/04/08

High Dene Residential Home 17/12/07

High Dene Residential Home 19/04/07

High Dene Residential Home 16/10/06

High Dene Residential Home 04/05/06

High Dene Residential Home 23/02/05

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Oak Ridge

Coopers Mill Ltd

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Paradise Lodge

Bilney Hall

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: High Dene Residential Home 105 Park Road Lowestoft Suffolk NR32 4HU     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: Julie Small     Date: 2 9 0 7 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: High Dene Residential Home 105 Park Road Lowestoft Suffolk NR32 4HU 01502515907 01502515909 highdene105@wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Subhir Sen Lochun care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: One Service user in the category of LD (E) as detailed in the application received on 20/02/07 may be accommodated at the home. Date of last inspection Brief description of the care home High Dene is registered to provide personal care for up to fifteen older persons, all of who may have dementia, and one who also has a learning disability. The home is in an adapted Victorian house with an extension to the rear of the building situated in a residential area of Lowestoft and on a local bus route. It is near to shops and other community facilities and within walking distance of the sea. Accommodation consists of eleven single and two shared bedrooms, all with wash hand basins and approximately half of them with en suite toilets. Residents accommodation is on the ground and first floors, with shaft lift access. There is one bathroom on the first floor that is suitable for residents. On the ground floor there is a main lounge, a Care Homes for Older People Page 4 of 32 Over 65 15 1 15 0 0 0 Brief description of the care home lounge/dining room and seating in the entrance hall. The second floor consists of office and staff rooms. There is a secure garden at the back of the property available for residents use. The Service User Guide states that the fees range from £495 to £550 per week. 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 unannounced inspection took place Wednesday 29th July 2009 from 10:15 to 16:05. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. During the inspection health and safety records, staff training records and the recruitment records for five staff were viewed. The care records of four people that live at the home were tracked, which included care plans and medication records. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and three staff members, two visitors and seven people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to Care Homes for Older People Page 6 of 32 the home and it was returned to us in the required timescales. One service user survey was returned to us before the inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 32 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. People who use this service can expect to be provided with information about the home that helps them to decide if it is the right place for them, to have their needs assessed prior to moving into the home and to be provided with a contract/written terms and conditions of living at the home. The home does not provide a intermediate care service. Evidence: A requirement made at the last key inspection was that the Statement of Purpose and Service Users Guide must include the required information. A random inspection was undertaken 19th February 2009 and it was noted that the Statement of Purpose and Service Users Guide had met with the required standard. At this inspection the Statement of Purpose and Service Users Guide were viewed and it was noted that people were provided with information that they needed to help them to make decisions about the home. A service user survey said that they had Care Homes for Older People Page 11 of 32 Evidence: been provided with enough information about the home before they decided to move in. The Statement of Purpose was viewed and included information about the home such as details of the provider and management structure of the home, the range of care needs that were provided, registration, activities, fire safety, reviews, care plans, a summary of the complaints procedure and the contact details for CSCI (Commission for Social Care Inspection), which needed to be updated to show the current contact details for CQC (Care Quality Commission), should people wish to contact us. The Service Users Guide was viewed and included information about the service that was provided at the home such as the accommodation, client group, admission, daily life at the home, fees, staff and management details and qualifications. A summary of the complaints procedure was also included and the contact details of the provider, local authority and CSCI, which also needed updating to show the contact details of CQC. The records of four people that were viewed included a statement which said that they had been provided with a copy of the Service Users Guide and we viewed a list of peoples representatives to whom a copy of the document was also sent to. The AQAA stated we have given a copy of the Service User Guide to all our residents or the same has been posted to their relatives. The records of four people that lived at the home were viewed and it was noted that each held written contract/terms and conditions of the home, which had been signed by the person and/or their representative to show that they had been made aware and agreed to the terms of living in the home. A service user survey said that they had been provided with a contract. Peoples records held a needs assessment which had been undertaken before they moved into the home and there were care plans which showed how their needs and preferences were met. A person and their relative were spoken with and they told us that the person had been visited in their home before they moved in, that they had been asked about the support that they needed and that they had visited the home prior to making decisions about if the persons needs could be met at the home. The AQAA stated prospective residents are assessed by the Adult Team for their suitability for funding and placement in the home. The manager and/or the deputy manager, once a referral is made will make an assessment as to the suitability of the prospective resident being appropriate for the home and that the home is able to meet the assessed needs of the individual. 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. People who use this service can expect to have their health and social care needs met and how they are to be met set out in an individual care plan and to be treated with respect. They cannot be assured that they will be fully protected by the homes procedures and processes for the administration, receipt and disposal of controlled medication. Evidence: Requirements made at the previous key inspection were the updating of manual handling risk assessments must be completed, to ensure that care staff have current information on which to base the residents care and minimise risks to them and records of checks on residents must be maintained in accordance with the care plan. A random inspection was undertaken 19th February 2009 and it was noted that the requirements had been met and the report stated three residents who spend most of their time in their rooms were seen. Each had charts for hourly checks, nutrition and continence monitoring, that were being completed. Two of these residents care plans were inspected and they stated that hourly checks should be taking place by staff. The senior carer on duty stated that they now do an hourly check on every resident. The Care Homes for Older People Page 13 of 32 Evidence: care plans seen were clearly set out. A separate file contained copies of all manual handling risk assessments. The manual handling risk assessments for the two residents tracked had been regularly reviewed, and stated that staff must follow the risk assessment at all times. At this key inspection the care records of four people that lived at the home were viewed and it was noted that they clearly detailed the support that they were provided with to meet their assessed needs and preferences. The care records were provided in three different folders in the home. Peoples finance records were kept in the managers office, peoples care plans and risk assessments were in a secure cabinet in the entrance hall of the home and the records of checks and details of the specific support that people required were kept in peoples bedrooms. The records that were kept in peoples bedrooms provided information that staff needed to ensure that they supported people in ways which met their needs, preferences and ensured that their privacy, dignity and independence was respected. The records included information of how people communicated and how staff should communicate with them, statements included staff to speak loudly and clearly, eye contact, gets anxious if feels rushed and allow time to respond. Details of the specific support that each person needed with regards to manual handling were included, which detailed the staff numbers and equipment that was needed and the methods of how they should be supported to transfer from areas such as from the bed to a chair. A detailed record of peoples daily routine was included, for example their preferred time of getting up, what they usually liked for breakfast, where they usually spent the day, such as in their bedroom or in the communal areas of the home, what areas of their support that they could manage independently and how staff should ensure that their dignity was respected. Other records which were kept in peoples rooms included a record of hourly checks on people, their fluid intake on an hourly basis, what they had eaten each day, what activities they had participated in and the support that they had been provided with. Peoples care plans were viewed and they detailed the support that people were provided with on a daily basis, a history of their lives, mobility, health care needs and risk assessments which identified the risks in their daily living such as mobility, manual handling, nutrition, falls and Waterlow skin assessments and the methods of minimising the risks. There were clear details of the outcomes for health care appointments which people had been provided with such as with an optician, doctor and district nurse. The care plans were regularly updated and reviewed with peoples changing needs and preferences, for example when their mobility abilities had deteriorated and how the support that they required had increased. Care Homes for Older People Page 14 of 32 Evidence: The AQAA stated care plans are individualised further and needs are reviewed and identified through a process of continual evaluation. Staffs are knowledgeable about the needs of all residents and are competent at meeting the assessed needs of individual resident. A person who lived at the home and their relative was spoken with and they told us that their needs were met, that they had recently had their eye sight tested and that a doctor was always called if needed. The persons relative told us that they were always informed if there were changes in the persons condition. They told us that their relative was always clean and tidy and that they were provided with an apron to eat meals with, which ensured that they did not dirty their clothing. Another visitor to the home was spoken with and they told us that their relatives needs were met at the home and that they were well looked after. Three people that lived at the home were spoken with and they told us that they were happy and that the staff cared for them. A service user survey said that they were provided with the support and that the medical support that they needed. Staff that were spoken with told us that the care plans provided them with the information that they needed to ensure that peoples needs were met and it was noted that they knew about the support that people were to be provided with. A staff member showed us the care plans that they were working on with the manager on the homes computer. They told us that they were working on typing up all the care plans, so that they were more legible than the existing hand written ones and that the reviews of the care plans would be easier to identify when peoples needs had changed. The interaction between staff and people that lived at the home was observed to be respectful and professional. Staff were observed to knock on peoples bedroom doors before entering and a staff member asked for peoples permission for us to enter their bedroom. A staff member was observed to offer to comb a persons hair after they told them that it needed combing and they ensured that they were sitting comfortably in their arm chair. People were observed to be clean and tidy. A shared room that was viewed provided a privacy curtain between the beds and there was a mobile screen which could be used in any area of the bedroom. The training records of staff that were viewed, which included certificates, showed that they had been provided with medication training. A staff member told us that senior staff were responsible for the administration of medication and two senior staff that Care Homes for Older People Page 15 of 32 Evidence: were spoken with confirmed that they had been provided with medication training. The homes medication procedures were viewed and they detailed the arrangements for the administration, handling and recording of medication. It was noted that there was a detailed PRN (as required) medication protocol. The Regulation 26 visit reports that were viewed showed that the medication processes were checked during the visits, however, it was noted that they had stated that there needed to be medication audits in place. A staff member was spoken with and they told us that they were aware that the manager checked the medication, however, they were unsure if they were recorded. It was recommended that regular medication audits be undertaken and recorded to show that the medication storage and administration is routinely audited to ensure that people were safeguarded. The medication was stored in MDS (monitored dosage system) blister packs in a secured medication trolley. A staff member showed us the controlled medication cabinet, which was secured and attached to the wall, they told us that they were aware of the legislation regarding the storage of controlled medication and that the arrangements met with the requirements. The staff member told us that the administration of controlled medication was recorded in the regular MAR (medication administration) charts and not in a controlled medication register. There was no appropriate method of recording the administration, receipt and disposal of controlled medication, which included a running total of the medication and the administration had not been witnessed by a second staff member, to ensure that controlled medicines were managed appropriately. The MAR charts of four people that lived at the home were viewed and it was noted that the medication was accounted for, signatures were in place when people had taken their medication and codes were used when people had not taken their medication, for example if they had refused pain relief medication. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be provided with support to maintain their chosen contacts and to be provided with a balanced diet. They cannot expect to be provided with an activities programme which meets their social needs and interests. Evidence: A recommendation was made at the last key inspection that people be provided with activities that meet with their social needs. However, it was noted at this key inspection that there were limited activities provided at the home and few activities which met the social needs of people with dementia. Staff that were spoken with told us that activities were provided to people each afternoon and that there was no staff member employed at the home who took the responsibility of ensuring that meaningful activities were provided. A staff member told us that they were finding it difficult to engage people in activities, for example due to their lack of interest and to people with dementia. People that were spoken with told us that there were activities sometimes provided, such as a church service and a visiting hairdresser. A service user survey said that there was always activities arranged at the home that they could participate in. Records of activities that people had participated in were viewed, both in the care Care Homes for Older People Page 17 of 32 Evidence: records of four people and an activities diary. Activities that were provided July 2009 were on ten occasions and included manicure, people talked about memories, people watched Gone with the Wind, people listened to a Gracie Fields CD, a person had their hair washed and set, a staff member looked at a book with a person and a church service. The AQAA stated activities are offered to residents and the various level of disabilities are taken in account, participate or not to participate is the residents choice and more able residents are taken in town if they so wish and less able ones are taken to the nearby park when the weather permits. Relatives are encouraged to participate and this year garden party was a very successful event which was very much enjoyed by both visitors and residents alike. During the inspection there were no activities provided at the home, we observed people wandering round the home, the television was on in the lounge but no one was watching it and some people were entertaining themselves in their bedrooms, such as watching television. There was a garden in which people could sit in, a person was observed to be standing by the back door, but they told us that it was too cold to go out. During the inspection we observed two people visiting their relatives. They were spoken with and told us that they were always made welcome at the home. Peoples care records that were viewed showed the contacts that people maintained. The AQAA stated High Dene is a small family type care home which operates an open door policy where visitors and friends of residents can visit at any time acceptable to the residents. The Home receives a good flow of visitors continuously. People spoken with told us that they chose what they wanted to do in their lives and that the staff listened to them. A service user survey said that the staff listened to them and acted upon what they said. Peoples care plans and daily records that were viewed showed how people had made choices each day, such as the areas of the home they wanted to be in and the food that they ate. The AQAA stated residents are able to live their lives as they wish and there is no coercion but gentle encouragement is offered all the time to support residents achieved their best potential. Each persons records that were viewed included a record of what they had eaten each day and the fluids that they had on an hourly basis. It was noted that people were provided with a balanced diet. During the inspection it was noted that people who chose to stay in their bedrooms were provided with jugs of cold drinks and there were choices of hot and cold drinks provided to people in the communal areas and Care Homes for Older People Page 18 of 32 Evidence: bedrooms throughout the day. People were provided with a take away lunch of fish cake and chips during the inspection, which people said that they had enjoyed. A staff member told us that the lunch could not be cooked due to the boiler work that was being undertaken in the kitchen area. People that were spoken with told us that they were always provided with drinks, that the food was good and that they were provided with enough to eat. A service user survey said that they usually enjoyed the meals at the home. The AQAA stated meal times are unhurried and a choice is offered daily. Individual and specialist needs are catered for and a nutrition chart is maintained for all residents. Snacks and drinks are offered throughout the day and early evening as part of the routine however residents can request the same at any time. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be protected from abuse and to have their complaints listened to and acted upon. Evidence: The AQAA stated we display prominently our simple to read and understand complaint procedure in the home. We tell every new resident and their relatives about our complaint/concern procedure and how to make a concern/complaint at time of admission and what they can expect and we welcome complaints and suggestions about the service and always have a member of staff to listen to. We deal with them promptly and we use complaints/concerns and suggestions positively and learn from them and better our services. Our staff are knowledgeable about the importance of taking any concerns/complaints seriously and dealing with them appropriately. The complaints procedure was summarised in the Service Users Guide and Statement of Purpose and it was displayed in the home, for the attention of visitors and people who lived at the home. The complaints procedure needed to be updated to show the current contact details of CQC, should people wish to contact us. People that were spoken with and a service user survey said that they knew how to make a complaint. We viewed the complaints book and it was noted that there had been no complaints Care Homes for Older People Page 20 of 32 Evidence: since the last inspection and the AQAA confirmed that there had been no complaints made in the last twelve months. The AQAA stated our staff have been trained in adult protection and abuse, and they are aware of policies and procedures that they need to follow and residents and families are aware of external agencies and services they can access and we have a rolling programme of annual training in adult protection and abuse. The staff training records that were viewed showed that the staff team had been provided with safeguarding training and refresher training. Staff that were spoken with knew about their responsibilities in reporting concerns about peoples safety. The AQAA stated staff are aware of how to whistle blow and they know the policies and procedures to follow if they have any concerns about the practice of their colleagues or the conduct of the manager or owner and that they will be protected for doing so as per the home policies and procedures. The homes safeguarding procedure was viewed and it was noted that it clearly explained how staff should report all concerns. However, it was noted that the procedure may benefit from being amended to show details of if staff should be questioning people, when there are concerns of possible abuse. The procedure also needed to be updated to show the CQC current contact details. The local authority guidelines for reporting safeguarding issues was available in the home for staff reference. A safeguarding alert had been made by the manager of the home, following an incident between two people who lived at the home, which showed that they had acted upon issues promptly and appropriately. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be provided with a clean, comfortable and well maintained environment to live in. Evidence: Requirements made at the previous key inspection included that maintenance work should be undertaken, that the dining room chairs were to be cleaned and stains removed and uneven paving outside of building to be addressed. A random inspection was undertaken 19th February 2009 and it was noted that the shortfalls had been addressed. The random inspection stated the outside of the building remained clear of rubbish and pigeon droppings. A note on the front door warned of a risk of slates slipping. The home had a risk assessment for this and had obtained an estimate for the work needed and in the back garden, the paving outside of the bay window had been improved, cracks had been concreted over and decorative planters settled over the most uneven area. There remained however an uneven area, which although not on a direct route, and marked with white lines, could remain a hazard for a person with dementia. At this key inspection it was noted that the roof had been repaired and the area of uneven paving in the garden, provided plant pots, which prevented people walking in the area. The dining room chairs were clean and free of stains. However, it was noted that one chair was unsteady, which we pointed out to a staff member who told us that the maintenance worker would be informed and that they regularly ensured that the chairs were safe to use. Care Homes for Older People Page 22 of 32 Evidence: The AQAA stated that they had made improvements in the last twelve months, which were we have completely redecorated several rooms, added safety signs in the building. We have planted several new plants in the garden and made it even more attractive, safe and pleasant for residents to enjoy. Our maintenance person maintains the grounds on an ongoing basis. We employ an in house part time maintenance person to attend to matters of maintenance in the home on an ad hoc basis. We have renewed all curtains in the home and redecorated most parts of the building. A tour of the building was undertaken and it was noted that the home was clean, comfortable and well maintained. The communal areas consisted of a comfortable lounge and dining room, which people were observed to use during the inspection. There were no unpleasant odours in the home. Peoples bedrooms that were seen were clean, comfortable and it was noted that they held peoples personal items of memorabilia, which reflected their individuality and choice. People that were spoken with told us that they were happy with their bedrooms and the home. It was noted that the net curtain in one bedroom was torn, which was pointed out to a staff member who stated that this would be addressed. The laundry was seen and it was noted that it was clean and tidy. There were hand washing facilities, including hand wash liquid and disposable paper towels in the laundry, kitchen and communal bathrooms and toilets in the home, which minimised the risk of cross infection. During the inspection staff were observed to use good infection control procedures, which included washing their hands and wearing protective clothing and gloves when supporting people with personal care. 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. People who use this service can expect to be supported by a staff team who are trained to meet their needs and to be protected by the homes recruitment procedures. Evidence: A staff member was spoken with and told us that there were usually three care staff that worked on the day shifts at the home and two waking night staff during the night. This was confirmed by the staffing rota which was viewed and observations of the staff working at the time during the inspection, which also included two domestic staff and a cook. The AQAA stated we make sure residents are always in safe hands at all times and there is a minimum of three staff in the day shift and two staff in the night shift available at all times to support our residents. Staff that were spoken with told us that there were enough staff to meet the needs of people. People that lived at the home that were spoken with told us that the staff were attentive to their needs, that they assisted them when they needed help and that the staff treated them well. Two visitors were spoken with and confirmed that the staff at the home were attentive to their relatives needs. During the inspection it was noted that the interaction between staff, people that lived at the home and visitors Care Homes for Older People Page 24 of 32 Evidence: was friendly, respectful and professional. Staff were attentive to peoples needs and it was noted that the care staff were visible throughout the inspection. The AQAA stated all our staff are carefully chosen and we employ the right person to do the job and not to fill a vacancy. We recruit quality staff and stringent procedures to check suitability before employment is offered. The recruitment records of five staff members were viewed and it was noted that the appropriate checks had been made which ensured that people were protected by the homes recruitment procedures and processes. The records included the staff members work history, identification, two written references, a POVAfirst (protection of vulnerable adults) check and a CRB (Criminal Records Bureau) check. A requirement made at the last key inspection was that staff were provided with an appropriate induction course. A random inspection was undertaken 19th February 2009 and the report stated three new carers had been appointed since the home was last inspected. Their records showed that proper checks were in place, and had evidence of an induction programme being delivered that met skills for care standards. The AQAA stated our staff are diligent, trained, competent in delivering quality care in an individualised and person centred way. We are proactive in meeting staff training needs, with plans for future changing needs of residents. All our staff are trained for example in mental health issues and dementia and have refresher courses to update their knowledge. The training records of four staff members were viewed, which included a list of each staff members training attendance and certificates. It was noted that the staff were provided with training which assisted them in meeting the needs of people that lived at the home, such as safeguarding, fire safety, manual handling, dementia, first aid and infection control. Staff that were spoken with told us that the training provision at the home was good and that they regularly received refresher training. Two staff members told us that they had achieved an NVQ (National Vocational Qualification) level 2 and one told us that they were working on their NVQ level 3. Two of the four staff training records that were viewed showed that they had achieved an NVQ level 2 qualification. The AQAA said that there were a number of staff who had achieved an NVQ level 2 and that the senior staff were working on NVQ level 3 awards. However, the AQAA did not include the numbers of staff that had achieved their awards. The manager was not present during the inspection so we were did not Care Homes for Older People Page 25 of 32 Evidence: identify if the home had met the target of at least 50 staff to have achieved a minimum of NVQ level 2 as identified in the National Minimum Standards relating to older people. However, Standard 28 was met at the previous key inspection and the report stated the manager advised that six of the 17 care staff, excluding herself have NVQ 2 or above. Random checks were made on the staff files of two of these, and they had evidence of the award. The manager advised that a further three were undertaking it. The visitors book showed attendance of the NVQ assessor in the home. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to live in a home which is managed in their best interests and to have their health, safety and welfare promoted and protected. Evidence: The homes manager was not present during the inspection. The AQAA stated the manager is qualified and has over 20 years of experience and has been a registered manager with CSCI (Care Quality Commission) for many years. The Service User Guide was viewed and said that the manager had achieved an NVQ level 4, it was not clear if they had achieved their award in management or care. Staff that were spoken with were complimentary about the managers style, they told us that the manager was always approachable, listened and acted upon concerns and that the manager had made improvements in the home since they had worked there. This was confirmed in the random inspection 19th February 2009 which identified the improvements that had been made to meet the requirements made at the last key inspection. It was noted at this key inspection that all the requirements made at the Care Homes for Older People Page 27 of 32 Evidence: previous key inspection had been met. The AQAA stated the manager seeks the views of her staff, residents and their relatives. People that lived at the home were spoken with and they told us that they felt that the staff listened to them and acted upon what they said. The recent satisfaction questionnaires were viewed, which had been completed by people that lived at the home about the service that they were provided with. A staff member told us that if issues were identified in the questionnaires they were addressed by the manager. The monthly Regulation 26 visit reports were viewed, which had been undertaken by the homes provider, that showed that people that lived at the home and staff were spoken with about their views of the home and the provider monitored the running of the home. The AQAA explained how peoples finances were safeguarded and stated the manager has introduced a robust system of financial administration of small amount of money for residents and is recorded individually in separate books for each resident. Any money handed to the home is recorded as receipts, witnessed and doubly signed and a receipt given to whoever hands the money. Any expense made on behalf of residents is recorded and a receipt attached. Expenditure sheet is prepared as necessary and sent to relatives managing the finance of the residents. Any money handed for residents use is kept locked by the manager. This was confirmed by a staff member that was spoken with and the records of two people that were viewed. The health, safety and welfare of people that lived at the home was promoted and protected. Environmental risk assessments were viewed which identified the assessed risks to people in the environment and methods of minimising the risks. There was a fire risk assessment in place, which safeguarded people in case of a fire. Fire safety records were viewed and it was noted that people were further safeguarded by the regular fire safety checks that were undertaken. At the time of the inspection it was noted that the homes boiler was being replaced. A staff member told us that this was because a health and safety check had identified that the boiler was no longer safe to use. We viewed a risk assessment that had been completed by the manager and it was noted that the issue was addressed promptly. A person that lived at the home and a visitor that were spoken with told us that they were aware that the boiler was being replaced and that it had not been a problem to them. Care Homes for Older People Page 28 of 32 Evidence: Staff were advised of how to support people in a safe manner in the homes health and safety related procedures and training. Training provided to staff included manual handling, fire safety, first aid, medication and infection control. The health and safety related procedures were viewed and included issues such as asbestos, infection control, diarrhea and vomiting, infection control, first aid, aggression, clinical waste, emergency, accidents and manual handling. Staff had signed and dated a document to show that they had read the procedures. It was noted that not all the procedures were dated to show when they had been written and reviewed, to show that they were up to date. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The administration, receipt and disposal of Controlled Drugs should be appropriately recorded. To ensure that people are safeguarded. 31/08/2009 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 9 It is recommended that medication audits are routinely and regularly undertaken and recorded to ensure that people are protected by the homes medication processes. It is recommended that people be provided with the opportunity to participate in activities which are of interest to them and which meet their social needs and preferences. 2 12 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). 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. 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