Inspection on 16/07/09 for Hopes Green Care Centre

This inspection was carried out on 16th July 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hopes Green Care Centre 11/02/09

Hopes Green Care Centre 01/02/08

Hopes Green Care Centre 27/02/07

Hopes Green Care Centre 12/06/06

Hopes Green Care Centre 30/01/06

Hopes Green Care Centre 23/06/05

Hopes Green Care Centre 19/02/05

Hopes Green Care Centre 09/07/04

Hopes Green Care Centre 09/03/04

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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 16/02/2010.

Key inspection report Care homes for older people Name: Address: Hopes Green Care Centre 16 Brook Road Benfleet Essex SS7 5JA     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: Michelle Love     Date: 1 6 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Hopes Green Care Centre 16 Brook Road Benfleet Essex SS7 5JA 01268752327 01268755518 hopesgreen@schealthcare.co.uk www.schealthcare.co.uk Exceler Healthcare Services Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Philomena Heather Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Personal care to be provided to no more than fifty service users over the age of 65 years. Total number of service users for whom personal care is to be provided shall not exceed 50. Date of last inspection Brief description of the care home Hopes Green Care Centre is a large home providing accommodation and personal care for up to fifty older people aged over 65 years of age who need assistance with personal care. The homes facilities include several communal lounge/dining areas and fifty single bedrooms all with ensuite facilities. The home is situated within easy walking distance of local shops and amenities, with Southend and Canvey Island main shopping centres a short car or train journey away. There are good bus and train links Care Homes for Older People Page 4 of 31 Over 65 50 0 1 1 0 2 2 0 0 9 Brief description of the care home to the area. The garden enables service users to access a patio area and garden safely. There is ample car parking for visitors and the home has adequate wheelchair accessibility throughout. 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 was an unannounced key inspection. The visit took place over one day by two inspectors and lasted a total of 10 hours, with all key standards inspected. Progress against previous requirements and recommendations from the last key inspection in February 2009 was also inspected. Prior to the previous inspection, the manager had submitted an Annual Quality Assurance Assessment. This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. This was completed and submitted to us in November 2008. Information recorded within this document has not been incorporated into this report as the information contained within it may be out of date. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. A partial tour of the premises was Care Homes for Older People Page 6 of 31 undertaken throughout the day, residents, peoples representatives and members of staff were spoken with and their comments are used throughout the main text of the report. The manager, deputy manager and other members of the staff team assisted us on the day of the inspection. Feedback of the inspection findings, were given as a summary to both the manager and operations manager of the service. The opportunity for discussion and/or clarification was given. At the time of the last key inspection we issued an Immediate Requirement Notice relating to poor medication practices and procedures and a Serious Concern Letter relating to poor care planning and risk assessing processes. Progress to check compliance to both issues were looked at as part of this site visit and our findings are recorded within the main text of the report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Some aspects of medication practices, procedures and records management have been improved, so as to ensure that peoples healthcare needs are met. Where people are at risk of losing weight, appropriate records, including weight gain or loss and action taken are now in place. This enables the staff and management team of the home to provide appropriate interventions and people can be assured that their nutritional needs will be monitored and met. Recruitment procedures within the home are now robust, so as to safeguard the people who live at Hopes Green Care Centre. The dining experience for people has improved and people are not spending a lot of time at the dining table before receiving their meal. Where people are given assistance Care Homes for Older People Page 8 of 31 and support to eat their meal this is undertaken in a timely manner. The homes care planning and risk assessing processes have been reviewed. Care plan documentation for people living at the care home has been re-written and updated, so as to ensure that the information recorded is detailed, person centred, up to date and reflective of the persons care needs. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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. People who come to live at the home can be confident that their needs will be assessed. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective service users needs. Records showed that admissions are not made to the home until a full assessment is undertaken by the management team of the home. In addition to the formal assessment procedure, supplementary information is sought from the persons placing authority and/or hospital. Information collated as part of the pre admission assessment process is used to inform the draft care plan and subsequent plan of care. As part of this site visit the care files for 2 people newly admitted to Hopes Green Care Centre were looked at. Records showed that both people were assessed prior to their admission to the care home. Information recorded was noted to be detailed and Care Homes for Older People Page 11 of 31 Evidence: informative. There was evidence to show that the prospective person and/or their representative were provided with an opportunity to visit the care home prior to admission, to have a look around the care home and to meet members of the staff team and existing residents. In addition there was evidence to show that the management team of the home had confirmed in writing to the prospective person and/or their representative that they could meet the individuals assessed care needs. One person spoken with confirmed that their next of kin visited the care home on their behalf and that the admission process had been smooth. We also spoke with a visiting relative of one person newly admitted to the care home. They too confirmed that they had visited Hopes Green Care Centre with their member of family, that their relative had been given a choice of room and the admission process had been satisfactory. They verified that they had been given a copy of a brochure about the home, but could not remember if this included the Service Users Guide. There is an up to date Statement of Purpose and Service Users Guide in place providing information about the services and facilities at Hopes Green Care Centre. The Statement of Purpose is located centrally and people are provided with a copy of the Service Users Guide. The home does not provide intermediate care. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the care home can expect to have a plan of care, however shortfalls identified could mean that outcomes for people are not always positive. Evidence: Records show there is a formal care planning system in place to help staff identify the care needs of individual people living at the care home, and to specify how these needs are to be met by care staff. In addition, formal assessments relating to dependency, manual handling, pressure area care, nutrition and continence are also completed for each person. As part of this site visit a random sample of 6 care files were examined (4 care files were examined in full and 2 care files were examined in relation to specific healthcare needs). Records showed that since the last key inspection in February 2009, care files for people living at the care home have been reviewed, updated and amended to ensure they contain all necessary information and are more person centred. Care plans inspected were generally observed to be more detailed, recording individuals care needs and providing guidelines for staff as to how the person should be Care Homes for Older People Page 13 of 31 Evidence: supported. Records showed that efforts were being made by the management team of the home to ensure that the care plans were person centred and included individuals personal preferences, likes and dislikes, strengths, abilities and weaknesses. For example one persons personal hygiene needs were clearly recorded detailing the support to be provided by staff, information about their personal preferences, specific information about their abilities and strengths and frequency of personal care support to be provided. While we recognise the improvements, further development is required in some areas. This refers specifically to some elements of the care plan for some people, not always being signed and dated by the person completing the documentation. This should be done as part of good practice procedures. Records also showed for one person that they could be resistant and/or aggressive towards others, in particular when personal care was being provided by care staff. A risk assessment was in place, however this did not include specific information for staff as to how this was to be proactively managed. In addition their care plan pertaining to personal hygiene made no reference to this and there was no plan of care relating to aggression and/or inappropriate behaviours. On inspection of daily care records these confirmed there were occasions when the person could be resistant and/or aggressive, however in some instances there was a lack of information detailing staffs actual interventions. Records also showed there were occasions whereby the person had a small dietary intake and/or refused meals, however their plan of care had not been updated to reflect this. Nutritional records confirmed there were occasions when the dietary intake for this person was poor. A risk assessment relating to poor nutrition was in place however this was not an up to date assessment and we found that the most up to date assessment had been archived. This means that staff working within the care home potentially have inaccurate information about the individual person. Staff spoken with were able to demonstrate an awareness and understanding of the care needs for this person. The Medication Administration Records (MAR) for the same person showed on occasions that they could refuse to take their medication. The care file showed that a plan of care was in place, however no risk assessment had been devised, detailing the risk and how this was to be minimised. Another care file made reference to the person experiencing pain as a result of a degenerative joint disease. On inspection of their MAR record this showed they were prescribed regular pain relief medication. A plan of care was available detailing the above, however no formal assessment relating to pain had been compiled and it was unclear from the care plan as to how this impacted on the persons quality of life. Care Homes for Older People Page 14 of 31 Evidence: Daily care records evidenced there were intermittent occasions when the person suffered discomfort and distress as a result of the pain experienced and this was confirmed by the resident. Staff spoken with confirmed to us that the person often found it difficult to mobilise and regularly was administered pain relief as a result of their physical condition. Improvements were noted in relation to risk assessment documentation. The manager was advised to ensure that risk assessments are devised for all areas of assessed risk and clearly record the potential risk and clear guidelines for staff as to how these are to be proactively managed and the risk reduced. For example the care file for one person recorded that they were recently admitted to hospital as a result of them taking their catheter out, however this was not reflected within their plan of care and a risk assessment was not devised. Daily care records are written each day and at least twice daily. Information recorded was in general informative and detailed. However care must be taken to ensure that there is evidence of staff interventions and actual care provided. Staff interactions with people living at the care home were observed to be positive. Staff were noted to have a good rapport with individual people and to provide care and support in a sensitive, respectful and dignified way. People were observed to enjoy the interactions and there was evidence to show that staff have a good understanding and awareness of individuals care needs. Two people told us, the staff team work very hard and will do anything for you and the girls are wonderful, they will do anything for you and with a smile. Another person advised us that staff are very good and are respectful of my disability. People spoken with were happy about the level of care provided. Medication practices and procedures were examined and we checked compliance to the Immediate Requirement Notice issued following the last key inspection. In addition a random sample of records for several people were also inspected. We watched the administration of medication during the morning and lunchtime period and this was noted to be conducted in a timely and satisfactory manner. Medication is stored securely with records maintained of the temperature for medication that requires cold storage and the rooms where medication is stored. Temperatures were noted to be within recommended guidelines. In general terms recording was much improved, with few omissions in the records made when medicines are given to people. However shortfalls were identified and these relate to evidence from one persons MAR chart detailing that one of their Care Homes for Older People Page 15 of 31 Evidence: medications (pain relief medication) was dispensed from the blister pack and left with them to self administer. Records showed that at the time of their next dose, the previous dose of medication remained in their room. On inspection of their care plan, this verified that all of the persons medication was to be administered by staff. The practice of leaving people who do not self medicate with their medication is poor practice and not in line with the homes own policy and procedure. The MAR records for another person showed that one of their medications was not administered for a period of 3 days as it was out of stock. We were advised that steps were taken by the deputy manager to resolve this issue as soon as possible. While we accept this, care must be taken to ensure that all staff who administer medication are vigilant and proactive so as to ensure that where medication is due to run out, further supplies are sought and available within the home and that people receive their prescribed medication in line with the prescribers instructions. As part of good practice procedures, handwritten MAR records were not double signed for 3 people, to confirm that the medication received was accurately recorded. Additionally, the date and quantity of medication received was not always recorded. Not all packets and bottles of medication had been signed and dated when opened and it was difficult to decipher when some medications had been started. We also looked at records for 3 people who are administered controlled drug medication. The storage facilities were seen to be satisfactory with records and actual medication accurately documented. Audits are undertaken to ensure that medication records are completed and accurate. We noted that controlled drugs utilised at the care home are audited by 2 members of staff at changeover on every shift. This is seen as good practice, however a discrepancy was noted in relation to one person and the audit inaccurate with the incorrect balance of medication recorded. This was discussed with the management team of the home at the time of the site visit. A copy of the staff training matrix was provided to us at the time of the site visit. Records show that all staff who administer medication have received up to date training. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the care home can be assured that their social care and dietary needs will be met. Evidence: An activities co-ordinator is employed at the care home from 09.00 a.m. to 14.00 p.m. Monday to Friday. We were advised that these hours are flexible so as to cover evenings, weekends and special events. Since the last key inspection the activities budget has been increased to £102.00 per month to spend on materials, projects and to fund external entertainers. In addition fund raising events are held to boost the activities budget. The activities co-ordinator advised us that she has completed training relating to dementia awareness and activities for the older person. An activities programme is devised and displayed for people living at the care home. In addition each person is issued with a copy of the activity programme. These showed that people have the opportunity to participate in a variety of activities such as religious observance, bingo, lotto, arts and crafts, quizzes, gentle exercises, pool, snooker, safety darts, basketball, board games, film afternoons, reminiscence and visits by external entertainers. In addition people are supported and enabled to access the local community and visits have included, going to the theatre/opera and going to Care Homes for Older People Page 17 of 31 Evidence: Tropical Wings. A newsletter is compiled and distributed to advise people of forthcoming events e.g. fete. An assessment of individuals social care needs is carried out by the activities coordinator and includes looking at peoples personal preferences, likes and dislikes and past hobbies and interests. The activities co-ordinator demonstrated a good understanding and awareness of individuals care needs and is clearly enthusiastic about their role. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. Both residents and visitors to the home confirmed they can see their member of family and/or friend at any time. Visitors stated they are always made to feel welcome by care staff. There is a rolling 4 week menu in place and this shows that people are provided with a varied diet throughout the day. The lunchtime meal was observed within both dining areas on the ground and first floors. A menu was placed on each table and was reflective of the meal provided on the day of the site visit. Tables were attractively laid with tablecloths, serviettes, condiments and glasses. A choice of drinks was available and people were given a choice. The dining experience for people was observed to be more positive and well organised at this inspection. This meant that people were not sat for long periods at the table waiting for their meal to be served and people who require assistance by staff to eat their meal, were provided with support in a timely manner. Food was served from a hot trolley and where people choose to have their meal in the comfort of their room, measures are in place to ensure that their meal arrives hot. Although people have preordered their choice of meal the previous day, people were asked what they would like in case they had changed their mind. Meals provided to people were attractively presented and portions of food noted to be appropriate. Several people were asked if they would like a second helping and/or if they had finished their meal, before the plate was removed. Alternatives to the meal were readily available and people spoken with stated that they found this helpful. For example on the day of the site visit one person had chosen chicken curry, however after a few mouthfuls they advised they did not like the choice and wanted something else. This was duly done and they were much happier with cornish pasty and chips. Where people required assistance to eat their meal, this was observed to be undertaken by care staff with sensitivity, dignity and respect. Comments from people spoken with on the day of the site visit relating to the quality Care Homes for Older People Page 18 of 31 Evidence: of meals provided were generally positive and included, the food is fine, I have no complaints, not bad and the curry is a bit watery, you win some and you lose some. Care Homes for Older People Page 19 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 can expect their concerns to be listened to and dealt with appropriately. Evidence: There is an appropriate complaints policy and procedure in place at Hopes Green Care Centre. Following the key inspection to the home in February 2009, the home has been made aware of 1 complaint which was initially brought to the Care Quality Commissions attention and referred directly to Southern Cross Healthcare to investigate. This related to alleged poor manual handling procedures being adopted by some members of staff, medication errors and no hot water being available in several peoples rooms. Records showed that the management team of the home dealt with the above in a timely manner and these have been addressed promptly and each area of complaint resolved satisfactorily. The outcome of the complaint was that 2 elements of the complaint were not upheld and 1 element was upheld. Several people spoken with confirmed they know how to make a complaint and know who to speak to if they are unhappy and/or concerned. One visitor also confirmed that if they had any concerns they would discuss this with the manager and/or deputy manager. Since the last key inspection there has been 1 safeguarding referral. This related to one persons pressure area care. From discussion with the manager and from evidence of documentation held within the home, there was evidence to show that this issue was dealt with appropriately by the management team of the home and they cooperated fully with the local Safeguarding Team. Care Homes for Older People Page 20 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. People can expect to live in a safe, comfortable, homely and well maintained environment which meets their needs. Evidence: A partial tour of the premises was undertaken throughout the day of the site visit. The home was observed to be clean, tidy and odour free. A random sample of residents bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display. People confirmed they are happy with their room and some people were observed to have telephone facilities and a fridge. No health and safety issues were highlighted at this inspection. The homes laundry facilities were examined and systems in place continue to be organised and well managed. A maintenance person is employed at the care home Monday to Friday 07.00 a.m. to 13.00 p.m., however their hours remain flexible and on call arrangements are in place to cover out of hours and weekend periods. On inspection of the staff training matrix this shows the maintenance person as having up to date training relating to fire safety, fire drills, food hygiene, moving and handling, COSHH (Control of Substances Hazardous to Health), health and safety, safeguarding, infection control and bed rail safety. Care Homes for Older People Page 21 of 31 Evidence: A random sample of safety and maintenance certificates showed that equipment in the home has been serviced and remains in date until their next examination. Records of fire drills were examined and these showed that these are regularly undertaken with records kept. In addition there is a fire risk assessment and the homes fire systems are checked each week. Care Homes for Older People Page 22 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. People can be assured they will receive appropriate care from a staff team who are regularly trained and who are recruited in line with regulatory requirements. Evidence: We were advised by the manager that staffing levels at the care home are 7 staff (including person in charge) between 07.30 a.m. and 14.30 p.m., 6 staff (including person in charge) between 14.30 a.m. and 21.30 p.m. and 4 waking night staff (including person in charge) between 21.30 p.m. and 07.30 a.m. each day. The manager is supernumerary to the above and the deputy manager receives 1 supernumerary shift per week. In addition to the above a variety of ancillary staff are employed and these include cook, kitchen assistant, laundry person, domestics, housekeepers and maintenance person. An administrator is employed at the care home for 25 hours per week, Monday to Friday. On inspection of 4 weeks staff rosters these evidence that staffing levels as detailed above have not always been maintained. These relate specifically to the night rosters provided to us. We have not been notified via Regulation 37 Notifications when staffing levels have not been attained and the measures undertaken by the management team of the home/registered provider to address the shortfalls. The deputy manager confirmed to us that the staffing levels and deployment of staff within the care home, is based on the the number of people residing at the care home and Care Homes for Older People Page 23 of 31 Evidence: not on their dependency levels. Throughout the day of inspection the deployment of staff within the home was seen to be appropriate for the numbers and needs of people currently living there and actual care provided was undertaken in a timely manner. Initially we were advised that no new people had been newly employed at the care home since the last key inspection in February 2009. However, from discussions with one member of staff it was apparant they had commenced employment at Hopes Green Care Centre since the last key inspection. On inspection of their recruitment file and one other chosen at random, all records as required by regulation had been sought and were readily available. The newest person employed confirmed they had received a comprehensive induction and this included 3 days whereby they shadowed an experienced member of staff. On inspection of the staff training matrix and training statistics sheet, this showed that since the last key inspection, training and/or refresher training in core subject areas has been provided to the majority of staff. This has included training relating to fire safety, fire drills, food hygiene, moving and handling, COSHH, health and safety, safeguarding and infection control. In addition some staff have undertaken training relating to nutrition, pressure area care, customer care, dealing with challenging behaviour, dementia awareness and bed rail safety. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that the care home is run in their best interests and provides positive outcomes. Evidence: The manager has managed Hopes Green Care Centre for the past 3 years and was formally registered with us in January 2009. At the previous key inspection to the home 7 statutory requirements and 3 recommendations were highlighted. In addition an Immediate Requirement Notice was issued in relation to inadequate medication practices and procedures. At this key inspection it was positive that the management team of the home have addressed 3 of the requirements and 2 of the recommendations. In relation to those requirements pertaining to care planning, risk assessing and some aspects of medication practices and procedures, significant improvements were noted, however a new timescale for action has been recorded for these requirements that remain outstanding. It is envisaged that the management team of the home will continue to sustain progress Care Homes for Older People Page 25 of 31 Evidence: and to make further improvements which will ensure positive outcomes for people living at Hopes Green Care Centre. There is a quality assurance system in place so as to seek the views of residents, relatives and other stakeholders, about the quality of the services, care and facilities provided at the care home. We were provided with evidence of comments from the latest quality assurance undertaken. In general most comments were observed to be positive and included, The care centre is always very clean and warm. The staff are always very friendly and helpful, I am very pleased with the care and attention my relative is receiving in your care-nothing seems to be too much trouble for anyone, they are very happy, your staff are exceptional with great patience, Occassionally I feel things are not always passed onto all carers where changes in [name of relative] care has been changed. I then have to chase things up, but in the main I think the home does a very good job and If I have any concerns I usually speak to the senior and care assistant on that shift. I often find tht there is no-one in the office, or if they are in they are very busy and unable to speak. The manager and administrator manages residents personal money held on their behalf. A computerised system is in place and the records of a random sample of peoples monies held by the home were examined and seen to be satisfactory with a clear audit depicting expenditure and monies received. Outside of office hours, there is a £50 float to cover emergencies and unplanned requests for money. Monthly visits by a representative of the organisation are conducted and a report compiled as part of Regulation 26. In addition there are regular staff, senior staff and manager meetings and evidence of the minutes for these were randomly sampled. We were advised that resident meetings are held approximately every 3 months. On inspection of a random sample of staff supervision records, evidence showed that staff are receiving regular formal supervision in line with National Minimum Standards recommendations. Records also showed that staff have an annual appraisal and that the areas covered are comprehensive. On inspection of the newest member of staffs recruitment file, their staff performance/appraisal form evidenced positive comments in relation to their knowledge of the job role, quality of their work, use of initiative and enthusiasm, team work, time keeping and attitude. It also showed that the member of staff was also given one-to-one feedback from the deputy manager and team leader as to their care practices and overall performance. Accident records for people who live at the care home were seen to be well organised. No significant trends for individual people were highlighted. Care Homes for Older People Page 26 of 31 Evidence: At this inspection we noted that there was a health and safety policy and procedure in place, however the infection control policy could not be located. The latter remains outstanding since the previous inspection to the home. The manager advised that a possible rationale for this could be if a member of staff was using the information as part of their NVQ course, however she confirmed that this should be returned for other staff to access, should they need to. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be 30/09/2009 devised for all areas of assessed risk so that risks to residents can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the person and steps to be taken to reduce the risk. Previous timescale of 31/3/09 not met. So as to ensure peoples safety and wellbeing. 2 27 18 Ensure there are sufficient staff, on duty at all times. Previous timescale of 16/3/09 not met. So as to ensure the needs of residents are met according to their specific needs and dependency. 31/08/2009 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 1 7 14 There is a plan of care, 30/09/2009 clearly identifying all aspects of the persons care needs and how these are to be met by staff. This will ensure that staff have the information they need so as to provide appropriate care to meet the individuals care needs. People must be protected from harm by having their medication administered safely and in accordance with the prescribers instructions. This refers specifically to medication being out of stock. So as to ensure peoples safety and wellbeing. 31/08/2009 2 9 13 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 1 9 Handwritten MAR records should be double signed by staff to confirm that information recorded is accurate. This should include the date and amount of medication received. Packets and bottles of medication should be signed and dated when commenced. Ensure there is an Infection Control policy and procedure readily available for staff to access. 2 3 9 38 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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