Inspection on 31/07/09 for Kent House

This inspection was carried out on 31st 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Kent House Augustine Road Harrow Middx HA3 5NS     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: Ram Sooriah     Date: 0 4 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 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 38 Information about the care home Name of care home: Address: Kent House Augustine Road Harrow Middx HA3 5NS 02084214550 02084215568 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Home Group Limited Name of registered manager (if applicable) Mrs Elizabeth Corbett Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary need on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Kent House is located in a quiet residential cul-de-sac in Harrow Weald off Long Elmes, not far from the Uxbridge Road. It is close to some local shops. Other public amenities are available in Harrow Weald or Harrow on the Hill, which are accessible by buses or by car. The home is about five-ten minutes walk from the bus stop and is located next to Headstone Lane train station. There is parking for about 8-10 cars in the grounds of the home. Care Homes for Older People Page 4 of 38 Over 65 40 0 Brief description of the care home The home was first registered in 1989. It is currently registered to provide personal care for forty people with frail older people care needs. It was re-registered in April 2009 under Home Group Ltd. Prior to that it was registered under Warden Housing, which was another part of Home Group. Home Group is the main housing association and is made up of smaller housing associations. It has two care homes. The building is a two-storey purpose built care home. Accommodation for residents is provided in thirty-two single and four double bedrooms all with en-suite facilities. There are thirteen bedrooms, two lounges, a large dining room and a conservatory on the ground floor. The rest of the bedrooms are found on the first floor. There is also a small kitchenette and a small lounge and library on that floor. The home has gardens to the rear and side that are well maintained and accessible to people who use the service. The home charges 560 pounds for privately funded residents and accept residents from local authorities. Residents from Local authorities do not pay a top up. At the time of the inspection there were thirty-eight residents in the home. Care Homes for Older People Page 5 of 38 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 report contains the findings of a key unannounced inspection that took place on Friday 31st July 2009 from 14:00-19:00 and finished on Tuesday 4th August 2009 from 11:45-16:30. This is the first unannounced inspection of the home since it was re-registered under the Home Group Ltd. The last key inspection took place on the 31st October 2008 when the service was rated as providing adequate outcomes for residents who live in the home. At the time the home was registered under Warden Housing. The new registration in April 2009, involved being registered under the Home Group Ltd. Warden Housing is part of the home Group. The home has kept the same management. During the period of time between the inspections, we monitored the home from notifications that were received and from contact with the home and other social and healthcare professionals. Care Homes for Older People Page 6 of 38 The manager completed an Annual Quality Assurance Assessment (AQAA) that we have used to inform our inspection and in writing this report.The AQAA was completed appropriately and included some numerical information about the service and information about how well the service meets national minimum standards. During this inspection we talked to at least eight residents and three relatives, toured the premises, looked at a sample of records, inspected a sample of medicines and talked to about eight members of staff. We also received twelve satisfaction questionnaires from residents, four from social and healthcare professionals and six from members of staff. We have used all the feedback together with our findings during the inspection to write this report. We thank all residents for their feedback and contribution to the inspection and the manager and all her staff for their cooperation and support during the inspection. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? There has been a long issue about the home not being registered appropriately. The organisation has now regularised its position and the home has now re-registered under Home Group Ltd. There is a a responsible individual and a registered manager who are both accountable for the running of the home. The home has reviewed the format for the care records to ensure that more comprehensive records are kept. These were mostly completed appropriately but there was still some fine tuning to do. We however note the progress that has been achieved. The care records include a format for the assessment of the needs of residents. These were completed appropriately for those residents whose care records were inspected. The home makes every effort to receive the needs assessment of the funding authority, but at times these are not made readily available to the home. The needs assessment and the care records address the cultural and religious needs of residents, although it does not always make clear how the religious needs of residents would be met. According to the manager the home gets visits from representatives of the Roman Catholic Church and Methodist Church but not from the Church of England. She said that despite her efforts, she has been unable to access a Church of England representative to visit residents in the home. The home has a quality management system that is consistently used in the home. Care Homes for Older People Page 8 of 38 This consists of systematic audits that are undertaken and a satisfaction survey of residents. The management of residents personal money is carried out to a good standard to ensure the safety of the property of residents. The home has carried out a health and safety risk assessment as per a requirement during the last inspection. It is however, not clear how thorough this audit was, as major issues about health and safety had not been noted and addressed. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 38 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 38 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 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that as far as possible people who are referred to the home or their representatives, receive the necessary information about the service for them to make an informed decision about choosing the home. The prospective residents needs are assessed prior to them being offered a place in the home to make sure that the home will be suitable for them. Evidence: The home was registered on the 3rd April 2009. At the time, a revised service users guide (SUG) and statement of purpose were provided as part of the application process, to proceed with the registration. These documents were assessed as appropriate. The manager stated that the SUG is given to all residents or to their representatives to provide information about the service. We asked four residents about whether they received enough information about the home before they became residents. One said Care Homes for Older People Page 12 of 38 Evidence: that their relative visited the home, another said that their friend visited the home and two said that social services placed them in the home. The residents whose friend and relative visited the home said that their friend and relative chose the home for them after the latters visited the home and ask questions about the service. They also received a brochure prior to deciding if the home would be suitable for the prospective residents. The other two residents who were placed by social services said that they received some information about the home before being placed. However, once admitted to the home, they then received a service users guide or brochure. Ten of the twelve residents who responded to comment cards stated that they received enough information for them to decide about moving into the home The manager stated that all residents that are admitted to the home are given a contract or statement of terms and conditions. We checked two newly admitted residents records and noted that a copy of the contract was given to each of them and that it was for them or their representatives to agree to the contract and to return these. It has been the norm for the home that prospective residents needs are assessed by mostly the manager, prior to them being offered a place in the home. In her absence a team leader would carry out the assessment of needs. Two residents care records were inspected for the pre-admission assessment. This was present in both cases and was appropriately completed. We also found copies of the needs assessment of the funding authority on file to demonstrate that the home tries to get as much information as possible about the needs of prospective residents before offering them a place in the home. The home has in the main, a full complement of staff that have worked there for many years and are familiar with the personal care needs of residents. Our findings have shown that the manager and her staff also seems to work closely with social and healthcare professionals in order to meet the needs of residents. We also noted during our inspection that the home only admits elderly frail residents whose primary care needs are personal care needs. As a result the home is well able to meet the needs of the residents that are admitted. The residents questionnaires showed that the majority of residents think that they always receive the care and support that they need. All people that we talked to said that on the whole they were satisfied by the way that their needs were being met. Care Homes for Older People Page 13 of 38 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. There has been an improvement in the standard of care records that are kept. These must however be kept updated with the changing needs of residents. Residents are supported to make sure that their personal and healthcare needs are met to a good standard. The home generally addresses the end of life care needs of residents appropriately, although the records could have been better to fully demonstrate that. The standard of the management of medicines was not that good to ensure the safety of residents. Evidence: We looked at the care records of four residents. We were informed that the format of the care records have been reviewed and updated. As a result there is now one folder for each resident that contained the working care records. The assessment of needs of residents are well completed and contain information about the needs of residents. These are pre-printed and there is a number of prompts for each need of residents. The relevant prompt is then highlighted to reflect the needs of individual resident. Care Homes for Older People Page 14 of 38 Evidence: Care plans generally contained the action to take to meet the needs of residents. We also noted that residents or their representatives were involved in drawing up the care records. Care plans were reviewed monthly and every six months a more comprehensive review was carried out. Notes were made about the outcome of the reviews. The care records contain a range of risk assessments to ensure the safety of residents and of staff. These include nutritional, falls, manual handling and pressure ulcer risk assessment. Other risk assessments were in place according to the needs of residents and included risk assessment for bed rails, whether residents can manage keys to their bedrooms, and for the use of covert medicines. These were on the whole agreed with residents or their representatives. In a few cases however, we noted that care plans were not updated with changes in the needs of residents. There were specific cases when residents lost weight or when their mobility had changed and when the risk assessment and care plans had not been changed to reflect the needs of residents. In another case instructions from a healthcare professional about the care of the resident had not been incorporated in the care plan of the resident. There was however evidence that residents had been seen by the GP for the weight loss, although the action plan to manage the weight loss was not very clear. Residents were being weighed monthly but we noted that the dates when residents were weighed were not recorded on the annual charts. The manager said that the dates were recorded when residents were weighed on the monthly charts. It is important to record the dates on the annual charts as this will enable a person looking at the record, make an informed decision about any weight change in relation to the timescale and determine whether the weight change is significant or not. The care plans of residents contained information about the physical needs of residents as well as some information abut the cultural and spiritual care needs of residents.For example there was some information about the dietary preferences of residents in relation to their cultural preferences but there was little information about meeting the spiritual needs of residents (see next outcome area). All residents presented with a good standard of hygiene and were appropriately dressed. Male residents were appropriately shaved and female residents were appropriately groomed. There was a section in the care records of residents addressing the capacity of residents and areas where residents were able to make decisions. This is good practice.The four questionnaires received from healthcare Care Homes for Older People Page 15 of 38 Evidence: professionals say that peoples healthcare needs are appropriately monitored and met by the home. They also say that the home always meet peoples privacy and dignity. Residents were referred to the GP, the district nurse service or to other healthcare professionals when required. Care records contained information about the outcome of the involvement of healthcare professionals in the care of the residents. We noted that two of the care plans checked, did not contain information about the end of life wishes and instructions of residents or of their relatives, and about their fears and expectations for the future. This information should ideally be recorded at the point of admission whenever possible. We were pleased to note that the manager has been looking at staff completing the knowledge sets about end of life care from Skills for Care, to improve staffs confidence in addressing this area. The home normally records the decision of residents or the residents representatives with regards to resuscitation. This is good practice. We also noted that this is a decision that is normally agreed with the relatives and staff in the home. It would be appropriate to involve the GP in this decision, as decision about resuscitation should always include the most senior clinical person responsible for the resident. Although the home provides accommodation for residents that require personal care, the manager and her senior staff said that residents do not normally get transferred to hospital or to care homes with nursing when they have end of life care needs. They said that residents would rather stay in the familiar environment of the home and be cared for by staff that are familiar to them. They added that residents will only get transferred when the needs of the residents are not being met in the home despite support from district nurses and other healthcare professionals. One healthcare professional commented that they were impressed about the standard of end of life care that a resident received in the home. We looked at the management of medicines in the home by randomly sampling the medicines of residents and looking at the medicines administration record (MAR) sheets. All medicines are kept in the medicines room on the ground floor. We found that the MAR sheets were on the whole signed when medicines were administered but the amount of at least five medicines were not recorded when received in the home. As a result we were not able to audit the amount of these medicines that should be in place. We checked the amount of one medicine and noted that the amount that was in place did not match the amount that should have been in place when taking into account Care Homes for Older People Page 16 of 38 Evidence: the amount that has been received and the number of times that the medicine has been given. We think that this could have occurred because the medicine was not administered as prescribed or because the amount of the medicine that remained from a previous cycle was not brought forward. We noted on one occasion that a medicine had been entered on the MAR sheet, in the box where another medicine had been entered, then crossed off. A new box should have been used to enter the medicine to make the entry as clear as possible. At least one medicine did not have a date of opening to ensure that the medicine would not be administered after the expiry date. In cases when a variable dose of a medicine was prescribed the actual amount administered, was not always recorded to provide clarity about the amount of medicine that was taken by the resident. We found that one antibiotic was being administered at 0800, 1200 and 1700. This means that the resident was not getting the medicine for a period of about 15 hours (between 1700 and 0800). This might have prevented the resident from getting the full benefit of the medicine. Care Homes for Older People Page 17 of 38 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 internal and external social and recreational activities for residents but it is not always clear whether the activities are provided according to residents choices. The meals that are provided are sufficiently nutritious although the content of the meals for supper could have been better. It is however not clear whether residents had a say about the meals that are cooked in the home. Evidence: The care plans of residents had a plan to address the social and recreational needs of residents. These were on the whole appropriately completed. There is a section of the needs assessment of residents that addresses the social and recreational needs of residents. However, at times a life history can provide more thorough information about the things that residents enjoy doing. A life history of residents also provides a person centered perspective to care plans. While two out of the four residents whose care plans we looked at had a life history, we noted that two did not. Staff said that they were in the process of writing a life history for all residents from information that is available to them and that in a few cases there was little information available for some residents. Care Homes for Older People Page 18 of 38 Evidence: The home employs an activities coordinator who works three days a week. The inspection report following the inspection in October 2008 states that an arrangement was being considered to increase the number of activities hours in the home. The manager later confirmed to us that this has been agreed and that an extra fourteen hours for activities has been budgeted for. The home has however not been able to recruit another part time activities coordinator. On the first day of the inspection, a board game was arranged in the conservatory. The AQAA states that an activity programme is provided three days per week which includes bingo, reading of the newspaper, quizzes, card games walks around the garden, trips to the local shops, knitting, music and movement and listening to classical music. During the inspection we noted that a few residents read, some watched TV and a few talked among themselves and with members of staff, and some rested in their chairs. We talked to the activities coordinator and residents about some of the activities that have been arranged in the home. We learned that there have been a few outings that have been arranged for residents. Some went to the local theatre, and a few went to places of interests such as the Ruislip Lido. We were informed that outside entertainers regularly visit the home, providing a diverse range of entertainment, such as sing a long, piano recitals, seasonal concerts, and a pantomime at Christmas, and that the local library also visit the home to provide large print and audio books. As well as outings in the community the AQAA states that local community groups are encouraged to visit Kent House, over the past few years the local junior school have entertained the clients during the year and refreshments are provided afterwards giving the clients an opportunity to chat with the children. The AQAA states that church Services are held fortnightly by the local churches. The manager clarified that there is a service for Roman Catholics twice weekly and that there is another service by the methodist church every two weeks. Whilst talking to residents, three said that they would like to attend a church of England service and that they do not get to see a representative of the Church of England as one does not visit the home. The manager said that despite her efforts she has been unable to access a Church of England service for the home. The home has a garden where residents take an active role in terms of maintenance and growing flowers.We also noted during the inspection that residents enjoy sitting outside. This area is relatively safe as it is at the back of the home. Care Homes for Older People Page 19 of 38 Evidence: Residents questionnaires showed that the provision of activities is the area that came second in the order of areas that residents were least satisfied with. We talked to some residents during the inspection and at least three told us that the activities that are provided do not always reflect their choices. The AQAA says: Activities are flexible and the client is always consulted. So while residents are consulted about whether they want to take part in activities, they do not seem to be consulted about the types of activities that they would like to see in the home. We noted some people visiting residents. We talked to a least three of them and they told us that they are always made to feel welcome and that they can visit the home at any time. They say that staff in the home are very friendly. The manager stated that the home provides fresh locally sourced meat, fruit and vegetables and dairy products. We were informed that breakfast is served around 09:00,lunch at around 12:30, supper at around 17:00 and at about 19:30 residents are offered a hot drink and biscuits. On the first day of the inspection, which was a Friday lunch consisted of fried fish, peas and chips. There were other meals that were prepared for residents who could not eat normal meals or who did not want the fried fish. Our survey has shown that in relation to all other areas that are addressed in the resident questionnaire, the provision of meals scored least. Whilst most residents were always happy with other aspects of the service, we noted that less people were always happy with the meals. One person commented that sometimes the food over the weekend are not so good as over the week. Three residents who talked to us said that they normally have a main meal and an alternative is provided if they do not like what is on the menu. They said that the onus is on them to say that they do not like a particular meal rather than them being asked about their choices. One person who sent a questionnaire said that the food is nice and they provide alternatives if I do not like something. We noted that the choices of residents were recorded when their needs were assessed and that the chef was aware of these and would prepare a different meal if it was identified that a resident did not like the meal on the day. The residents however, told us that they were not normally consulted about the range of meals that made up the menu. We checked the menu and noted that it normally contains only one choice for the main meal and therefore residents could not choose from a choice of meals. We also observed that the menu was not comprehensive and did not include the vegetables and the desert that would be served with each meal. On the day of the inspection Care Homes for Older People Page 20 of 38 Evidence: residents were offered sandwiches, tea and a desert for supper. There was no hot meal or soup on the day and we were informed that this was because the assistant chef was unable to work the evening shift to prepare supper. From the menu that was kindly provided to us we noted that residents do not always receive a hot meal or soup for supper. The supper for Sundays generally consisted of sandwiches, tea and a desert. On some days residents receive a salad but there is no hot meal or soup on these day. When soup is provided there is no hot meal that is included on the menu. During the inspection in May 2007 we suggested that the home review the menu according to guidance from the Food Standards Agency (Food Standards Agency, (2006) Food served to older people in care homes. www.food.gov.uk ; and Food Standards Agency, (2006). Example menus for care homes http:/www.food.gov.uk/multimedia/pdfs/examplemenus.pdf ). The manager said in the AQAA that Guidance has been sought as recommended from the Food Standards Agency for the Provision of Meals in Care Homes. There was some evidence of this in terms of the meals that were included in the menu, but the menu still lacked in terms of choices and comprehensiveness, as described in the guidance from the Food Standards Agency. Care Homes for Older People Page 21 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that complaints are taken seriously and will be investigated as required. Staff are familiar with the safeguarding adults policy and are aware of the action to take when allegations and suspicions of abuse are made or observed. Evidence: The home has not received any complaints or allegations of abuse since the last inspection. In the past complaints have been appropriately dealt with by the service. The complaints procedure is available in the brochure of the home. All residents who responded to questionnaires said that there is someone that they could contact if they were unhappy. The residents that we talked to also said that they would talk to the manager, the person in charge or to their relatives if they felt unhappy about the care that they received. However, eight (67 ) respondent knew how to make a formal complaint, three did not know and one was not sure. We noted that the manager was very approachable to residents, visitors and staff and we therefore think that people would talk to the manager if they have concerns about the quality of care. We believe that the manager would take the issues seriously and will ensure that these are dealt with. Healthcare professionals who responded to questionnaires confirmed this. They said that they had confidence that the home would deal appropriately with the concerns, that are raised by people using the service, or by any other person. Care Homes for Older People Page 22 of 38 Evidence: All members of staff who responded to questionnaires said that they knew what to do if they had concerns about the home. We spoke to staff about the safeguarding adults procedure and they were able to demonstrate that they knew what to do if there were allegations and suspicions of abuse. They also knew that they had to look into causes of unexplained injuries such as bruises. Inspection of the accident and incident records showed that accidents and incidents were looked into in terms of causes, and explanations were put forward for unexplained injuries. Care Homes for Older People Page 23 of 38 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 home provides a comfortable and homely environment for residents. Evidence: The home is found at the end of a close. There are parking areas in the front and a small garden with lawn, patio and flower beds at the rear and on the side. The grounds of the home were on the whole maintained and there were flowers to provide colours and a pleasant environment. Externally the building was in an appropriate condition. We were informed that all the communal areas have been redecorated and carpets have been replaced.There is a main lounge and a quiet lounge on the ground floor and a library on the first floor. All the lounges were appropriately furnished and furniture was in good condition. We also noted flat screen televisions in the two lounges on the ground floor. The dining area was also in a good state of decor and appropriately furnished. The home has a conservatory on the ground floor that is enjoyed by residents. However, a few residents were wearing their hats in the conservatory and they said that it does get hot in summer when the sun shines directly through the glass. Staff reported that they make sure that residents are protected from strong sunlight and heat when the residents sit in the conservatory and that they discourage residents Care Homes for Older People Page 24 of 38 Evidence: from sitting there when the sun gets too strong. There is a fan and doors can be opened (although these give access directly to the home from the street), but the conservatory would certainly benefit from blinds/shade, to keep direct sunlight away from people sitting there and to keep this area cooler. The corridors have been redecorated and we were informed that the home has a cyclical plan for redecoration on a five year programme. The manager said that there are plans to redecorate 6-7 bedrooms in the near future. We looked at many bedrooms and we found that they were all in a good state of decor and personalised with residents possessions that have been brought into the home. Some residents had small items of furniture, pictures,photos and items of decoration. Bedrooms are en suite with toilet and wash hand basin. There are bathrooms/showers on each floor and toilets close to the communal areas on the ground floor. The side of a bath on the ground floor had come off, but the manager said that this was going to get repaired soon. The home was clean and there were no odours. Eleven out of the twelve residents who responded to questionnaires said that the home is always clean and free from odours and one said usually. One resident commented that their room is always tidy. The home has sluices but does not have a sluicing disinfector. There was evidence that staff have had infection control training. The manager said that all protective equipment is provided to staff as required. Care Homes for Older People Page 25 of 38 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 staffing levels and the competency of staff that the home provides, are on the whole appropriate to meet the needs of residents that live in the home. Evidence: There is normally a duty officer and six carers for the morning shift (07:00-14:00) and a duty officer and five carers for the afternoon shift (14:00-21:00). At night there are two carers and a team leader on call. The manager is supernumerary. There is no deputy but there are four team leaders that are in charge of shifts. Where necessary the home uses an agency to cover shortage of staff. At the time of the inspection there was a vacancy of 1.5 full-time equivalent of a carers post. The manager clarified that she was in the process of recruiting for these posts. The home employs ancillary staff in the kitchen and for cleaning. One domestic/cleaner is allocated to each floor and over the weekend there is one weekend cleaner. We were informed that agency staff also cover the shifts when there is a shortage of staff. There were many (at least three) comments in residents questionnaires about the friendliness of staff and how this helps to provide a good atmosphere in the home. A resident said that staff are well organised. Analysis of the response that we received for our survey shows that six out of twelve residents think that staff are always Care Homes for Older People Page 26 of 38 Evidence: available when residents need a member of staff, four said usually and two said sometimes. Six said that staff always listen and act on what they say, five said usually and one said sometimes. This area, which mostly look at the availability and response of staff when residents request something, did not score as strongly as other areas of the survey such as, whether the residents receive the care and support that they need. This would indicate that the home needs to study these responses to see if there can be an improvement in these areas. Three out of the six comments of residents about what could the home do better were about staffing. One resident commented about having to wait long before going to bed, another about having to wait to use the toilet and the third about the home needing to have more staff. We looked at the personnel files of three members of staff and noted that all employment checks were carried out as required. All applicants completed an application form, had two references, proof of identity and eligibility to work in the country and a CRB check. They all had an induction but we noted that the induction did not include the common induction standards from Skills for Care. The manager stated that all staff start with NVQ training soon after they start and therefore do not do the common induction standards. Skills for Care says that The 12-week CIS induction period enables care workers to give high quality care and support, provide recognition for their work, and prepare them for entry onto NVQ health and social care programmes (http:/www.skillsforcare.org.uk/entry_to_social_care/common_induction_standards/c ommon_induction_standards.aspx). Therefore, as an NVQ takes about one year or more to cover all the occupational standards (units), the common induction provides a relatively quick form of training in key areas to make sure that care workers have a basic competency to be left alone to care and support residents. The induction as per Skills for Care is not a substitute for NVQ training. The evidence collected to meet the common induction standards can always be used for NVQ training. According to the AQAA the home has thirty care workers and out of this number twenty have an NVQ qualification. As a result the home has more than 50 of its care workers qualified to NVQ level 2 or above. The home keeps a record of training that is carried out in the home. We noted that staff were mostly up to date with mandatory training and that the training for an update in mandatory training has started for this year. Our staff survey showed that staff receive relevant training to care and support residents. Care Homes for Older People Page 27 of 38 Evidence: We noted that a supervision programme was in place and that that a record of supervision that has taken place was kept in the home. We talked to staff about supervision and they said that they were happy with the support that they receive from senior staff and that they receive supervision from line management every two months. Care Homes for Older People Page 28 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is on the whole managed appropriately to meet its aims and objectives and those of the organisation. Residents personal money is managed to a good standard to protect residents interests. A few health and safety issues that could put residents at risk, were noted during the inspection. Evidence: The manager has now worked in the home for about twelve years. She has a qualification in management, but does not have the Registered Managers Award. She is experienced and familiar with issues that arise in a care home. We were able to discuss the care needs of residents with her and she demonstrated that she had a good knowledge of the needs of the residents that lived in the home. There was no deputy manager in the home but there were four team leaders, who as well as being in charge of shifts, also have additional managerial responsibility. For example one is responsible for the management of medicines and another is Care Homes for Older People Page 29 of 38 Evidence: responsible for care plans. We noted that the home did not arrange residents meetings. The manager said that she has an open door policy and residents or their relatives can always have access to her. A few residents said that they would have liked to have a meeting to discuss issues in the home and to make suggestions about things that can improve their quality of life. We strongly recommend that these are arranged as residents would enjoy contributing to the running of the place where they live. One person said that this does not have to be negative and that it can be a positive thing. The manager stated that six monthly satisfaction surveys are carried out. The last one was carried out in December 2008. There was a summary of the results of the survey but no action plan to address areas that did not score strongly. The home also has a system of audits to monitor the quality of the service that it provides. Some areas such as cleaning are audited weekly and other areas, such as care records, are audited monthly. There is an annual audit that is based to some extent on the national minimum standards. Monthly regulation 26 visits are carried out and reports are available for inspection. The management of the personal money of residents was checked. We noted that good records were kept and the system was clear and easy to audit. The administrator is responsible for the management of the personal money of residents. Each resident that has money with the home has a separate container where the money is stored. All the personal money of residents is kept in the safe. We checked the balance and the expenses that were made on behalf of two residents chosen at random and noted that the balance was correct and that receipts were kept for all expenses that were made. We did not see a record of the property and valuables that are brought into the home by residents or by their relatives and friends. This would have ensured an audit trail of residents possessions to safeguard residents from financial abuse as far as possible. The home carries out regular checks of the fire detection equipment and fire emergency light system. There was evidence that staff receive regular fire drills. An up to date emergency fire plan and fire risk assessment were available for inspection. The home also had a health and safety risk assessment and contingency plans to deal with emergencies. During a tour of the premises we noted that there was no thermostatic valves at some Care Homes for Older People Page 30 of 38 Evidence: hot water outlets to which residents had access to, despite a requirement in 2007. These included hot water outlets in communal bathrooms and toilets, and in a few bedrooms. In one case there was a reading of about 60 degrees centigrade at the hot water tap in one bedroom. We did not also see consistent records to show that the water temperature was being systematically monitored at hot water outlets to which residents had access to. The water temperature was being checked as part of the monitoring for legionella but at selected and randomly chosen hot and cold water outlets. We imposed an immediate requirement on the home to address the above, requesting that a risk assessment be carried out and control measures be in place as required, to make sure that residents were not placed at risk of scalding. We also noted that a few windows on the first floor did not have window restrictors and that the restrictors that were present on windows that had them, could be easily disabled by hand. These were therefore of minimal use. As a result, we imposed an immediate requirement on the home to address the above requesting that a risk assessment be carried out and control measures be in place as required to make sure that residents were not placed at risk of falls from a height. The immediate requirements were met within the appropriate timescales. The home had an up to date portable appliance test certificate, a wiring test certificate and a gas safety test certificate. A certificate was also available to show that the water system had been tested for legionella. LOLER certificates were available for the hoists. There was evidence that the lift was maintained. Care Homes for Older People Page 31 of 38 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 32 of 38 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 38 13 The home must provide a 11/08/2009 risk assessment about the management of the scalding risks that residents face from hot water outlets, by the 11th August. To assess the risks of residents getting scalded and to have control measures in place as required to ensure the safety of residents. 2 38 13 The home must provide a risk assessment about the management of the risks that residents face with regards to falling through windows that can be fully opened. To assess the risks of residents falling from a height and to have control measures as required to ensure the safety of residents. 11/08/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All care plans and risk assessments must be reviewed and updated when residents needs change. 17/11/2009 Care Homes for Older People Page 33 of 38 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 To make sure that a person reading the care plans and risk assessment will get the most up to date information about the needs of the residents. 2 9 13 The date of opening of all liquid and eye medicines must be recorded on the containers. To ensure that the management of medicines is carried out safely. 3 9 13 All medicines must be 17/11/2009 administered as prescribed and in cases of a variable dose, the actual amount that is administered must be recorded. To ensure that the management of medicines is carried out safely. 4 9 13 Medicines must as far as possible be given at regular intervals to ensure that residents receive the maximum benefit from the medicines. To ensure that the management of medicines is carried out safely. 17/11/2009 17/11/2009 Care Homes for Older People Page 34 of 38 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 5 9 13 The amount of all medicines that are received in the home must be recorded. To ensure that the management of medicines is carried out safely. 17/11/2009 6 12 16 The home must demonstrate 17/11/2009 that residents are consulted and involved in decisions about their daily life and about their choices. This must include decisions about the meals that are provided and the social and recreational activities that are arranged in the home. To ensure that residents choices are accounted for. 7 33 13 The home must keep a 11/11/2009 record of the valuables and property that is brought into the home by residents or their representatives. To provide an audit trail and to safeguard residents valuables and property as far as possible. 8 38 13 The home must have systems in place to monitor the water temperature at hot water outlets to which residents have acess to at intervals as determined by its risk assessment. 11/11/2009 Care Homes for Older People Page 35 of 38 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 To ensure that any problem with hot water is promptly identified and addressed to reduce the risk of scalding. 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 8 The dates when residents are weighed must be recorded to give an indication of the timescale when residents were last weighed. That the warfarin book of residents be kept with the MAR sheet to enable easy reference to it, if the dose of warfarin need to be checked. Each medicine should be entered in a clear box on the MAR sheet. The care records should as far as possible contain information about the instructions and wishes of residents with regards to end of life care. The resuscitation status of residents should be discussed with the GP whenever possible. The home should support residents who are from the main churches with their spiritual needs. This could include visits by ministers from these churches whenever possible. The home should consider providing a blind for the conservatory to provide shade for residents who sit in that area and to keep the temperature down. It is recommended that all new members of staff to the home complete the common induction standards as per Skills for Care. It is strongly recommended that the home arrange regular residents and/or relatives meetings to involve them as much as possible in the daily life of the home and for them to contribute to the running of the home whenever Page 36 of 38 2 9 3 4 9 11 5 6 11 13 7 19 8 29 9 31 Care Homes for Older People 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 possible. 10 35 Following a satisfaction survey, the home should have an action plan to address the areas that require improvement. Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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