Inspection on 06/07/09 for Icknield Court

This inspection was carried out on 6th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Icknield Court Icknield Court Berryfield Road Princes Risborough Buckinghamshire HP27 0HE     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: Chris Schwarz     Date: 0 7 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: Icknield Court Icknield Court Berryfield Road Princes Risborough Buckinghamshire HP27 0HE 01844275563 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.fremantletrust.org The Fremantle Trust Name of registered manager (if applicable) Helen Diane Jeffrey Type of registration: Number of places registered: care home 90 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 90 The registered person may provide the following category/ies of service only: Care home only -PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category -OP Dementia -DE Date of last inspection Brief description of the care home Icknield Court is a purpose built care service located close to shops and transport links in Princes Risborough. Accommodation is on two floors with six house groups, three of which are for people with dementia. Houses have their own dining area and kitchen facilities and a lounge. Each person has a single bedroom with ensuite shower and toilet. Communal bathrooms have adapted baths suitable for people with disabilities. Care Homes for Older People Page 4 of 31 Over 65 0 90 90 0 Brief description of the care home There are pleasant garden areas with seating for people to enjoy some fresh air. Fess at the time of this visit ranged from £619 to £700 per week for residential care and from £700 to £750 per week for dementia care. Information about the service is contained within a statement of purpose and service users guide which were available in the entrance hall. 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 unannounced key inspection was conducted over the course of two days on 6 and 7 July 2009 and covered all of the key National Minimum Standards for older people. It was the services first inspection since registration. Prior to the visit, a detailed selfassessment questionnaire, the Annual Quality Assurance Assessment, was sent to the manager for completion. It was returned in good time and provided a good standard of information about the service and statistical information needed to plan the visit and assess standards of care being provided. Surveys were sent to a selection of people living at the service, staff and visiting professionals. Fifty three replies were received from people using the service, relatives, staff and visiting social and health care professionals which have helped to form judgements about the service. Information received by the Commission since registration was also taken into account. Care Homes for Older People Page 6 of 31 The inspection consisted of discussion with the manager and other staff, such as the deputy manager, two group care co-ordinators, activity organisers, carers, the chef manager and administrative staff. There were also opportunities to meet with people using the service. Some of the services required records were looked at such as care plans, recruitment files, training records and finance records and the accommodation was viewed. People with dementia are not always able to tell us about their experiences, therefore a formal way to observe people has been used in this inspection to help us understand. This is called the Short Observational Framework for Inspection (SOFI) and involved observing up to five people who use services for two hours and recording their experiences at regular intervals. This included their state of well being and how they interacted with staff members, other people who use services, and the environment. Feedback on the inspection findings and areas needing improvement was given to the manager and operations manager for the service at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 31 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 using the service are thoroughly assessed prior to admission and are given opportunity to visit beforehand to ensure it meets their needs. There is a good range of information about what people can expect from the service in the statement of purpose and service users guide. Evidence: The Annual Quality Assurance Assessment informed us that a statement of purpose and service users guide were in place. A full and thorough assessment was said to be undertaken for all prospective users and they are invited to look around and share a meal if they wish. The first four weeks were described as a trial period which can be extended if necessary. It said the team aim to make sure the person who carried out the persons community assessment is on duty to welcome them when they arrive. The information included that users are given a contract outlining the terms and conditions of residence and that respite care is provided in addition to permanent care. Care Homes for Older People Page 11 of 31 Evidence: On arrival at the service, there was access to a copy of the statement of purpose and service users guide in the entrance hall. Both were well written documents setting out what people can expect from living at Icknield Court such as its aims and objectives, a service users charter, qualifications of staff and how to make a complaint. The service users guide had colour photographs throughout including those of staff and the two cats. Other information was also provided in the entrance area such as the registration certificate. Pre-admission assessments of three people were seen. Each had been completed using a corporate format that covered areas such as mobility, communication, washing and bathing, continence, dressing and personal grooming, dietary needs, medication and health care needs. These were dated. There were also personal move plans in place where service users had been living in the two services which Icknield Court has replaced. These outlined peoples wishes and preferences in moving to the new service and people met during the course of the two days expressed positive comments about how the move had been handled. Relatives and people using the service who completed surveys said they had received enough information to help them make a decision about using the service. One added all the staff, and the manager in particular, deserve to be applauded for managing the move to the new Icknield Court so effectively. There was a big change in the home environment when this happened, and all the new equipment and facilities are much appreciated by staff and residents. She added inevitably, much of the cosiness and feeling of being part of one big family has now been lost now that it is a much larger home. Intermediate care is not provided at this service. 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. Peoples individual needs and preferences are recorded in their care plans and kept under review to make sure information is current. Health care needs are well met to promote well-being. Management of medication has been inconsistent and places people at risk of harm. Evidence: The Annual Quality Assurance Assessment advised that care plans were in place for each person, which are checked monthly and reviewed as necessary. It said these were kept secure to protect sensitive information. Assessments were said to be in place for risks such as pressure damage, nutritional needs, moving and handling, falls and fractures. People using the service were described as having access to doctors, nurses, chiropody treatment and medication was being managed using a monitored dose system. Medication reviews were said to take place and staff were trained in the handling of medicines. Privacy and dignity were described as given a high priority by the staff team. It said handover systems were in place to ensure staff are kept up to date with peoples changing health care needs. Care Homes for Older People Page 13 of 31 Evidence: Health care professionals who returned surveys said the services assessment arrangements always or usually ensured that accurate information is gathered so that the right service can be planned. They said peoples social and health care needs were always or usually properly monitored and reviewed and that staff always or usually seek advice and act on it to meet needs and improve well-being. They said the service usually supports people to administer their own medication or manages it correctly if they are unable to do this themselves. They considered that peoples privacy and dignity were always or usually respected and that people were usually supported to live the life they choose wherever possible. They felt staff and managers usually have the right skills and experience to support peoples social and health care needs and that they respond to needs arising from equality and diversity. Relatives who returned surveys expressed similar views about peoples care, as did service users. One relative said they always contact me if there are any concerns with my mum. Another said we would commend the staff, especially the key workers, for their care, interest and service to residents above and beyond the call of duty. Another said no complaints at all about the care and service that my mother receives in all respects, it is first class. Other comments from relatives included kind, friendly people. If you need help or hospital it will be arranged for you. One relative felt there needed to be more regular updates to families about peoples conditions. Another felt that relatives meetings and newsletters had stopped since the service moved which meant they were not so well informed about what is going on in general. During the inspection, the manager and operations manager advised that there had been lots of communication relating to users moving into the new service which had then naturally stopped once people had arrived. A consultation meeting was going to be arranged which relatives would be invited to. A social care professional said common themes mentioned in reviews by the families are the levels of communication. The home always advises the families of any incidents. Clients and families always report the staff to be kind, caring and friendly. She felt it could improve through ensuring any actions identified as a result of a review need to be fulfilled. A doctor said provides a happy environment for its residents and takes a strong interest in their physical health. Another doctor added caring staff, interested and informative. Excellent working relationship with the managers who support me during my GP round. Eight care plans from two lounges were read. Care plans were stored in locked cupboards. Care plans followed a corporate format and contained a photograph of the person, an essential information sheet (date of birth, doctor details, next of kin, Care Homes for Older People Page 14 of 31 Evidence: religion, allergies etc), a life story at a glance, summary of their care plan and the full care plan. Care plan information included information about needs such as peoples mobility, communication, social skills, washing and bathing, continence, family, leisure and recreation, health and medication needs. Where people had dementia, this was noted in their care plans. Where equipment was needed, such as pressure relieving mattresses or cushions, this was seen to be in place and in use. All care plans were dated and signed. Some difference in quality of care plans was discussed with the manager, who was already aware of this and was carrying out audits. Assessments were in place for risk of developing pressure damage, nutritional needs, falls, fractures and moving and handling. The majority had been reviewed on a regular basis and updated where necessary. The manager was advised which files showed this not to be the case. Peoples weight was being noted but this was not consistently being done in accordance with frequencies indicated in care plans and in some cases was because specialist scales were required. Dependency level assessments were also seen, which had been reviewed recently. Records were being kept of health care interventions and the service had a treatment room which visiting doctors and nurses use to see their patients. Food and fluid charts were in place where needed and records of turning to relieve pressure were being kept. Medication was being managed using a monitored dose system whereby the pharmacy pre-pack tablets into blister packs for each person. Medication for each house was being stored in cupboards with key pad entry. In two houses it was observed that keys to the medicines trolley were accessible within the cupboards with the potential for untrained staff to have access to medicines. Observation of medication administration in one of the houses reflected good practice. The managers attention was drawn to a record sheet for the previous week where a medicine had been signed as given but was still in the blister pack. Controlled medicines were being stored separately in the service. An audit of these was undertaken and all supplies tallied with entries in the controlled drugs register. It was noticed that one controlled medicine had been stopped three weeks previously but was still waiting to be returned. The manager said this was part of the contract with the supplying pharmacy and it can take a few weeks for them to collect these items. She is advised to monitor this to make sure that unwanted controlled medication is not kept on the premises unnecessarily. Care Homes for Older People Page 15 of 31 Evidence: Since the service opened, eight notifications have been made of medication errors including giving service users other peoples medicines, continuing to use medicines which have been stopped by a doctor and giving a medicine twice. Action has been taken by the manager to address this such as writing to all relevant staff, following up in supervision sessions and putting in place a red tabard system so that other staff know who is handling medicines and to not interrupt them. It is acknowledged that action is being taken to improve how medicines are handled and administered at the service and both the manager and operations manager were taking matters seriously. However, there is still some improvement needed as identified in the report and the service needs to have a sustained period of safe practice to show these actions are taking effect. 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. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. A range of meals is prepared to make sure that nutritional needs are met. Evidence: In the Annual Quality Assurance Assessment we were informed that people using the service can choose to join in activities or spend time alone. Information provided said that three activities co-ordinators were employed at the service, covering 56 hours per week. Links with local schools and churches were described. A programme of activities was described as being planned and displayed on notice boards. We were advised that people are consulted about activities and meal provision during residents meetings. We were told there is a Tuesday morning beauty salon with a National Vocational Qualification qualified beautician and reflexologist and that there are pets at the service. Meals were described as relaxed with menus placed on each dining table and providing a nutritious and balanced diet for older people. The three activities co-ordinators were met during the course of the inspection. They had put together a range of activities for people living at Icknield Court such as coffee mornings, gentle exercises, an art group, bingo, cookery and craft, a current affairs Care Homes for Older People Page 17 of 31 Evidence: group and afternoon tea with poetry and classical music. Links were taking place with the Risborough festival which was running the same week as the inspection, and some service users had enjoyed lunchtime concerts at a local church as part of this. A recent appreciating animals event at the service had been successful, with a variety of animals brought to the service; a PAT dog also visits occasionally. Records of activities showed that entertainers are brought in such as singers and a theatre company who produce a variety show. A volunteer runs a weekly shop. Several people were seen reading daily newspapers that they have delivered. Activities for the week were displayed on notice boards in each of the houses. Service users in one house were seen having their nails done with the carer showing them the selection of colours of polish to help them make a decision about which to choose. A cognitive stimulation therapy group was planned to be taking place over the course of 14 weeks with a group of men at the service, which sounded particularly positive. Peoples religious needs were being met with a weekly hymn service, communion twice a month and a visiting Catholic priest. A member of staff said in a survey that one of the things the service does well is provides activities regularly. Two staff and a few service users thought there needed to be more activities. A social care professional said Icknield Court is now a much larger home and they provide a very good range of activities for all clients. Three relatives felt that the service could improve through providing more stimulation for people with dementia. A four week menu was being used at the service. Dining tables had the menu for the day displayed and were set with table cloths and napkins. Cooked breakfast was available to people as well as cereals, porridge and toast. People were seen to be offered alternatives at meal times and those requiring assistance were given gentle support with their meals. During a meal on one of the houses some gentle music was playing, which added to the ambience and is to be encouraged. Lots of drinks were seen to be encouraged and biscuits offered with morning and afternoon tea/coffee. Most service users said in surveys that they usually enjoyed the meals provided for them. Four service users said that food needed to be improved, it was sometimes undercooked or overcooked and they wanted more variety. Care Homes for Older People Page 18 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. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. Evidence: In the Annual Quality Assurance Assessment we were informed that there are complaints and safeguarding procedures in place. We were advised that complaints are dealt with promptly and logged in a folder. Information provided said people using the service are asked if they have any concerns at each residents meeting. We were told that staff are recruited in line with good practice to make sure that all checks are undertaken and that all staff receive bi-annual safeguarding training. No complaints or use of restraint were identified in the Annual Quality Assurance Assessment; one safeguarding incident was recorded. The operations manual at the service contained a complaints procedure which clearly set out the process for responding to any issues raised. A file had been set up to record any complaints and as none had been received it contained only compliments from a range of people such as relatives, a care manager and a district nurse. People using the service said in surveys that they knew who to speak with informally if they were unhappy and how to make a complaint. Staff who completed surveys said they knew what to do if anyone raised any concerns about the service. Social and health care professionals said in surveys that the service has always responded appropriately if they, a person using the service or another person has raised any Care Homes for Older People Page 19 of 31 Evidence: concerns. One said I feel confident that the manager addresses any concerns or issues raised. A safeguarding procedure was also in place and staff had been receiving training as part of their initial induction and in house courses. Some updating was needed from some of the training records looked at and dates for addressing this had already been set up and displayed on the duty office notice board. Action taken in response to the one safeguarding incident had been appropriate and involved contacting other agencies, with Social Services taking the lead role. The manager had put in place measures to keep the person safe. A copy of the local authority inter agency safeguarding procedures was available at the service and there was a copy of the deprivation of liberty safeguards as well. 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. The building is new and purpose built and has been designed to a high specification to promote a positive environment for older people. Standards of cleanliness and odour control throughout the building were good, keeping accommodation fresh and hygienic. Contact with the environmental health department is advised to make sure that best practice is being observed with kitchen facilities. Evidence: In the Annual Quality Assurance Assessment we were advised that the building is divided into six houses, 3 of which provide care for people with dementia on the ground floor. Information provided told us that each house has its own lounge/dining area and kitchen area and that bedrooms are single and have ensuite toilets and showers. Communal toilets and assisted bathrooms were said to be in place. All parts of the building were described as being wheelchair accessible and the necessary aids and adaptations had been provided to meet peoples needs. People were said to be encouraged to bring in items to personalise their rooms. We were advised that there are outside areas for people to use. Information informed us that laundry equipment complies with environmental health and safety requirements and staff receive training in infection control. The service is located within walking distance of shops and facilities in Princes Risborough and there are bus links close by. A railway station connecting the town to Care Homes for Older People Page 21 of 31 Evidence: Aylesbury and London is at the other end of the town. There is parking at the front of the building and there is good signage to indicate you have arrived at Icknield Court. The entrance to the building is bright with information readily available about the service and what it can provide, plus additional useful information for relatives and users. Entry to the home is via a doorbell, which was promptly answered. Accommodation was arranged as described in the Annual Quality Assurance Assessment with each of the 6 houses having their own lounge/dining area, kitchen and single ensuite bedrooms. Communal toilets and bathrooms were close by. People with dementia were being cared for on the ground floor and had the freedom to wander into other groups if they wished. Lounge furniture was comfortable to sit on with small tables provided for putting drinks and other items on. Dining chairs had gliders to improve manoeuvrability. Large floor to ceiling windows in lounges provided good views over the gardens, which several service users commented on positively. Ground floor lounges had access to the gardens which were nicely planted with flowering shrubs and plants and provided lots of seats and benches to enjoy some fresh air. People could also access the gardens via the entrance hall. Improvement was taking place to extend the pathway around the garden. A bowling club is located next to the service and there was a possibility of a gate being fitted to enable service users to make use of it. Bedrooms were of good size and service users had chosen the colour of paint and soft furnishings. Ensuite showers and toilets were provided. Rooms that were seen were varied in the amount of personalisation and showed that encouragement had been given to bring in personal effects. Corridors were wide with grab rails fitted with sensory nodules. There were windows and seating areas where corridors came to an end, providing a natural focus for people. Upstairs corridors had air conditioning installed. Windows throughout the building were fitted with restrictors to prevent accidents. A passenger lift had been fitted for access between floors. There was a staff training room upstairs which is also used for activities and church services and a large communal lounge which is used for coffee mornings and other activities and can be used by anyone at other times. A hairdressing room had been provided upstairs and a medical treatment room. A smoking room for service users was provided on the ground floor. A mobile pay phone was available for people to use. Office facilities for the manager, administrative staff and duty seniors was located centrally, off the entrance hall. There was also a bar/tea and coffee area where people could make drinks. The laundry was located on the first floor with industrial type equipment to cope with Care Homes for Older People Page 22 of 31 Evidence: the demands of a large care service. The kitchen was below it with the tumble drier extractors blowing onto kitchen windows and the fluff collecting on mesh screening. The manager advised that the extractor outlet was due to be relocated imminently. Laundry and kitchen floors were fitted with suitable flooring. There were some issues with the design of the kitchen that need to be addressed. For example, a walk in fridge and freezer have been provided. The digital temperature gauges for both were well above safe limits due to hot air from the kitchen entering into them each time the doors are opened. A row of stainless steel work surface was said by the chefs to be unusable when the heated trolleys are plugged in underneath. A reserve fridge and freezer sited in the kitchen staff cloakroom may contravene food safety regulations; the manager and operations manager were advised to contact their local environmental health department to discuss the issues they have with the kitchen and possibilities for improvement. Throughout the building there was good regard for cleanliness and odours were being managed well. Sluice rooms were clean and in good order. Toilets were stocked with the necessary items and adaptations were in place for people with disabilities, such as raised toilet seats and grab rails. Comments from relatives included facilities are excellent, the rooms are very comfortable and to have an ensuite for each person is wonderful, the home is always very clean, it always looks nice and clean and the building is new and purpose built therefore all communal rooms are excellent, light and airy. Excellent communal garden with seating and easy access from inside. Bedrooms light and spacious. People using the service said in surveys that the building is always kept fresh and clean. Care Homes for Older People Page 23 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. The service provides staff cover to meet needs and undertakes thorough recruitment procedures to protect service users. Some updating to training is needed to make sure that staff have up to date skills to support the people who live there. Evidence: In the Annual Quality Assurance Assessment we were told that ninety three care and twenty three non care staff are employed at the service and that no one had left since the service opened. A quarter of care staff were said to have achieved National Vocational Qualification at level 2 or above. Staff induction was described as following the Skills for Care/common induction standards format and that thorough recruitment checks were being carried out. We were informed that a rota is in place and all staff work in accordance with the General Social Care Council code of practice. Training was said to be provided to a high standard. The manager said in the information provided she was aiming to achieve minimum recommended levels of staff supervision and to increase numbers of staff with National Vocational Qualification. Staff who completed surveys said that they are always given up to date information about peoples needs. They said their employer carried out checks such as Criminal Records Bureau disclosures and sought references before they started work. They said their induction covered the areas they needed to know about very well and that training was relevant to their role, helped them keep up to date with new ways of Care Homes for Older People Page 24 of 31 Evidence: working, helped them to understand and meet individual needs and gave them enough knowledge about health care and medication (where applicable). They said they have regular opportunities for support and meetings to discuss how they are working. They thought the ways in which information is shared usually worked well and considered they always have enough support, experience and knowledge to meet the different needs of people, such as those arising from equality and diversity. Additional comments included I enjoy working for Icknield Court. The atmosphere within the team is great and the care for our service users is great. Training is good. Several other staff considered that one of things the service does well is the care of its users. One person said staff needed more time to be able to talk and listen to service users. One carer said I would have no hesitation in placing a family member at Icknield Court, another said a very caring home. Everyone made very welcome. A health care professional said there were friendly, helpful staff and said one of the things the service does well is communicates with us. A doctor said always have a sense staff are committed, caring and supportive to patients, relatives and other staff. A relative said staff are extremely pleasant and helpful. Very approachable and very caring towards the residents. So far on all my visits, I have not heard of one complaint from the residents. People using the service expressed similar views. One relative was concerned that a carer who she described as providing very good care for her mother could, like other established staff, be asked to work in other parts of the home. The relative considered this would be detrimental to her mothers care. Another relative expressed concern that young inexperienced staff were providing care to people with dementia and that they were not engaging appropriately with users, for example having Radio 1 playing at the weekends and motor racing on the television, talking to each other rather than with users and not handling agitation appropriately. Recruitment files for seven staff were looked at. Each contained the full range of required checks such as two references, Criminal Records Bureau disclosure and proof of identification. Application forms had been completed and photographs were in place in most files. Each person had been given medical clearance to work. Rotas were being maintained at the service. Duty senior staff were observed arranging cover for shifts where there were gaps, calling on relief staff, existing staff or the providers agency Frebank to obtain cover. Where outside agency staff were needed, the service had obtained individual proformas of the persons experience, training and confirmation of thorough recruitment from the agency. These were kept in the duty office for reference. Care Homes for Older People Page 25 of 31 Evidence: It was possible to see from staff files that staff undertake an induction as specified by Skills for Care. The provider has recently changed the induction from 5 to 6 days to cover all mandatory areas plus dementia awareness. Probationary reports (not read) were also seen on peoples files to summarise their performance during initial months of employment. A copy of the General Social Care Council code of practice was attached to the notice board in the duty office, for reference. Training records were looked at. Entries for the majority of staff on a spreadsheet matrix had not been fully completed and not all certificates of attendance been added to development files either. It was difficult to see from these records when or if a particular course had been attended. The manager had already done an audit of training deficits before the inspection and written to staff individually to highlight where they needed to attend training and dates for courses were pinned on the notice board in the duty office with names added by staff to secure a place. Observation of staff interaction showed some positive approaches, such as bending down to speak with people, using their name, use of appropriate touch and asking people their preferences such as where they would like to sit. Some areas for improvement were seen in one persons approach which included standing over people to address them, frequent use of the term mate and calling one person the wrong name. This person did not routinely work in the particular house. A couple of staff were reminded by a group care co-ordinator about how to communicate with one of the service users which they had not been aware of. There were examples of staff communicating well with each other to make sure they knew who had been given breakfast, who was being helped up and who needed to see the doctor that day. Where one person was going out shortly after breakfast, this was communicated to staff who in turn reminded the person and helped her to be ready in time. Care Homes for Older People Page 26 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. The management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. Evidence: In the Annual Quality Assurance Assessment the manager advised that she had not completed National Vocational Qualification level 4 but was aiming to do this in the coming year. We were informed that she is experienced in providing care to older people and has undertaken regular training to update her skills and knowledge. Clear lines of accountability within the service were described and we were told that the manager promotes open, positive and inclusive leadership. An annual development plan for the service was said to be in place and regular monitoring undertaken by the provider, including a quality audit each year. We were advised that two administrators support the care team and there are processes for external financial auditing. Records were said to be kept to show health and safety is being monitored and risk assessments are in place. Information in the dataset showed that maintenance and Care Homes for Older People Page 27 of 31 Evidence: equipment is being serviced and/or tested as recommended and that staff have access to policies and procedures to guide them in their work. The manager is registered with the Commission and had completed her National Vocational Qualification level 4 since the Annual Quality Assurance Assessment was completed. Several people commented about her in surveys. A member of staff said we have an excellent manager. The move to new Icknield Court was managed so well by her. Always willing to listen to both staff and residents. We are very lucky to have Helen. Another carer said Helen Jeffrey (manager) always available to residents, families and staff. A relative said the manager is always very cheerful, friendly and approachable. Another relative said Icknield Court and its management and staff could be used as an example of excellence. There were reports of monitoring visits undertaken by the provider and one by some of the trustees. An infection control audit had been carried out in February this year and there had been pharmacy and dementia care audits. The operations manager advised that she had conducted a care audit at the end of March, with the report awaited. Peoples finances were being managed appropriately by administrative staff. People using the service can choose to opt into a residents savings system. Access to the computerised records is restricted and there are back up manual records to refer to with receipts and signatures in place. A float of money is kept on the premises for staff to access on behalf of service users when administrative staff are not on duty. A financial audit by an external company was planned to take place a few days after this visit to review procedures. There was good regard for health and safety. Policies and procedures to guide staff were contained in the operations manual. A falls register was being maintained and accidents and incidents logged. There were certificates of hoist servicing, portable electrical appliance testing and calibration of blood pressure monitors. Regular checks of hot water temperatures, window restrictors and radiators were being carried out. Certificates confirming safe electrical hard wiring and gas safety were seen prior to registration and were satisfactory. The manager was advised to put in place a risk assessment for storing one persons electric wheelchair in their room overnight to charge the battery. Care Homes for Older People Page 28 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 29 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 9 13 Medication is to be handled, 16/08/2009 administered and stored in a safe and consistent manner. This is to ensure that people receive their medicines safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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. 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