Inspection on 15/04/09 for Inver House

This inspection was carried out on 15th April 2009.

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

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

Other inspections for this house

Inver House 28/04/08

Inver House 15/09/06

Inver House 26/01/06

Inver House 12/07/05

Inver House 03/03/05

Inver House 17/08/04

Inver House 11/03/04

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 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Inver House Foreland Road Bembridge Isle Of Wight PO35 5UB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Annie Kentfield     Date: 1 5 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Inver House Foreland Road Bembridge Isle Of Wight PO35 5UB 01983872312 01983875814 joanne.bennett@islecare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Islecare Ltd care home 52 Number of places (if applicable): Under 65 Over 65 0 52 0 dementia old age, not falling within any other category physical disability Additional conditions: 52 0 52 The maximum number of service users to be accommodated is 52 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: Dementia (DE) Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Inver House is currently registered to provide care for up to 52 older people. The home has just completed a major refurbishment of existing accommodation and the completion of new accommodation. The home has 16 rooms in the specialised dementia unit and 36 rooms in the residential unit at the home. Inver House is a large three-story period building situated next to a GP Surgery. There is some parking available in front of the house, or street parking nearby. The building is accessible and has a passenger lift to access the upper floors. Care Homes for Older People Page 4 of 31 Brief description of the care home Fees at the home range from pounds 376.67 per week to pounds 785.00 per week. This is dependant on the type of accommodation and the care needs of the individual. Full details of fees are available from the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report details the evaluation of the quality of the service provided at Inver House and takes into account the accumulated evidence of the activity at the home since the last inspection, which was carried out in April 2008. The inspection took into account the homes Annual Quality Assurance Assessment (AQAA); and comment cards received from 5 users of the service, 2 relatives, 1 care manager and 5 members of staff. Included in the inspection was an unannounced site visit to the home, which took place on the 15 April 2009 and was conducted by two inspectors from the Care Quality Commission (Mick Gough and Janet Ktomi). Evidence for this report was obtained from reading and inspecting records, touring the Care Homes for Older People Page 6 of 31 home and from observing the interaction between staff and users of the service. The inspectors were able to speak with 2 visitors to the home, 7 members of staff, and a number of service users to obtain their views on how the service was meeting their needs and expectations. It was also possible to speak with the homes registered manager. The home is registered to provide support for 52 residents and at the time of the inspection there were 29 people living at the home. What the care home does well: What has improved since the last inspection? What they could do better: There were 2 requirements and 1 recommendation made as a result of this visit and other points, which need to be addressed to help improve the service provided for residents are contained within the main body of the report. General observations were: When the home is carrying out the needs assessments of potential new users of the service the home needs to obtain care management assessments for residents who are funded by the local authority and it must also amend the assessment form currently being used to ensure that there is sufficient space to record all the care needs of service users. The home has recently fully integrated a new computerised care planning system, however due to the fact that this is relatively new, the updating of care plans need to be regularly monitored untill all staff are confident with the new system and staff should be encouraged to inform senior staff when there is any conflicting information recorded on the care plans. The manager must also ensure that whoever reviews residents plans of care have all of the information they need to update care plans so that the assessed needs of residents can continue to be met. The home has clear guidelines for staff when administering any when required (PRN) medication and it was recommended that the PRN guidelines are kept in the treatment room along with the medication trolleys so that they are readily accessible when staff are administering medication. The home does not hold all of the information and documents in respect of persons Care Homes for Older People Page 8 of 31 carrying on, managing or working in a care home as laid down in Schedule two of the care home regulations. The manager explained that these records were held centrally at the organisations head office. However there is no agreement in place for recruitment records to be held centrally so copies of all of the relevant documents must be kept at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of the service have their care needs assessed before they move into the home, however the home needs to obtain care management assessments for residents who are funded by the local authority and it must also amend the assessment form to ensure that there is sufficient space to record all the identified care needs of service users. Evidence: We were able to speak with a visitor whose relative had been admitted approximately 2 months prior to the visit. She confirmed that she had visited the home, been provided with written information and had any questions answered. She had the opportunity to view the home and the rooms available prior to her mother moving in. She also confirmed that the manager had visited her mother in the hospital and completed an assessment. She was very happy with the admission procedure and the way her mother had settled in. Care Homes for Older People Page 11 of 31 Evidence: We viewed pre admission assessments for 2 people admitted into the dementia wing. The home uses the assessment form provided by the company. This consists of two sides of A4 paper and the form covered all the necessary areas including, medical history, communication, continence, dressing, falls, mental health, mobility, night care, nutrition, safety, skin, washing etc, but the form did not give sufficient space for additional comments. The form for one service user stated - needs some help with eating and drinking but it was not clear what actual help was needed. One form did have additional comments written of the reverse of the pages. This issue was discussed with the manager who agreed that the forms could be improved and she told us that she usually kept any additional information in her head and then included this in care plans. We did not see any care manager assessments in any of the folders viewed and the manager told us that she does not routinely request or get these. The home needs to obtain care management assessment for residents who are funded by the local authority and it must also amend the assessment form to ensure that there is sufficient space to record all the care needs of service users. Intermediate care is not provided at the home. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of residents are set out in an individual plan of care and residents have access to all relevant health care professionals and their health care needs are met, however the computerised care planning system and reviewing procedures need to be monitored. The administration of medication is generally satisfactory and residents at the home are treated with dignity and respect. Evidence: We looked at Care plans for 3 service users and the plans viewed had a good level of detail and care plans contained life history/social history information as well as information regarding the persons likes and dislikes, their usual time of getting up and going to bed, normal routines and other individual personal information that may be relevant was also recorded, the plans would enable a persons needs to be met. All of the care plans are kept on a computer system, which has been in use since June 2008 but has only recently been fully integrated. Discussions with staff confirmed that they are confident with the parts of the system they have to use, however when Care Homes for Older People Page 13 of 31 Evidence: looking at care plans with one of the shift leaders she appeared less confident and had problems finding some information. All of the plans viewed had been reviewed and updated monthly, however in the past the manager has reviewed all of the care plans herself but this is now being delegated to other staff and this relies on the person doing the review to be fully aware of all changes to the persons care needs and as such care plan reviews need to be monitored to ensure that they are up to date and accurate. We viewed a care plan for one resident who presented challenging behaviour and when we spoke to staff regarding what action they would take to deal with a situation their response was that it was best to leave the person alone and return later, however the information on the care plan stated that the person responds to gentle calming and not being challenged and this did not provided a consistent approach by staff. This was discussed with care staff who said that the key worker probably had not fed back the information to the person who reviewed the care plan. We also found Information on one care plan that the person had lost weight, and it was recorded on 30th dec 08 at 55.90kg, on the 11th Feb 09 at 54.30kg, and on the 10 March 09 at 52kg, this showed that in one month the person had lost 2.30 kg. The care plan did have information regarding the persons body mass index but this had not been updated and the person had not been reweighed since 10 March 09. The care plan record on review stated that she had lost weight but there was no indication of what action to be taken. This was discussed with the manager who updated the computer care plan for two weekly weight checks to be taken. The care plan should also state what action staff should take should the person lose more weight. Due to the fact that the computerised care planning procedures are relatively new staff need to be supported when reviewing and updating care plans untill all staff are confident with the new system. Staff should be encouraged to inform senior staff when there is any conflicting information recorded on the care plans. The manager must ensure that whoever reviews residents plans of care have all of the information they need to update care plans so that the assessed needs of residents can continue to be met. Risk assessments for moving and handling and other risks were also on the computer system and we viewed moving and handling risk assessments and these were found to be comprehensive and appropriate to the people. Risk assessments had been regularly reviewed. Residents at the home are registered with one GP surgery, although they may have different GPs. The manager informed us that service users may keep their own GP if the GP is in agreement. Community Nurse services are provided and call into the home on a regular basis, and residents in the dementia wing of the home have access to Care Homes for Older People Page 14 of 31 Evidence: community psychiatric nurses from the local hospital. There is a visiting optician and dental care is organised through the health authority, the manager told us that some residents have their own dentist and optician and the home supports them to attend appointments when required. A chiropodist calls every 6 to 8 weeks and residents who are diabetic receive foot care from a local surgery and we were informed that any other health care professionals are arranged through GP referral. The manager told us that she has an excellent relationship with all the health care professionals. One relative spoken with felt that her relatives health care needs were met and residents spoken with said that they were well treated at the home and we spoke to a number of residents who were all very positive about the care they received, comments included The staff are wonderful, I couldnt ask for better and I am well looked after. All of the residents spoken with and all who completed surveys told us that they were well cared for and their health care needs were met. The completed AQAA told us that residents health care needs were met and that individuals plans of care ensured that residents were well looked after. Medication procedure at the home were looked at and there is a clear policy and procedure for medication receipt, storage, administration and disposal and all staff who are authorised to administer medication receive appropriate training. Medication is stored in a locked treatment room in the dementia wing in two trolleys (one for dementia and one main house). Only seniors or shift leaders administer medication. The treatment room had a thermometer and air conditioning and this room, which had previously been used as a laundry during the refurbishment still had two washing machines and one tumble dryer and sluice machine in the room. These should now be removed. The treatment room contained a fridge, which was kept locked and this contained a thermometer but this did not record maximum and minimum temperatures so only recorded the current temperature and not the maximum and minimum temperatures for the past 24 hrs. We found that there were 2 bottles of folic acid stored in the fridge and the expiry date on these were the 27th April and the next delivery was not due until the start of May. The fact that these expired before the next medication delivery had not been noted or acted on by the home and the manager agreed to address this issue. The home uses a monitored dose system provided by a local pharmacist and medication administration records were checked and these were generally in order. Currently there are no service users who self medicate and there were clear guidelines for administering any when required (PRN) medication and this was kept in a file in the office. It is recommended that the PRN guidelines are kept in the treatment room along with the medication trolleys so that they are readily accessible when staff are administering medication. The home has purchased a new metal controlled drugs cabinet and this was in the treatment room but had not yet been fixed to the wall. This Care Homes for Older People Page 15 of 31 Evidence: was discussed with the manager who confirmed that this would be appropriately secured to the wall. Currently the home does not hold any controlled drugs. Staff were observed interacting with residents appropriately and they were seen to treat them with dignity and respect. We spoke with two of the homes domestic staff who told us that they had received training with regard to dignity and respect and they told us they always consult with residents before they bring laundry up to residents rooms. Staff were heard to use residents preferred form of address when talking to them and staff were seen to knock on residents doors before entering. It was clear from observing staff supporting residents that they got on well together and there was a very pleasant atmosphere in the home. All of the residents and staff spoken with were very positive, residents told us that the staff were kind and caring and that if they wanted anything all they had to do was ask 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. The home provides a range of activities for residents, which meets their expectations and the recreational interests of residents are provided for. Residents are able to maintain contact with family and friends and visitors are welcome at any time. Residents are supported to exercise choice and control over their lives and are provided with a wholesome and balanced diet in pleasant surroundings at a time convenient to them. Evidence: The home employs 2 activities co-ordinators who organise activities in the home. There is a monthly newsletter which is produced by the activities staff and this gives information on what has been happening in the home and has a quiz and puzzles for residents. The newsletter provides a detailed plan of activities for the moth and there is also a weekly activities programme produced with picture symbols. The activities coordinators work flexibly to meet the residents needs and the programme for April included, target games, armchair exercise, films, sing alongs, baking, arts and crafts, flower arranging, visiting entertainers, visits from local pre school children, bingo, Easter egg hunt, one to one activities with individual residents, visiting PAT dog, hairdresser, manicures, hand massage and there are also outings and minibus trips. Care Homes for Older People Page 17 of 31 Evidence: Residents who completed surveys were full of praise for the activities co-ordinators and said that they were very happy with the activities organised. Relatives spoken to confirmed that their relatives seemed to enjoy activities and got a lot of enjoyment from them. On the day of the visit residents were seen to be participating in flower arranging and those residents we spoke to told us that there was always something going on. The home has the use of a mini bus each week and trips out are organised by staff. Activities take place around the home and those residents with dementia are catered for and activities take place for them. The home has a computerised recording system and the activities staff record who takes part in each activity and there is also recording for those residents who have been asked to take part but have declined. The activities staff told us that any interactions with residents are recorded, so if they just spend time chatting with residents this is recorded. Staff told us that they have access to this system and also record any interactions with residents. The home has a clear visitors policy and there are no set times, visitors sign in at the home and the visitors book is kept in the hallway. We were able to speak with two visitors to the home who told us that they were always made welcome and said they had never experienced any problems in visiting relatives, the manager told us that visitors are encouraged and always welcome to stay and have a meal if they wished. Residents were observed to be free to choose where and how they spent their time and there were no restrictions imposed upon them. We observed staff supporting residents and they were able to make informed choices and are able to control their own lives as much as possible. Residents told us that they are free to get up and go to bed when they want and that staff will support them in whatever they choose to do. A tour of the home showed us that a number of residents had brought some of their own possessions into the home and rooms had been personalised. The home operates a five week rolling menu and residents told us that they were very happy with the food provided by the home, they stated that the food was plentiful and good. Residents are offered a choice at meal times and menus are written up each day. We spoke to the cook who told us that breakfast was flexible and normally consisted of cereals and toast but residents could have anything they wanted such as a cooked breakfast or egg on toast. The main meal of the day was at lunch time, and on the day of the visit lunch was roast beef and fresh vegetables or cauliflower bake, followed by pineapple upside down cake and custard or ice cream. The cook told us that if the choices available were not to residents liking than an alternative would be provided. The evening meal was a snack type meal such as egg on toast, or sandwiches. We were told that the kitchen is always open and staff will make residents a drink or snack at any time. The home has 3 dining areas and these were pleasantly decorated with tables laid with tablecloths, napkins and condiments. We observed Care Homes for Older People Page 18 of 31 Evidence: lunch being taken in the dining room and meals were unhurried and staff provided suitable support for residents if needed. Two residents require their food to be pureed and items were pureed separately to provide an appealing meal with different colours and textures. The completed AQAA told us that the mealtime experience should be pleasant for everyone and they frequently receive complementary feedback for residents and visitors. Residents spoken with on the day of the visit and those who completed surveys all told us that the meals at the home were good and that food was appetising and plentiful. 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. There is a simple, clear and accessible complaints procedure, which includes timescales for the process and any complaints are logged and responded to appropriately. There are policies and procedures in place to protect and safeguard residents. Evidence: The home has a clear complaints procedure, which contains all of the required information and this is available in other formats to meet residents requirements. There is a complains form which provides information on the complaint, together with the actions taken to investigate and also the homes response. Residents told us that they were confident about raising any concerns they may have. We spoke with relatives who confirmed that they did have information regarding the homes complaints procedure but had not had to use it, but they would if they felt it necessary. Residents told us that they would raise issues with staff or relatives if necessary. Staff members spoken to were aware of the complaints procedure and said that they would support anyone to make a complaint if they wished to do so. The homes completed AQAA told us that there had been 6 complaints made since the last inspection and all had been satisfactorily resolved. The manager confirmed this when we visited. Staff receive training on adult protection and the home has a whistle blowing policy Care Homes for Older People Page 20 of 31 Evidence: and also a copy of the Isle of Wight safeguarding protocol. Staff spoken to were aware of their responsibilities in this area and knew what to do should they have any concerns in this area. Staff told us they were confident that if they reported any issues to the manager, appropriate action would be taken. Staff were also aware of the role that social services played in any safeguarding issues. We also spoke with the manager on this subject and she was aware of her responsibilities in this area. A recent safeguarding investigation was carried out by Social Services under their agreed procedures for safeguarding vulnerable service users. The investigation concluded that the home had taken appropriate action, including the temporary suspension of a member of staff, pending the outcome of the investigation. The investigation also concluded that action had been taken by the home to review and update risk assessments and risk management plans. The investigation noted that the home is now promptly reporting any incidents or events in the home that affect the safety or well being of people using the service. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe and well maintained environment and have access to comfortable indoor and outdoor facilities, they are provided with the specialist equipment they require and the home was clean, pleasant and hygienic and free from offensive odours. Evidence: We conducted a tour of the building and this included all communal areas of the home including bathrooms, toilets and lounges. The kitchen and some bedrooms were also seen. The home has just completed a major refurbishment programme and this has resulted in all rooms being upgraded and additional accommodation being provided. The refurbishment has been completed to a very high standard. There is a dementia unit to the home and this contains 16 single bedrooms, 9 of which are en-suite, there are also 2 lounges, 1 dining room, 1 sitting area, 1 activities area, a bathroom, a shower room and 2 WCs. The residential unit contains 36 single rooms all of which are en-suite with WC and shower, there are also 3 bathrooms with high quality assisted baths, 3 lounges, 2 dining rooms, an activities area, a computer room and a fully fitted hairdressing salon. There is good storage facilities for wheelchairs and hoists when not in use. Infection control procedures were observed to be followed and there are antiseptic Care Homes for Older People Page 22 of 31 Evidence: hand gel dispensers situated around the home. All bathrooms and WCs had hand washing facilities with soap and towels available. There is a brand new laundry at the home and this contains two industrial washing machines and 2 industrial tumble driers, there is also a rotary iron together with normal ironing facilities. The homes domestic staff carry out laundry tasks and they told us that suitable protective equipment is provided. The laundry area has suitable hand washing facilities available and we pointed out the need for the home to have suitable signs in place regarding hand washing. The home was clean, pleasant and hygienic throughout. 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. Staffing numbers and the mix of staff currently meets the needs of service users. Staff morale was good and there was a good rapport between service users and staff. Service users are generally protected by the homes recruitment procedures, however not all of the required recruitment records are held at the home. The home provides training for staff to enable staff to support service users effectively Evidence: The homes staff rota was examined and this showed that in the dementia unit the home provides 3 members of staff on duty am, and pm there are 3 members of staff plus a care support staff member. In the residential part of the home there are 3 members of staff on duty AM and PM there are 3 members of staff and a care support assistant. At night there are 4 members of staff awake throughout the night. In addition to care staff there are 3 domestic staff on duty each day plus a cook and a catering assistant. A maintenance man works flexibly and there is an administrative assistant. The manager is in the home 5 days a week and she is in addition to the care staff, she told us that she is available at any time. Staffing numbers were discussed with the homes manager and we were told that at present she felt that staffing levels were more than sufficient as current levels reflected the numbers of staff that will be working when the home has 52 residents. However the manager will need to continue to monitor staffing levels based on residents needs. Residents told us that were always Care Homes for Older People Page 24 of 31 Evidence: staff around to provide help and support and we observed that staff went about their tasks enthusiastically and were able to spend time with residents. The home employs a total of 24 care staff, and of these 8 already hold a minimum of NVQ2 and four staff members are working to achieve National Vocational Qualifications. The manager told us that she has 11 staff members who are going to be enrolled on NVQ course in the coming months. The home has policies and procedures in place with regard to recruitment and staff recruitment records were inspected for 4 staff members; All records seen contained references x 2, Criminal Record Bureau & Protection of Vulnerable Adults checks, however the records did not contain all of the information required under schedule two of the care home regulations. The manager explained that these records were held centrally at the organisations head office. However there is no agreement in place for recruitment records to be held centrally so copies must be kept at the home. We discussed staff training with the manager and she stated that there is a clear induction procedure for new staff and there is a new computerised system for monitoring staff training. At present the information on training is held in staff files and is yet to be transferred onto the computer system. When this is completed there will be an easily identifiable training matrix, which will give instant information on the training completed by each staff member together with dates for training updates. Training records seen showed us that staff receive training in adult protection (safeguarding), fire safety, moving and handling, first aid, food hygiene, infection control and communication. The training plan for the coming year showed that all staff including domestic and kitchen staff will be undertaking a 3 day dementia training course so that all staff are able to provide the correct type of support. The deputy manager at the home currently provides dementia awareness training and the manager has completed the course in dementia mapping and is also a manual handling trainer. Residents told us that they felt that they were in safe hands and staff told us that the home provided them with the training they needed to carry out their roles effectively. Care Homes for Older People Page 25 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 arrangements in place at the home are satisfactory and the home operates in the best interests of residents. Quality assurance procedures are in place and service users financial interests are protected by the homes policies and procedures and the health, safety and welfare of residents and staff are protected by the arrangements in the home Evidence: The manager at the home has been running the home for over 5 years, she has the skills and experience needed to manage the home and staff spoken with told us that she is very supportive and is always available if they need any guideance or support, she told us that she operates an open door policy and is always available to provide support and advice. The manager told us that the organisation conducts an annual quality audit and this includes an audit visit from the provider organisation. The manager sends out Care Homes for Older People Page 26 of 31 Evidence: satisfaction surveys to residents and relatives and these are collated and results are published. Regulation 26 visits are conducted every month by the regional area manager and reports are kept at the home and were available for inspection. There are monthly staff and residents meetings and the manager told us that the minutes of these meetings are kept. The homes completed AQAA told us that there is an effective quality assurance programme and we were able to confirm this at the visit to the home. The home is not appointee for any service users, however the home will hold small amounts of personal money for people in the safe at the home. The administrator or senior staff member on shift holds the key to the safe and only they have access. All money is held separately in plastic wallets and full records and receipts kept and those viewed were correct. Records viewed showed appropriate expenditure on hairdressing, papers, chiropody etc with a clear audit trail. Health and safety policies are in place and available to all staff members and staff have undertaken training in health and safety. There is storage in dementia wing for any substances hazardous to health and this is kept in a cupboard under the sink in the dining room. When we visited the lock had broken and therefore allowed access to a range of substances hazardous to health, also the lock on another cupboard was not working. The manager organised for the workmen to get new locks and these were fitted during the inspection, however the keys for the locks were kept in the dining room and accessible to anyone and should be kept securely. The home has just completed a major refurbishment programme and has been visited by the building control officer who has issued a satisfactory completion certificate and this will have ensured that all relevant servicing and testing of equipment had taken place. The homes fire log book showed that all required testing of equipment is carried out and there was an in date fire risk assessment for the building. All residents and staff spoken to were happy with the health and safety arrangements in the home. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 3 13 The registered person needs to obtain care management assessment for residents who are funded by the local authority and it must also amend the assessment form to ensure that there is sufficient space to record all the care needs of service users. This will help to ensure that the home has all the information it needs to ensure the home is suitable for the purpose of meeting the service users needs. 18/05/2009 2 29 19 Unless there is a written 18/05/2009 agreement that recruitment records can be held centrally the registered person must ensure that all documents and information specified in paragraphs 1 to 7 of Schedule 2 of the Care Home Regulations 2001 are kept at the home. This is to ensure that the recruitment procedures are robust and to ensure the fitness of workers. 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 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 It is recommended that the PRN guidelines for when required medication are kept in the treatment room along with the medication trolleys so that they are readily accessible when staff are administering medication. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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