Inspection on 28/01/09 for Honey Lane Care Home

This inspection was carried out on 28th January 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Honey Lane Care Home 01/08/07

Honey Lane Care Home 24/08/06

Honey Lane Care Home 08/02/06

Honey Lane Care Home 07/07/05

Honey Lane Care Home 14/12/04

Honey Lane Care Home 13/07/04

Honey Lane Care Home 07/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Honey Lane Care Home Honey Lane Waltham Abbey Essex EN9 3BA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Bernadette Little     Date: 2 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Honey Lane Care Home Honey Lane Waltham Abbey Essex EN9 3BA 01992718558 01992653463 dawn.sharp@carebase.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Towertrend Limited Name of registered manager (if applicable) Mrs Dawn Sharp Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: One person, under the age of 65 years, who requires care by reason of dementia Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 41 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 8 persons) The total number of service users accommodated must not exceed 41 persons Date of last inspection Brief description of the care home Honey Lane Care Home is a 2-storey purpose built home providing care for people over the age of 65. Residents bedrooms and communal areas are situated on the ground floor with administration office and staff room on the 1st floor. The home is divided in to three separate areas i.e. Forest (2 units), Abbey and Saxon. The home has a large Care Homes for Older People Page 4 of 31 care home 41 Over 65 41 8 2 0 Brief description of the care home car park. The home is located about 2 miles from the centre and main shopping area of Waltham Abbey. It is on a main bus route and there is good access by road as the home is in close proximity to the M25. The current scale of charges at the home ranges between £438.00 - £902.00 per week, as advised by the manager on the day of the site visit. The actual fee depends on the source of funding, assessed care needs and/or type of accommodation available i.e. double/single bedroom. There are additional charges for items of a personal nature. The homes Statement of Purpose and Service User Guide are available from the home. 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: two star good 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 last key inspection of this service was undertaken on 1st August 2007. An Annual Review of the service was undertaken in July 2008 that identified that we did not have enough current information to rely on and needed to review our inspection plan and undertake a key inspection by the end of January 2009. This site visit was undertaken over an eight hour period on one day as part of that key inspection. Time was spent with residents, visitors and staff and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is to detail their assessment of what they do well, what has Care Homes for Older People Page 6 of 31 improved and what they plan to do better. The AQAA contained an adequate level of information that was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute to residents, relatives, staff care managers and health professionals. Subsequent to the site visit, surveys were received from four residents, four staff, seven relatives and one health professional. The information provided and comments made are reflected in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit along with the operations manager and both assisted with the inspection process. The outcomes of the site visit were fed back and discussed with the manager and operations manager and opportunity given for clarification were necessary. The assistance provided by all those involved in this inspection process is appreciated. What the care home does well: What has improved since the last inspection? A new manager has been appointed since the last inspection and who has demonstrated a number of changes and improvements in the time they had been in post. These include actively progressing the ongoing redecoration programme, introducing a mobile shop for residents, introducing a weekly check by the keyworkers of each persons room to make sure that they have their own clothes as sometimes in a dementia care setting items get borrowed from one room to another and arranging for additional staff to be on duty at times where previous accident records indicated a concern. A new menu system has been introduced that has been devised in consultation with nutritionalists to ensure that the diet is balanced, enjoyable and offers plenty of choices to residents. More permanent staff have been recruited resulting in a decrease in agency staff, thus offering more continuity and consistency of care for residents. More recent recruitment procedures have been made more robust to safeguard people using the service. New procedures have been put in place, for example to ensure that staff make themselves aware of the care plans and care needs of the people they are caring for to assist them to meet these more effectively. A minibus is now available to take residents on outings so providing more opportunities for stimulation and enjoyment. Training on dementia care is being provided for the two Care Homes for Older People Page 8 of 31 activity coordinators to enable them to support people more effectively. 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 set out 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. Prospective residents can expect to be provided with information on which to base a decision to live at Honey Lane and have an assessment of their needs so they can be sure they can be met there. Evidence: All surveys received from residents at Honey Lane confirmed that they had received enough information about the home before they moved in so they could decide if it was the right place for them. They also confirmed that they had received a contract and copies of contracts were seen on files sampled. One relative spoken with advised that they had looked up the homes reports on the Internet, visited prior to their relative being admitted but not had been given any information about the home. The manager said sometimes the service user guide and contract go out before admission but must be provided at least on the day of admission. Good practice would indicate this information would be made available prior to admission and the preadmission Care Homes for Older People Page 11 of 31 Evidence: assessment could record this. Residents spoken with confirmed that they or their relatives had been able to visit the home prior to admission. The AQAA states that a comprehensive pre-admission assessment is carried out on all prospective residents. Files of some people recently admitted were sampled to look at how well the manager had assessed their needs prior to admission to ensure that the staff skills and the facilities at Honey Lane were appropriate to meet these. The manager stated that following one recent assessment she had refused to offer the person a place as she felt their needs could not be met at Honey Lane. Files reviewed showed that a pre-admission assessment had been undertaken by a member of the management team for each person. The assessments were sufficiently detailed to give a clear view of the persons requirements. There was evidence that prospective residents or their relatives had been involved in the assessment, which is good practice. However, there was no evidence on the files reviewed that the home had written to the person as required, to confirm to them that based on the homes assessment, the home could meet their needs. The operations manager stated that this would now be implemented. Intermediate care is not offered at Honey Lane. 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. Although there are some shortfalls in care planning, there are generally positive care outcomes for residents and their medication is safely managed. Evidence: Care plans were reviewed for three residents and were found to vary in the quality of the information provided to staff on how to provide care to individuals. The manager and operations manager agreed that there needed to be more specific information in some areas of care planning to support good care outcomes. Care plans of more recently admitted residents were recorded as written some days after admission rather than being in place for the person on admission, based on their assessment. Baseline assessments were in place but were undated and unsigned. Risk assessments such as for tissue viability, falls, moving and handling and nutrition were undertaken sooner after admission and showed some cross-reference to care plans, which is good practice. Care plans included reference to the persons likes and dislikes such as times for going to bed and getting up, but were not signed by the residents or their representative. Care Homes for Older People Page 13 of 31 Evidence: On one care file where the nutritional risk assessment indicated a cause for concern, the care plan on this care need was not completed, although a weight monitoring chart was in place. Additionally for this person, their preadmission assessment indicated some verbal aggression and resistance to personal care. While the triggers for this were identified in a plan of care there was a lack of information for staff on how this was to be managed in practice. On another residents file, care notes recorded been very unsettled and confused or appeared to become very agitated but with no information on what action was taken to support the resident. On the care plan of a longer tern resident, it was noted positively that where a high risk of pressure sores was indicated, there was a clear care plan in place relating for example to equipment to be used, frequency of turns and bed rests and this was supported by a turning chart. This care plan had been regularly reviewed. All surveys from relatives and the majority from service users indicated that they feel the care home always or usually meets the needs of the residents. One person who said they only sometimes receive the care and support they need added carers are not always around when needed and another said that they had to bring to staffs attention when their relative had swollen ankles. Surveys from other residents indicated that staff are always or usually available when they need them and that staff listen and act on what they say. One person commented the manager or a senior carer will always listen to any queries we may have. In surveys and discussions staff stated that they are given up-to-date information about the needs of the people they support, and one person added both in the care plans and hand over and in discussions with colleagues. Staff observed and respond to residents needs promptly and spoke to them with respect. Residents spoken with and able to comment confirmed that staff looked after them well. Care files and care notes confirm that residents are supported to access health care services such as GP, district nurse, dietitian, optician or chiropodist. The manager advised of supportive professional relationships with both the GP and district nurses who will come in on request, in addition to a GP visiting the home routinely once a week. Surveys from residents indicated they always receive the medical support they need with the exception of one survey which indicated this only occurred sometimes but did not provide any additional information. A survey received from a health professional indicated the view that the care service always seek advice and act upon it to promote residents health, that peoples health care needs are always met by the service, their privacy and dignity is maintained and staff have the right skills and experience to support residents health care needs. They add a comment all patients Care Homes for Older People Page 14 of 31 Evidence: are put at the centre of care. Medication storage and a sample of records were reviewed. A medication care plan was in place for any person prescribed as required medication which is good practice. Medication administration record (MAR) charts were reviewed and no omissions were noted. The medication records sampled tallied with those medicines remaining in the blister pack. Dated photographs of residents were available on the MAR to support identification, as was specific relevant information relating to the person such as difficulty with swallowing. Entries sampled in the controlled drugs register were appropriately maintained and tallied with the remaining medicines. An up-to-date signatory list was available to show the signatures of staff deemed competent by the manager to administer medication. Care plans made reference to promoting privacy and dignity, for example when people were being hoisted, but did not specify how staff were to achieve this in everyday practice. A senior staff spoken with was unable to clarify this in conversation. Discussions with care staff indicated a knowledge of privacy and dignity and confirmed that this is an area discussed as part of their induction. Staff were also observed to talk to residents respectfully. A survey from a relative stated my relative does not like a male carer to wash or bath them. When there is a lot of turnover of staff and male carers are available to help my relative, the senior carers try to make sure that they are bathed by a female member of staff. The health professional survey confirmed that individuals privacy and dignity is respected as far as it is possible in patients with dementia. Care Homes for Older People Page 15 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. Residents at Honey Lane can expect to enjoy an increasing range of appropriate activities but may not always be best supported in making choices. Evidence: In their AQAA the manager advised that they are going to start compiling full life story books on each of the residents to establish exactly what they used to do for a living or as a hobby so that they can adapt things in the home to emulate these. They also plan to access additional training for their activities staff and to involve care staff in activities as part of daily care. This was observed in practice during the site visit when care staff engaged with residents in looking at magazines, sitting and chatting or a seated exercise game with balloons. In discussion the manager also confirmed that they now have shared access to a minibus and plan to arrange an outing for residents once a week. They have also introduced a mobile shop so that residents can choose their own toiletries or sweets etc. There are now some 40 staff hours allocated to supporting activities and both activity coordinators are to attend dementia training with the homes manager. The activity coordinator advised of a four-week plan that is not set and is flexible to work Care Homes for Older People Page 16 of 31 Evidence: with the needs and preferences of the residents at any time. The manager proposes to develop a pictorial plan of activities that may assist more residents to demonstrate their preferences. Most service user surveys received indicated that were always or usually activities arranged by the home that they could join in with although one person said there was never anything suitable. Another comment said I have been made aware of a few activities, would like more information on what they do regularly each week. A survey from a relative who advised of a specific impairment of a resident said their needs for entertainment like joining in games are restrictive, but they (staff) do try to engage with them when possible. Another person said they had very recently been made aware of plans for activities at the relatives meeting at Honey Lane. All relatives and residents spoken with and comments in surveys indicated that visitors are welcomed at Honey Lane. A number of relatives were at the home on the evening of the site visit to attend a relatives meeting. Surveys received from residents and those spoken with confirmed that most people liked the meals provided at the home. The AQAA advised that the newly introduced menu system was devised in consultation with nutritionalists to provide a balanced and suitable diet that offers plenty of choice. The menu was displayed in the hallway and outside each dining room and demonstrated choices available. The manager advised that menus had been provided on tables but were removed by residents. Tables in the dining room were pleasantly set for small groups, with some residents eating breakfast there while other people ate in their own bedroom. A record is maintained of what residents choose from the menu but a full record of what residents actually eat is maintained only for those residents who are identified as at risk. This is an outstanding issue from the last inspection. It is recommended that residents, particularly those with dementia, be offered an active choice at the time of their meal, rather than choosing something from a menu the day before. 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. People living at Honey Lane can expect to feel listened to and to be safeguarded by staff knowledge of the procedures around complaints and protection. Evidence: The complaints procedure was displayed in the entrance hall and so was readily available to visitors. It provides limited information on the timescales that people will receive responses at the various stages, so that they know what to expect. The detail may lead people to believe erroneously that the Commission is a complaints investigation agency, and does not provide information on the available option of taking the complaint to Social Care (Social Services). A relative spoken with said that the manager was approachable and they felt they would be able to raise any concerns. A complaints logging and tracking form was available to record both written and verbal complaints and timescales, outcomes and actions taken. Surveys from residents confirm they know who to speak to if they are not happy and that they know how to make a complaint. Surveys from relatives also confirmed that they knew how to make a complaint and that the care service had responded appropriately if they had raised any concerns with comments such as Always responded to any concerns, The manager or a senior carer is always available if there is a query or complaint and Management take on board when and if a complaint. Care Homes for Older People Page 18 of 31 Evidence: Carebase have a detailed policy and procedure on Safeguarding Vulnerable Adults. There have been three referrals to the safeguarding team since the last inspection. These had been appropriately referred by the homes managers and appropriate action taken for example, in suspending or dismissing staff. One related to a residents medical care and was found not to be upheld. The second related to inappropriate moving and handling by two staff members and was upheld. The third related to an allegation made by a resident regarding the way they were handled by a staff member. This was found not to be upheld, but the investigation identified concerns that the staff member involved had had no induction training and had no knowledge of the residents care plan, that would identify the way they should be cared for and any specific risks for them. The current manager advised of their subsequently introduced requirement for staff to sign to confirm their understanding of their responsibility to read and be aware of the care plans of people they are to support. Surveys received from staff confirmed that they would know what to do if anybody raised a concern with them regarding Honey Lane. The staff training matrix demonstrated that all but one care staff had attended training on safeguarding vulnerable people in the last sixteen months. Staff files sampled contained evidence of this training. The manager advised that outsourced training is booked for April 2009 and that staff are provided with training on safeguarding vulnerable people and whistleblowing during their initial three day induction period. It is also covered as part of Skills for Care induction and there is also a plan to obtain a training video. Staff spoken with were able to identify types of abuse and confirmed that they would report it without hesitation, to their manager or more senior person within the organisation, or to the Commission if that was appropriate. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents of Honey Lane live in an improving environment that is being developed to meet their needs. Evidence: There are three main units at Honey Lane, Saxon, Forest 1 and 2 and Abbey, each with communal spaces and facilities, served by a central kitchen and laundry. The AQAA stated that there has been much refurbishment and improvement of the environment at Honey Lane and that there is an ongoing redecoration programme. At the time of the site visit new furniture was being fitted to 23 bedrooms and the manager confirmed that all bedrooms will be refitted. In addition all lounges are imminently to have new furniture and all lounges, corridors and approximately one third of bedrooms are to have new carpets in the near future. New large screen televisions had been provided in the lounges. Arrangement of furniture in the lounges was being implemented that allowed areas for watching television as well as quieter areas. The manager also advised of setting out furniture in a flow arrangement that will not present as barriers or stop people moving around, to support people who need to walk round, an issue for many people living with dementia. A reminiscence room has Care Homes for Older People Page 20 of 31 Evidence: been created and an additional visitors room will be created upstairs. There is a plan to make the central courtyard and outside garden areas more user friendly, to enlarge the hairdressing room to make it a nicer facility and experience for residents and to provide a wet room that would provide an accessible shower facility for all residents. Areas of the home viewed, both communal and residents bedrooms, were clean and there were no odours noted. Bedroom doors had glass viewing panels that did not present as homely but these did have a curtain to promote privacy. Bedroom doors did not have suitable locks fitted to positively promote resident choice and privacy. Many bedrooms presented as personalised and there was some basic support for orientation with photographs on bedroom doors to help residents to recognise their own personal space. The laundry doors contained a notice to keep them locked, but both were found unlocked with no staff in the area. A chlorine based liquid was available in an unlocked cupboard and latex gloves were readily available to residents around the home. Both present a potential risk to residents and the operations manager was advised to ensure safe storage for hazardous items. The laundry and kitchen were noted to be clean and tidy. No paper towels for hand drying were available in one bathroom. This does not promote best practice in management of infection control. Relative surveys mainly indicated that the home is always fresh and clean. Comments from relatives surveys included when you enter the care home it smells good, has been times when soiling found in bedroom including soiled clothes that left a smell and because this is a dementia home it is inevitable that at times there is a smell when accidents occur but these are dealt with quickly. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for by a more stable staff group that will offer continuity of care, and to be better safeguarded by the improving recruitment and developing induction procedures. Evidence: Comments received from residents, relatives and a health professional either through conversation or surveys were positive regarding the care staff at Honey Lane and included they are nice members of staff who are approachable and carers are good and hard working at all times and staff are excellent. Other comments from surveys included at times there has only been one member of staff on in my relatives section, had some concerns i.e. hot cups of tea left with those unable to hold them and clients wandering in and on out of each others rooms with no intervention from staff. Another person said that sometimes agency care staff do not have the right skills and experience to look after people properly. The manager advised that for the current residents group, day staffing levels are two carers on Abbey unit, three carers over the two Forest units, two carers on Saxon unit including the senior and the additional carer available between 8am and 6pm. There is also a deputy manager and two activities coordinators as well as ancillary staff. Night Care Homes for Older People Page 22 of 31 Evidence: staffing levels are advised as one senior plus three carers. Staff spoken with were clear that lounges were not to be left unsupervised and this was observed in practice. Staff confirmed in surveys and discussion that the current staffing level is adequate to meet the needs of current residents and one commented there will always be the odd times when it seems there are not enough staff but in reality there are. The manager advised that there has been some recent successful recruitment, and although some agency staff are still being used while references and checks are being obtained and new staff are still shadowing, they should have a full complement of permanent staff in the very near future. This will improve continuity of care for residents. As stated in their AQAA, the manager confirmed that as a minimum, all staff, apart from those recently recruited, have completed or are working towards completion of NVQ level 2. New staff will commence this training in the near future and the manager stated that all staff are informed at interview that they are expected to undertake training to least NVQ level 2 standard. Additionally two staff have completed NVQ level 3 and another four staff wish to progress to this level. Files were reviewed for two staff recruited since the manager came into post to assess if appropriate information, references and checks had been undertaken to ensure that prospective staff are suitable people to care for the residents at Honey Lane. Both contained applications, two references, a declaration of health and offences, evidence of identity and timely Pova First and Criminal Record Bureau checks. One file indicated that the person had commenced work on the date that their reference had been received, but the manager confirmed that this had been hand delivered as agreed with the person, prior to the shift starting. This file contained an employment history only for the last three years and there was no evidence available that the reason for the gap had been explored and recorded as required. The more recent file indicated new safeguards put into place by the manager as an integral part of the recruitment process, including for example staff signing a separate declaration to confirm their work history is accurate, that they have received key policies and procedures including that relating to safeguarding adults and understanding of the requirement on them to read the care plans. There also was evidence that written references had been confirmed by telephone by the management at Honey Lane. Profiles for recently used agency staff, identified from the rota, were requested for review. The manager confirmed that no written confirmation had been obtained that agency staff had had appropriate training and recruitment checks to ensure residents Care Homes for Older People Page 23 of 31 Evidence: were safeguarded. Rotas did not contain the full name of agency staff used to confirm the identity of the person providing care. A staff induction checklist was noted on each of the two permanent staff files reviewed which was signed by the new member of staff and confirmed receipt of the employment handbook covering issues such as confidentiality. While there was evidence that Skills for Care induction progress log had commenced, the manager confirmed that the two entries, last dated over two months ago, were not satisfactory and this is an area for development. This was a requirement from the last inspection that is expected to be addressed by the new manager. A recently employed and previously experienced staff member spoken to confirmed that they had had an induction that included them shadowing an experienced member of staff. They had also been provided with training for example, on safeguarding vulnerable adults and moving and handling. Surveys received from staff also indicated that they had had a satisfactory induction. The training matrix provided of current training was reviewed to consider whether staff were provided with appropriate training to meet the needs of people using the service. This identified that the majority of staff had up-to-date training in mandatory issues relevant to their role such as medication, moving and handling, health and safety, food hygiene, safeguarding, fire awareness and infection control. Some staff also had additional training such as first aid and on the mental capacity act. It was disappointing to note that, in a home registered to provide care to people living with dementia, only five carers and two senior carers are recorded as having attended dementia training and none are recorded as having attended training on managing behaviour that challenges. The manager advised the training for staff on dementia is to be provided in the near future. Training files for two longer serving members of staff were sampled and confirmed the information in the training matrix. Comments from staff surveys or those spoken with felt that they had good access to training and that it was encouraged by the organisation and one person commented My manager is very good in training her staff and I appreciate the way I am trained. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to benefit from the improving management systems that promote their best interests and to have their views listened to. Evidence: A new manager was appointed in August 2008 and advised they effectively took up post in October. The manager confirmed that they have appropriate experience in care settings including working as a deputy manager, have achieved the Registered Managers Award and are currently undertaking a one-year course in Dementia Care from the University of Surrey. The manager advised they have introduced a system whereby a short report is written by staff over the 24-hour period, so that the manager always has up-to-date information on issues such as accidents, admissions or staff sickness. As advised in their AQAA and confirmed during this inspection, the manager has implemented a number of changes and improvements in the limited time they have Care Homes for Older People Page 25 of 31 Evidence: been in post, including improving the environment for residents, putting plans for staff training in place, ensuring care staff understand their responsibility in knowing the care needs of the people they provide care to and in improving the more recent recruitment practices for permanent staff. The manager also demonstrated an awareness of the need to improve care planning, to provide additional training for staff, review staff recruitment files to ensure they contain all the required information and implement effectively induction training to Skills for Care standard, with confirmation that these will be implemented. The registered provider has a quality assurance system in place that includes obtaining the views of residents and relatives. Recently received completed surveys from relatives and residents were available. These demonstrated satisfaction with the services provided including for example availability of social activities, food and support received. A copy of the report of this survey will be sent to the Commission once available. There was also evidence that the registered provider undertakes detailed monthly audits, reviews and reports of the home as required to reassure themselves that the home is running as it should. The management of the home did not look after any personal money of behalf of the people living there. Relatives are invoiced routinely for such items as hairdressing or chiropody services. Findings of the review of records are included throughout this report and indicates that some records needed to be improved including care plans, daily care notes, record of nutrition and also the rota which did not clearly identify the name of all staff working at the home. Records of accidents and events required to be notified to the Commission were well maintained and readily available. The manager advised that having reviewed the accident records on coming into post, they requested an additional member of staff between 8am and 6pm. The manager stated this was agreed by the registered provider and has resulted in a 70 per cent decrease in the number of accidents occurring in the home, leading to a more positive outcome for residents. Clear and well maintained records were available to show us that regular checks were made, for example of the hot water temperatures, the fire alarm and call bell system. The manager agreed that checks need to be routinely undertaken on the cold water system to in relation to management of Legionella. Risk assessments were available relating to safe working practices and minutes of regular health and safety meetings were available. There was a letter from Essex Fire and Rescue Service advising of a satisfactory standard of fire safety at their recent site visit. There was no evidence of the timing of fire drills and the staff who attended as routine practice to support Care Homes for Older People Page 26 of 31 Evidence: effective monitoring. The manager confirmed that all staff undertake a fire drill as part of their fire training. Care Homes for Older People Page 27 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 28 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Ensure that each persons care plan includes all aspects of their assessed needs and provides staff with clear detail on how these are to be met in practice from the day of admission. The activities programme and life history work should continue to be developed to ensure there are suitable and meaningful occupations for residents to meet their individual needs and capabilities. Residents should have an active choice of meals offered in a way and at times that enable them to use it effectively. A record should be kept for all residents of the food provided in sufficient detail to enable the record to demonstrate that the diet is nutritionally satisfactory. The complaints procedure should provide better information for people on the timescales they can expect for responses and also on their option to contact Social Services to make a complaint. Paper towels should be available in all bathrooms to support effective handwashing and management of infection control. 2 12 3 4 14 15 5 16 6 19 Care Homes for Older People Page 29 of 31 7 8 19 19 Materials that present potential hazards to residents should be risk assessed and stored safely and securely. The ongoing maintenance and refurbishment programme should continue to ensure that residents live in a well maintained environment. Doors to residents bedrooms should be fitted with locks suited to residents capability and that are accessible to staff in emergencies, with keys provided to residents unless their risk assessment suggests otherwise. To safeguard residents, ensure that all required information has been obtained in respect of all members of staff who work at the care home. This includes agency staff. To safeguard residents and ensure that staff are competent to meet their needs, ensure that all staff receive training appropriate to the work they are to do and to meet the needs of the residents living at the home, such as in dementia care. This also includes structured induction training. Ensure that the full names of all staff are recorded on the rota at all times. The timing of fire drills and the staff who attended should be recorded to support effective monitoring. Ensure regular checks of the cold water system are undertaken and recorded. 9 24 10 29 11 30 12 13 14 37 38 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!