Inspection on 06/08/09 for Holly House (Milton Malsor)

This inspection was carried out on 6th 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holly House (Milton Malsor) 16/03/09

Holly House (Milton Malsor) 26/09/08

Holly House (Milton Malsor) 30/08/07

Holly House (Milton Malsor) 25/01/07

Holly House (Milton Malsor) 07/11/05

Holly House (Milton Malsor) 18/08/04

Holly House (Milton Malsor) 05/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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: Holly House (Milton Malsor) 36 Green Street Milton Malsor Northampton Northamptonshire NN7 3AT     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: Ansuya Chudasama     Date: 0 6 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 31 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 31 Information about the care home Name of care home: Address: Holly House (Milton Malsor) 36 Green Street Milton Malsor Northampton Northamptonshire NN7 3AT 01604859188 01923840278 info@hollyhouseresidential.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Parvin Kumar Menon,Mrs Madhu Menon care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Holly House (Milton Malsor) care home is registered to provide personal care to male and female service users who fall within the following categories: Old age: not falling within any other category (OP) - 22 Dementia: over the age of 65 years (DE(E)) - 22 The maximum number of persons to be accommodated at Holly House (Milton Malsor) is 22 Date of last inspection Brief description of the care home Holly House is a residential care home situated in the village of Milton Malsor, south east of Northampton. The home provides care for 22 older people. The premises consist of a detached house, and all rooms are single with en-suite facility. A service users guide to the services the home offers is supplied to applicants and the Care Homes for Older People Page 4 of 31 Over 65 22 22 0 0 1 6 0 3 2 0 0 9 Brief description of the care home last Inspection Report is available on request. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Care quality Commission (CQC) policy and methodologies which require review of key standards for the provision of a care home for older people that takes account of the peoples views and information received about the service since the last inspection. Evidence used and judgments made within the main body of the report include information from this visit. We looked at the Annual Quality Assurance Assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service; these are called notifications and are a legal requirement. We also looked at previous key inspection Care Homes for Older People Page 6 of 31 and the results of any other visits that we have made to the service in the last 12 months. This key inspection was carried out on the 6th of August 09. The registered providers Mr and Mrs Menon of the home helped out with the inspection process. This inspection was brought forward due to attending a strategy meeting where concerns were raised regarding a patient that was admitted to hospital with numerous pressure sores. During this inspection we tracked the care of three people who use this service. This involved reading their care records and also talking to them wherever possible to obtain their views on the service. We also spoke to some of the other people who live in the home and relatives who visited the home. Documentation relating to staff recruitment, training, supervision, medication administration, complaints and health and safety were also examined. We had the opportunity to talk to some of the staff who were on duty and a tour of the home was also conducted. The fees for this home are presently between £359 and £525 per week. At the time of the inspection there were 18 people in the home. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Information on fees charged by the home for people to stay at the home also needs to be recorded in the service user guide. This is so the people know what fees are being charged for staying at the home. All the people in the home need to have a contract with the home so they are aware of their rights and responsibilities. Records required by regulations such as the staff working rotas must be available at the home for inspection purposes. The staffing rota needed reviewing to ensure that there were sufficient staff on duty to meet the peoples needs. Care Homes for Older People Page 8 of 31 The home needs to ensure that the environment meets the needs of the people with dementia in line with nationally recognised good practice in dementia care. Ensure that the people are involved, and informed in a format that meets the peoples needs of the meals and choices that are available to them. Provide the people with structured activities that they know when and at what time, and who will be carrying this activity in a format they understand. Ensure that the care plans are updated when a persons needs change so the right care is put in place and staff are aware of how the persons needs are going to be met. Staff must record appointments made with health professional in the persons file. This is to show that the home contacts the health professionals when required. Ensure that the water temperatures are maintained at the level this should be kept in the laundry room, in one of the bathrooms and in the communal toilet. 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 31 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 31 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 peoples needs are being assessed prior to their admission to the home to ensure the home can meet their needs. Evidence: The registered manager told us that everyone who lives at Holly House has been given a copy of the homes Statement of Purpose and a Service User Guide. He also explained that the Service User Guide is available in other formats such as large print on request. A copy of this was not available at the home. At the last inspection it was recommended that the the home should consider producing the information documents in formats more suitable for some of the more disabled residents. The AQAA states for what we could do better says we need a website and produce detailed information at a glance and restart our news letter. Some information required can be made available in large fonts and or be provided with CD. Care Homes for Older People Page 11 of 31 Evidence: The complaints information in both the Statement of Purpose and Service User Guide needs to have the telephone number of CQC and Social Services. A copy of the complaints procedure needs to be included in the guide with the address and telephone number of the registered manager, CQC and Social Services. Also such words used as grumbles in the Service User Guide are not positive words to use and all complaints or concerns raised should be taken seriously. A copy of any service user views of the home was not included. This is information for people to know how the home is meeting the needs of the people being cared for. The home has 12 people with dementia needs however the Service Users Guide and Statement of Purpose does not state how their needs will be met by the home. We are aware that the staff have received some training on dementia care but the facilities at the home have not been adapted to the specific needs of these people and in line with good dementia care practice. Information on fees charged by the home for people to stay at the home was not recorded in the service user guide. One family member we spoken to said that they had chosen the home as it was recommended to them. It was also said that the home was a nice size. The people we spoke to say that their family had visited the home before they had moved in. Records show that the peoples needs are assessed by the home before they move into the home. This is to ensure that the home is right for them. Evidence showed that some people have signed a contract with the home. The manager explained that at present only people who pay for their own care have a contract with the home. People whose care is funded by a local authority do not have a contract with the home. The home has a contract with the local authority for people who are funded by them. The inspection report was not displayed in the home as stated at the last inspection. Care Homes for Older People Page 12 of 31 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. The home has systems in place for care planning and recording, but these are not always fully completed to reflect changes in need to meet the peoples needs. Evidence: Each person who lives at the home has an individual plan of care. This contains information that staff need to care for people in the right way. We were told by staff that the manager writes the care plans and staff reviews the plans on a monthly basis for the allocated people they key work. Where changes to the peoples needs had occurred, the plan of care had not always been updated to reflect these changes Care plans seen had information recorded about the peoples preferences. It is important that staff have this information to make sure that they care for people in the right way. There was some evidence of people being helped to make choices such as what clothes they wanted to wear. One of the plans viewed was discussed with a senior member of staff who was unable to tell us the content for this particular person. The staff informed us that they were Care Homes for Older People Page 13 of 31 Evidence: not responsible for reviewing this persons care plan. All care plans were being reviewed by staff on a monthly basis for the people they were responsible for. However the information was not being updated in the care plan that gave instruction to the staff about how the persons needs were being met. For example information read in one persons review notes said that the person was being washed and dressed in bed but this was not recorded in their care plan. The notes also said that the person was refusing medication, they were aggressive and depressed. But there was no information recorded in the care plan to say how this was being managed, which may result in inconsistency of care being delivered. The AQAA says for our plans for improvements in the next 12 months is a need to consolidate on present quality of delivery of personal and health care and continue to evolve the care planning process and these then reflect a very personalised care. We need to continue to improve on monitoring and observation skills, better accuracy of report writing, improve on care plans writing and reviewing skills by the key workers. Records looked at the inspection show that the people have now been assessed to find out if they are at risk of developing pressure sores. Where it was identified that there was a risk, measures were put in place to reduce the risk such as provision of specialist equipment and helping people to change position regularly. We noticed one persons file lying on the dining table at the back of the room. There were no staff in the room at that time. The dining room was also used as an office/work base at the back of the room. This did not provide a homely feel to the room. We observed that telephone calls and conservations were undertaken in this room, which are overheard by us and the people.. The administration of medication is generally well managed with all entries on the medication record being signed to show that people are receiving their medication as prescribed. Care Homes for Older People Page 14 of 31 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. Activities are not person centred so there fore do not fully meet the peoples social and emotional well being. Evidence: When we arrived at the home, the lounge area was warm and all the people were sitting in the lounge and this felt crowded. There is a library/quiet room available, however the entrance was blocked by peoples walking frames and chairs. We were told that all the people had breakfast by 9-30 am. We observed that the television was on and music was being played in the same room from a different source. Some of the people were observed sleeping or just looking or gazing at people or objects. We were told by people sitting near the door side that they could not see the television because a table and chairs blocked their view. One person was observed to ask several times what time it was and whether she had had her cup of tea yet. Staff did not respond to her questions. The people were asked what was for dinner and it was said that they did not know this. We were also told that the information on the board was too small for the people to see. Care Homes for Older People Page 15 of 31 Evidence: On discussion with the owner we were informed that the cook was having the day off and they were cooking the meal. Due to the inspection process the cook came at lunch time to help out the owners. The owner also informed us that the people can have any thing as an alternative to eat. However people with dementia would not be able to make this decision without having information in a format that they would understand to help them make choices. We were given two different menus and it was unclear which menu was being offered. The food on the menu did not fully reflect the meal provided on the day. The people were observed sitting at the table for some time before they were served meals and some people were getting angry and agitated. Some people needed the assistance of staff to eat. We observed two people being feed standing up by staff and observed little or no interaction between staff and the person. We observed that the demands on staff at this busy time meant that they were not able to spend time with the people to socialize with them. The AQQA says our plans for improvements in the next 12 months is to produce picture menus, pictorial signages, providing loop systems for improve hearing of TV and equipment for those with hearing aids. The people spoken to said ever so nice here and have something different and yes thank you dinner nice. Most of the people were observed enjoying their food. We were asked by the manager to speak to one of the relatives on the phone. They informed us that the staff are very caring, and the home has a friendly and warm atmosphere. It was said that their family member was happy at the home. Another person spoken to said that they were quite happy and staff were nice. Peoples individual plans of care did contain some information about their interests and hobbies. Activities sheets were seen which contain a record of the activities that people had taken part in such as listening to music, singing, quizzes and bingo. The home does not have an activity person but we are told that the staff or the cook or one of the owners do the activities. We were told that the home has an entertainer who comes twice a month and they do music and singing sessions and the people enjoy this. On the day of the inspection we observed the owner who is rostered to do the cooking from 10am to 1pm is doing chair exercises but we observed that not many people were responding to this activity. The TV is also on. In the afternoon we observed a staff member trying to play skittles with one person, however they have to leave when the bell rings and therefore continuity is not maintained. The staff is not able to carry on with the game as the relatives arrive and there is no room to do this. The activity Care Homes for Older People Page 16 of 31 Evidence: list seen did not have a date or the time the activities were being undertaken and by whom and how long this lasted. We observed activities were being done on the basis when staff had time to do this. Therefore the approach was not person centred, and was not structured around to meet the peoples needs. Care Homes for Older People Page 17 of 31 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. The staff are trained in the area of protection and know the procedures for reporting any concerns to ensure the people are kept safe Evidence: The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. A family member spoken to said that if they had any concerns, they would talk to the staff. The manager said that the home has not received any complaints since the last inspection. Staff spoken to say that they know how to raise any concerns that they may have. They had also completed the training on safe guarding of vulnerable adults procedures. The home has not made any safe guarding referrals to Social Services safeguarding team. However a referral was made to the safe guarding team in relation to concerns raised by the hospital. Following this incident we asked the provider to provide us with information on existing residents well being. The outcome of this investigation was not known at the time of writing this report. Care Homes for Older People Page 18 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable accomodation is provided but the equipment and maintenance of the home was inadequate and therefore the peoples health and safety needs are not always met. Evidence: Holly House is a large detached property that has been extended to the rear and side. Communal areas consist of a lounge, library and dining room. There were pictures on the walls and some flowers and ornaments to make the communal areas feel more homely; however the lounge appeared quite crowded with chairs all around the edge of the room. A door leads from the lounge to the garden but this was blocked by a chair and so was not in use. The doorway from the lounge to the dining room had a step, which staff told us could cause problems for people with limited mobility. We observed one person struggling and we were told by them that there was a handle on one side of the wall but it would help out if another handle was put on the other side. They found the yellow stripes at the end of the door way confusing and not helpful. This was put there for people who are blind. We are told by staff that they escorted any one that was blind to the dining room. Records show that where this is felt to be a risk for people a risk assessment had been carried out. Care Homes for Older People Page 19 of 31 Evidence: The dining room was a large room with patio doors leading to the garden. People were seen sitting on the patio area and walking in the garden. The AQAA says our plans for the improvement in the next 12 months is to develop sensory based garden and surroundings of pleasing odours and scents, presently, whole issue of conservatory and additional enhanced facilities are being planned for and are in planning stages with an architect employed to prepare plans and submit for planning permission including conservatory, wet room, communal toilet, extending lounge space. All of the bedrooms in the home have an en suite toilet. Bedrooms seen had been made personal with photographs and personal effects. Although some of the people living at the home have dementia there was little evidence of any pictures or signs to help people orientate around the home. The registered manager explained that they do put up signs for people when they are needed but at present no-one needed any assistance to find their way around. The AQAA says that 12 out of 18 people have dementia in the home. The communal toilet downstairs also had no sign to say what it was. The floor needed attention as the tiles were coming off. The door had a hole from the inside. There was no hot water when using the water in the wash basin. We were told by the owner that this was being sorted. The frame around the toilet was looking rusty. One person was helped to the toilet and said that it was dark when they were in the toilet. This was because the light was not switched on by staff that helped the person. One persons bed appeared to be damaged, the manager said that this bed would be exchanged with a spare bed to ensure that the person had somewhere safe and comfortable to sleep. This person was also using a bed rail which had been supplied by the persons family. Records show that this rail had not been assessed by the home to ensure that it was suitable and safe for the person to use. The manager said that he would complete a risk assessment on the bed rail without delay. The home has a bathroom downstairs and two bathrooms up stairs. The water in one of the bathrooms was very hot and exceeded the recommended 43 degrees centigrade. The manager said that this bathroom was not used and was going to be converted into a shower room. The home has a laundry area in an outbuilding and the hairdressing room was attached to the laundry room. The hair dressing room needed the decor improving to make it pleasant for the people to use. This was also stated in the AQAA The hairdressing salon needs to be pleasant experience who use it by improving its aesthetic appeal. The laundry room did have a sluice facility but the hot water tap Care Homes for Older People Page 20 of 31 Evidence: was not working when we turned it on. The owners informed us that they are taking steps to upgrade the plumbing system. Care Homes for Older People Page 21 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inadequate staffing numbers do not meet the needs of the people at all times Evidence: The recruitment of staff is well managed with all of the necessary pre recruitment checks being carried out to ensure that staff are suitable to work with older people. Staff told us that they had an induction when they first started working at the home which included working alongside an experienced colleague to make sure that they had all of the information that they need to do their job in the right way. Records show that staff attends training courses such as food hygiene, safeguarding of adults, dementia care, infection control, fire safety, palliative care and moving and handling. Staff told us that they have regular supervision sessions with the manager to make sure that they are doing their job in the right way. We were told that this happens on a two or three monthly basis. We observed that there was a rota for the week in the kitchen. We asked to see previous rotas for the week but were told that these were kept at the managers home. We were told that these would be faxed to CQC but at the time of writing this report we had still not received this information. We asked to see next weeks rota but Care Homes for Older People Page 22 of 31 Evidence: the manager told us that he had not done this yet. At the last inspection it was said that the rotas were not yet completed for the following week, therefore staff could not plan their rest time as they were unaware of the shifts. We were told that staff meetings are held regularly and the last minutes of the meeting viewed was dated 29th of October 08. The manager told us that he had carried out a staff meeting 4 weeks ago but he had not typed the minutes and these were not at the home. Meal time observation showed that the two care staff were very busy helping in the dining room, kitchen, serving meals to the people, and helping two people with feeding. The staff also helped clear the tables and helped people to the lounge or to their rooms and with toileting. Due to the amount of chores the staff have to undertake, they were not able to socialise and spend quality time with the people at meal time. The staff told us that they also give out medication and do laundry work and review peoples plans and record in daily notes of the people, which may impact on time spent with the people. We observed that staff did not have much time to spend with the people to do meaning full activities. The training records showed that the staff have not been on activity training for the people they care for. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes quality monitoring system is not sufficient to ensure all the peoples needs are fully met. Evidence: The Statement of Purpose says that the owners Mr and Mrs Menon are in process of completing NVQ level 4 and Registered Managers Award and we are told that they undertake various other courses. One of the owner of the home is also the registered manager of the home. The rota shows that the manager spends 4 days a week at the home from 10am to 5pm. Records show that the necessary safety checks such as fire checks, checks on the water system and portable appliance testing have all been carried out recently. The last fire drill was carried out on the 23/2/09 Some records relating to more than one individual person were recorded on the same page. This could compromise peoples right to confidentiality if someone wanted to Care Homes for Older People Page 24 of 31 Evidence: access their records. The manager explained that the home conducts satisfaction surveys for the people living there. Two completed surveys for 2009 was seen and seven for 2008 were completed, the outcome was positive. However the home should send surveys questionnaires to all the families, staff, and other professionals involved with the care of the people. This is to get their views on how the home is meeting the needs of the people. The outcome from their quality assurance audit was not displayed. At the last inspection the manager was informed that they were to prepare and supply a report in respect of the quality of care in the home which must be kept under review. We were not given a copy of this at the inspection. The AQAA says our plans for improvement in the next 12 months is to have effective and systematic quality assurance and quality monitoring system. The home is in discussion with Business Link, an organization to help to improve quality. The Home intends to pursue investors in people award. We believe we are already well underway but needs to document quality and record outcome and performances, and to be able to identify weaknesses and then improve on this. Discussion with staff showed that they were receiving supervision on a one to one basis, on a two to three monthly basis. This was confirmed by discussing with the manager. Most of the records were being stored in locked cabinets, however we did see a persons file on the table of the dining room unattended. There was information that we asked for and this was not available in the home. For example the previous staff working rota, and minutes of staff meetings. The home does not keep any personal money of the people living at the home. The invoices are sent to the peoples relatives who undertake this task. The hot water in the laundry room was not working and the water in the communal downstairs toilet was cold. Also water tested in one of the bathrooms was very hot. The Environmental Health Officer had visited and gave the home 3 Stars. Care Homes for Older People Page 25 of 31 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 26 of 31 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 8 12 Peoples care plans must be updated to reflect changing needs. This is to make sure that the people get the care that they need 24/11/2009 2 8 12 The care plans must have detailed information to state how the home is managing the needs of people who are aggressive, depressed and refusing medication. This is to ensure the persons care needs are dealt with promptly to meet their needs. 24/11/2009 3 12 12 Provide the people activities that are delivered competently in order to provide them with appropriate stimulation. 18/11/2009 Care Homes for Older People Page 27 of 31 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 This is to ensure that the people are socially stimulated to meet their needs. 4 27 18 The staffing hours worked 24/11/2009 must be clearly recorded with the hours the staff work at the home. This is so we have accurate information about how many hours the staff work at the home to meet the peoples needs. 5 27 18 Review the staffing rota to ensure that there are sufficient staff on duty at all times. This is to ensure that the staff have enough time to undertake their duties and meet the needs of the people. 6 37 17 Records required under the regulation must be available at the home for inspection purposes This records show evidence that the home is being properly managed with in the regulations 29/10/2009 18/11/2009 Care Homes for Older People Page 28 of 31 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 2 3 1 1 1 Ensure that the inspection report is displayed where the people and their relatives can view this. Ensure all the information required is included in the service user guide and statement of purpose. Ensure that the service user guide has information recorded about fees charged by the home so the people know the cost of staying at the home Ensure all the people have a contract so they are aware of their rights and responsibilities Ensure the risk assessments for falls are reviewed and updated when a person has falls. All calls to health professionals needs to be recorded in the peoples files. This is to show that appointments are made when needed. The staff and management needs to carry out phone calls and conversations about the people in a private place where their confidentiality and privacy is maintained. Provide people with opportunities to discuss menu options provided in the home. This is so the people enjoy the food that they like Inform the people of the choices of meals being offered on the day in a format that they understand. Staff should review how they assist people with feeding to promote their dignity. Meal times should be reviewed to ensure that there are sufficient staff to ensure that people are not kept waiting for their meals. Up date the complaints procedure with the information stated in the report of standard one. This is so the people have up to date information when they want to make a complaint. A system needs to be in place to review the maintainance and equipment available in the home. This is to ensure that the people are kept safe and their needs met in a comfortable environment Provide a quality assurance system that takes account of all the people and their relative and staff and other 4 5 6 2 8 8 7 10 8 15 9 10 11 15 15 15 12 16 13 19 14 33 Care Homes for Older People Page 29 of 31 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 professionals involved with the people to find out their views in how the home is meeting its aims and objectives in meeting the needs of the people in the home. 15 16 17 36 37 38 Ensure staff receive six supervisions per year to monitor the work they do in the home. Ensure the peoples confidential information is recorded in their indiviual files to maintain their confidentiality. Ensure the water temperatures are maintained at the level this should be to ensure the people are protected from any risk. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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