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Inspection on 21/05/09 for Ladydale Residential Home

Also see our care home review for Ladydale Residential Home for more information

This inspection was carried out on 21st May 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Overall, people who use the service and were involved with the inspection process are happy with the care staff who support them. We received very positive responses from discussions we had with relatives and healthcare professionals who visit the home on a regular basis and are impressed with the quality of the service. The home has worked hard to address high staff turnover and this is much improved since the last key inspection visit. Staff development and staff training is a high priority and this is confirmed by two National Vocation Qualification Assessor we spoke to on the day.

What has improved since the last inspection?

Two requirements made in the last Key Inspection Report have been met. There is now low staff turnover which provides more consistency for people who use the service. The manager has obtained an up to date copy of the Local Authority Safeguarding Procedures as recommended in the last report. This document provides vital information about appropriate and timely referrals for protection of vulnerable adults from abuse. The home is decorated throughout to a high standard.

What the care home could do better:

There are concerns regarding medication procedures. We have provided greater detail in the body of this report. Three requirements have been made regarding medication. All communal bathrooms and the hairdressing salon would benefit from refurbishment to make them pleasant and relaxing areas in line with the rest of the care home.

Key inspection report Care homes for older people Name: Address: Ladydale Residential Home 9 Fynney Street Leek Staffordshire ST13 5LF     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: Linda Clowes     Date: 2 1 0 5 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 32 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 32 Information about the care home Name of care home: Address: Ladydale Residential Home 9 Fynney Street Leek Staffordshire ST13 5LF 01538386442 01538385158 ladydale@arc-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Aegis Residential Care Homes Limited care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 2 MD minimum age 55 years on admission. 3 LD minimum age 35 years on admission. 4 PD minimum age 55 years on admission. Date of last inspection Brief description of the care home Ladydale Residential Home is situated in a quiet, mature residential area in the historic market town of Leek. It is a well-established care home for the elderly that provides accommodation for up to fifty-four people. 3 2 0 4 Over 65 0 6 54 20 Care Homes for Older People Page 4 of 32 Brief description of the care home The main house has four floors. The majority of bedrooms are situated on the ground and first floors. A shaft lift and stair chair lift provide easy access to various levels in the home. The newer single-storey wing accommodates ten people and has its own communal lounge/dining area. Ladydale also has two small annexes, The Coach House with three semi-independent units and The Lodge with two semi-independent units. People who use the service are able to access all areas of the home as they choose. Ladydale is attractively decorated and furnished throughout to a high standard. Fifty of the bedrooms are single, two are double and 45 have en-suite facilities. Assisted bathing and shower facilities are situated throughout. The home has ample communal lounge and dining space. There are off-road parking facilities and attractive mature gardens surrounding the property with a very pleasant secluded patio area with seating. There is a comprehensive activities programme for people who use the service to access as and when they wish. Care Homes for Older People Page 5 of 32 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: One inspector carried out this unannounced inspection. We inspected against the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The objective of the inspection is to evaluate whether people who use the service and their family carers experience services of good quality that offer and promote independence. Both the Registered Manager and Deputy Manager were present at the inspection which took pace over a period of 8.5 hours. We looked at peoples care plans, personnel files, complaints files, medication records, health and safety records and gave a feedback session. Prior to the inspection the Providers had completed a self-assessment tool which is Care Homes for Older People Page 6 of 32 known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to undertake a self-assessment, which focuses on how well outcomes are met for people using the service. Information from this AQAA is used to plan the inspection visit and references to it have been included in this report. The AQAA was returned on time and gave us a reasonable picture of the current situation within the service. We spoke directly with people who use the service, relatives and visiting professionals. People tell us that the home provides a satisfactory service and that they feel comfortable and safe. Professionals who visit the home regularly tell us that the staff at the home respond promptly to healthcare concerns. Relatives tell us that they are welcomed into the home and that they are confident that the care staff and management have the best interests at heart of people who use the service. We identified concerns regarding medication as part of this inspection and discussed these fully with the manager and deputy manager on the day. We are confident that they will address these issues. We have made three requirements and six recommendations as a result of this visit. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 8 of 32 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 9 of 32 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 service provides information so that people are able to make an informed choice about whether the home is suitable for them. No person moves into the home without having their needs assessed. Evidence: No requirements were made in this outcome group in the last inspection report People tell us that they receive information about the care home prior to moving in. We saw a copy of the Statement of Purpose and Service User Guide displayed on the Notice Board in the front entrance hall of the home. We find the Statement of Purpose to be somewhat confusing as it is not clear regarding the name of the proprietor. We have asked the manager to review this to ensure it is accurate. Literature and documentation provided by the care home must give clear and unambiguous information about the service and its proprietors. Care Homes for Older People Page 10 of 32 Evidence: The home consists of the main house together with a single storey extension (known as the new wing) and semi-independent accommodation in the grounds, known as The Coach House and The Lodge. Three people with learning disabilities have lived in part of the semi-independent accommodation for approximately ten years and all three have been interviewed as part of this inspection. They have free access to the communal areas and facilities in the main care home. The main building and new wing accommodate people who are elderly. The home is fully occupied on the day of our visit with fifty-three people (one person is using a double room as a single). Twenty-four are publicly funded and twenty-nine are privately funded. Where possible, people are invited to sample by visiting the home prior to admission. Decisions about permanent admission to the home are not made until the person has been in residence for some four weeks to enable everyone to consider whether Ladydale is suitable for their needs. A key worker (care assistant) is allocated to each person. The key worker is responsible for a small group of people who use the service. The key worker is responsible for ensuring daily records for her group are up to date. A senior care worker is also deployed on each shift . The Statement of Purpose for the home tells us prior to agreeing the admission of a potential resident the Care Manager will visit the person at home or in hospital unless the person prefers to visit the home and is able to do so. We looked at the files of four people who recently moved into Ladydale and found current care plans and assessments completed by social workers and a representative of the care home. This ensures that peoples needs are fully assessed prior to admission in order that the home may determine whether it can meet the persons needs. Ladydale does not provide intermediate care and so Standard 6 (Intermediate Care) was not assessed. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are set out in an individual plan of care. There are concerns that some medication practices may place people who use the service at risk of harm. Evidence: No requirements were made in this outcome area in the last inspection report. We recommended that each person is weighed at point of admission and our inspection of records tells us that this is now being carried out at point of admission and thereafter on a monthly basis. We looked at the care plans (support plans) for four people who used the service. These are all satisfactory with sufficient information generated from the needs assessment to inform staff how to provide for the persons individual care needs. Records are clear and informative and reviewed every month. The AQAA tells us that residents are assessed to ensure that we can meet their needs and a care plan is fully completed and our inspection of files confirms this. Care Homes for Older People Page 12 of 32 Evidence: We spoke with four community healthcare professionals during the day and each confirms that in their view Ladydale provides a very good quality of personal care. One community nurse tells us the home always contacts us promptly and appropriately so that we can tend to healthcare needs. Managers and staff know everyone and are concerned for their welfare. We spoke to the people being case tracked and also to many other people who use the service on the day and all expressed satisfaction with the service provided by the home. People tell us that care staff are caring, sensitive and respectful. Relatives spoken with are glowing in their praises for the good quality care provided. It is disappointing, therefore, to find that there are concerns with medication procedures. We observe one of the morning medication rounds being carried out at 10.30 am and the lunchtime round at 1.00 pm. We observe one person being administered paracetamol which should have a minimum of four hours between administration of doses. When we speak to the senior carer administering the medication she confirms that she has administered the morning dose at about 8.00 am but the medication administration record (MAR) does not show this. We made a recommendation in the last key inspection report for consideration to be given to the timing of medication rounds to ensure that sufficient time is allowed between each administration session to meet the individual needs of people who use the service. For one person prescribed pain relief (paracetamol) there is no record of any having being administered for the whole of May. There is no record to confirm that any had been offered and refused. The senior confirmed there are no paracetamol for this person in the medicine trolley. We checked the stock cupboard and there is none in stock. We are concerned that pain relief is not being offered to this person. The MAR sheet contained no record at all in relation to the administration of this prescribed medicine. The pain relief medication for another person is specific take two when required but on occasions only 1 tablet is administered. There are occasions when the record shows that it has been offered but refused. There is no record of the general practitioner being consulted about this situation and clearly the medicine is not being administered as prescribed when only one tablet is given. Another person is prescribed co-codamol either one or two as required. There are occasions when the number of tablets administered are not recorded. A check of the number received and the number administered does not correlate and so we are not able to follow an audit trail for the prescribed medication. Care Homes for Older People Page 13 of 32 Evidence: One person is prescribed a medication to be administered weekly on a Thursday. However the MAR chart has not been signed for 14/05/09 and it is not possible to confirm whether this has been administered or not. One person has Calcichew take 2 daily. On three days one had been given at lunch time and one at tea time. When speaking to the Deputy Manager it is apparent that the General Practitioner has stated that the two Calcichew tablets must be taken at lunchtime as there is a concern regarding other prescribed medication being detrimentally affected. The person administering the medication was not aware of this. The prescription label should be more specific in this case and the home needs to address this with the general practitioner. The care plans/medication records do not have a protocol for pro re nata (prn) or as and when medication to advise staff under what circumstances this should be administered. e.g. where the prescription states take one or two tablets when required the protocol should clearly instruct staff under what circumstances they may administer either one or two tablets and when. Each persons as and when medication must have written instructions for staff clearly specifying the circumstances when this medication may be administered. The manager was advised to consult our website for further advice on this issue. The home must liaise with General Practitioners to ensure that the prescription labels on all medicines are explicit and easily understood. They must not accept as directed or as before instructions in relation to prescribed medicines, including prescribed creams, liquids and drops. One person was prescribed one Citalopram tablet every day but there were gaps in the MAR sheet for the 14 and 16 May with no reason recorded. We identified that care assistants are in many instances administering prescribed creams and drops. They are not, however, completing a medication administration record. The home must ensure that it has accurate records in place for all medicines, including prescribed creams, liquids, drops and homely remedies. They must also ensure that where medication is stored in bedrooms it is located in a secure facility. All care staff responsible for the administration of prescribed medication, including creams, liquids and drops must be suitably trained and assessed as competent to do so. Care Homes for Older People Page 14 of 32 Evidence: We have made requirements as part of this report regarding these medication issues. The service has a home for life policy. The AQAA tells us that six people were cared for by the service during terminal illness. Care plans show peoples wishes about plans following their death where they have expressed these. This clearly demonstrates that people are consulted in decision making. Care Homes for Older People Page 15 of 32 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 promotes individual lifestyles and helps people who use the service to maintain significant family and community contacts. People who use the service may be assured that their nutritional needs will be addressed by the care home. Evidence: No requirements were made in this outcome area in the last inspection report. Generally staff are aware of the need to support people who use the service, to develop their skills including social emotional, communication and independent living skills. There is an Activities Programme in place to provide enjoyment and stimulation. Copies of the Activities Programme are displayed in the home. The Service issues a bimonthly Newsletter which also outlines activities and planned outings. Today, several people receive Communion and the lay visitor confirms he has been visiting for many years. It is understood that such visits take place every two weeks. Care Homes for Older People Page 16 of 32 Evidence: There is a monthly in-house religious service which also took place on the day of our visit as well as a visit from a Fashion Shop so that both men and women could purchase new items of clothing. There are regular entertainers. This month a ventriloquist is visiting for the first time. A regular painting class is held. The home has employed an extra Activities Co-ordinator since the last key inspection so that there are now two Activities Co-ordinators. One works twice a week for two hours on a one-to-one basis with people who use the service and will take people out of the home on various visits and shopping. The second Co-ordinator works for two hours on Tuesday and Friday and will take the lead on board games, providing a trolley shop, arranging entertainers and other in-house activities. We observe people moving freely around the home. The majority of people who presently use the service spend the morning in their bedrooms also having their breakfast there, and then have lunch in the dining room. Other people choose to have breakfast in the communal dining room. People we spoke with confirm that the daily routines in the home were relaxed, flexible and varied to meet individual choice. We observe staff practices which promoted individual rights and choices, e.g. asking permission before moving people, giving people choice of meals and drinks, knocking on doors, etc. Relatives we spoke with tell us that there is always something going on if people wish to take part. The wishes of people who do not want to take part in activities is respected. One person tells us that they liked to spend all their time in their own room but left their bedroom door open so that they could see people passing by. A keyworker is designated to the learning disability unit. We speak with everyone in this unit and find that they remain happy with their lives in the home. Records show that individual choice and lifestyles are promoted within a robust risk assessment framework. The home offers a four-weekly rotational menu which contains fresh meat and vegetables. The majority of cakes are cooked in house and everyones birthday is honoured with a Birthday Buffet that includes a birthday cake. The cook attends Residents Meetings as food is often an agenda item so that she can respond to individual food choices. Fresh fruit salad is offered every afternoon. Cooks are appropriately trained, although it was noted that the Food Hygiene Certificate for one lapsed on 04/04/09. There is no evidence to confirm that one has Care Homes for Older People Page 17 of 32 Evidence: NVQ for cooking and the home is asked to obtain this for their records. We discuss with the manager the possibility of allocating a tea making area for staff to reduce the numbers of people entering the kitchen environment and thereby reducing the risk of cross-contamination. (see standard 38 - Management & Administration) Care Homes for Older People Page 18 of 32 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 and their relatives can be confident that their complaints are listened to and appropriately handled. The service has policies and procedures in place to ensure that people are protected from abuse. Evidence: No requirements were made in this outcome area in the last inspection report. Details about the homes complaints procedure are contained in the Service User Guide. The complaints procedure is also displayed in the home. Relatives we spoke to say they know about the complaints procedure. We speak to people who use the service and they tell us that they feel confident that any complaints they raise will be dealt with promptly. The AQAA tells us that no formal complaints have been raised with the home since the last inspection. There has been one safeguarding referral that has been appropriately referred to the Local Authority Safeguarding Team for investigation. The manager is aware of the protocols and procedures in respect of Safeguarding Adults from Abuse. The AQAA tells us that staff are trained in Safeguarding of Vulnerable Adults from Abuse. We ensure that staff are aware of safeguarding of vulnerable adults policy. The training records show that staff have received Protection of Vulnerable Adults training. Care Homes for Older People Page 19 of 32 Evidence: The home has an open culture that allows people using the service and their advocates to express their views and concerns in a safe and understanding environment. People tell us they are happy with the service provided and feel safe and well supported. There is a clear system for staff to report concerns about colleagues and managers. Staff have access to whistle blowing polices and procedures at the start of their employment. We, the commission, have received no safeguarding alerts or complaints about Ladydale since our last inspection. Care Homes for Older People Page 20 of 32 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 location and layout of the home is suitable for the needs of the people who use the service. The home is attractively decorated, clean and hygienic. Refurbishment and redecoration of all the bathrooms and hairdressing salon would greatly improve facilities for people who use the service and provide a more pleasant and relaxing environment. Evidence: One requirement was made in this outcome area in the last inspection report for all parts of the home to which service users have access to be free from clutter and trip hazards. We consider that this requirement has now been met. We recommended that storage of paper goods be improved due to impact from damp. This has been addressed. We also asked for the home to give consideration to security of the building in view of the number of entrances and exits in the home. This has not been carried out at the time of this inspection, although the manager stated that this was shortly to be carried out and showed us a copy of the quotation for work to be carried out. We returned to the home on 28/05/09 and find that this work is being carried out. During this visit we discussed with the manager the provision of gates or fencing to the side and rear of the building to increase security and privacy for people who use Care Homes for Older People Page 21 of 32 Evidence: the service. We have made a recommendation regarding this. The home in the main provides a well-maintained and pleasant environment. However, the lower ground floor bathroom and hairdressing salon and other communal bathrooms in the home are in need of refurbishment in order to provide a pleasant and relaxing experience for people who use them. We were told by the Operations Director at the time of our key inspection visit on 9 May 2007 that bathrooms would be upgraded within twelve months. As this has not yet taken place we have made a recommendation as part of this report. The AQAA tells us we have a maintenance programme in place with written records that are updated regularly. We inspected this record. Since the last inspection essential wiring has been carried out in the kitchen/dining area of the home. New light fittings have been installed in the TV lounge, dining room and conservatory. A new chair stairlift has been installed. A new cooker and airconditioning has been installed in the kitchen. We recommended at the last inspection that consideration be given to upgrading the reception area. There is some improvement with the introduction of a new seating area and relocation of the signing in area into the hallway (the latter a suggestion received in the homes Suggestion Box). We inspected a small random sample of bedrooms and find that these are personalized with many personal possessions brought from home. The vast majority of rooms are for single occupancy. One double bedroom is being used as a single and two rooms (comprising bedroom and sitting room are used for a couple). Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides sufficient skilled and experience staff to meet the needs of people who use the service. Robust recruitment procedures and Induction Training protect people who use the service. Evidence: No requirements were made in this outcome area in the last inspection report. Ladydale has a care staff team of thirty-two, with an ancillary team of eighteen. The records tell us that nine care staff have NVQ level 3 in care and twenty-nine have NVQ level 2 in care. At the last key inspection it was highlighted that there had been a high turnover of staff but this has greatly reduced with only seven care staff having left in the past twelve months. This is much more positive as a stable staff team provides consistency for people who use the service. There is ongoing NVQ training at all levels. We met two NVQ Assessors who visit the home on the day of this inspection. They tell us that the home is very constructive with staff and provides time off to undertake training. They also said that the manager works with staff to provide support during their studies. The AQAA tells us that Cooks and Assistant Cooks have attained NVQ certificates and the Administrator has attained NVQ level 3. Care Homes for Older People Page 23 of 32 Evidence: People who use the service, relatives and healthcare professionals who visit the home on the day of this inspection tell us they are satisfied with the service, they say they are confident that staff are skilled and able to meet the needs of people who use the service. Visitors confirm that staff keep them informed of any changes to their relatives and that there are usually sufficient staff on duty when they visit. The records show thorough induction training that focuses on key policies and procedures and which staff have signed. On-going training has taken place in a range of specialist subjects. Regular supervision of care assistants and seniors is carried out by the Deputy Manager. Staff spoken with on the day confirm that they receive the training they needed to do their job. They also state that managers are approachable and supportive. Care Homes for Older People Page 24 of 32 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 home is managed by a qualified and experienced manager. There are clear lines of accountability throughout. The best interests of people who use the service are promoted by staff at all levels. Evidence: One requirement was made in this outcome area in the last inspection report for all care staff to be appropriately supervised. We find that this requirement has now been met. The manager has the required qualifications and experience to run the home. There is a strong ethos of being open and transparent in all areas of the running of the home. The manager has completed the AQAA, which is a legal document, and returned it to us in the timescales. The AQAA gives a reasonable picture of the current situation within the service, although there are areas that could have provided more supporting evidence to illustrate what the service has done in the last year, e.g. training courses Care Homes for Older People Page 25 of 32 Evidence: provided for care staff, information about staff meetings, how equal opportunities is promoted. It is disappointing that monitoring procedures in the home have not picked up the issues with medication identified during this inspection. We have made requirements about medication as part of this report and we will return to monitor how well the service has responded to these issues. People we spoke with, including visiting professionals confirm that the manager is approachable and inclusive. The AQAA tells us that the service has policies and procedures in place and that these are reviewed. The service has an Administrator who also has input into the recruitment procedure, ensuring that new staff have appropriate checks in place and that all documents are full and accurate. The manager tells us that the home has retained its Investors in People Award which is now effective until 2012. The AQAA tells us that the manager works in accordance with Health and Safety legislation and all records are kept accurately. We looked at the homes maintenance and fire records and find these to be up to date. In the main people who use the service maintain responsibility for their own finances or have family members or solicitors who acted on their behalf. The home holds small amounts of personal allowance for a few people. Records of all transactions are double signed by the Administrator and Registered Manager. We inspected a random sample of records and monies held on behalf of people who use the service and found these to be accurate and transparent. Ladydale seeks the views of people who use the service by asking them and their relatives to complete Satisfaction Questionnaires. These are organized by the Clinical Manager based at Headquarters. The Clinical Manager responds to any issues raised and brings them to the attention of the manager. The last Satisfaction Survey/Quality Audit was dated January 2009. The document gives an analysis of responses received. It is displayed on the Notice Board so that anyone can access it. The response shows that generally people are satisfied with the services provided by the home. Care Homes for Older People Page 26 of 32 Evidence: We checked and find that there is current insurance in place. The Certificate of Registration is displayed in the home as required by our regulations. Care Homes for Older People Page 27 of 32 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 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 12 Regulation 12(1)(a) & 30/06/2009 18(1)(c)(i). All staff responsible for the administration of medicines, including creams and drops, must receive training and be assessed as competent to do so. This will ensure that people who use the service are supported by trained and competent staff. 2 9 12 Requirement 12(1)(a) & 13(3). The service must ensure that arrangements are in place for the safe storage of all prescribed medicines including creams and liquid medicines. This will ensure that prescribed medicines are only accessible to persons for whom they are prescribed. 30/06/2009 Care Homes for Older People Page 29 of 32 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 3 9 12 Requirement 12(1)(a) & 13(2). Arrangements must be in place for the recording, handling and safe administration of all prescribed medicines in the care home. This will ensure that people who use the service receive their medicines as prescribed. 30/06/2009 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 1 It is recommended that the Statement of Purpose is reviewed so that it contains accurate and up to date information, particularly in relation to the ownership of the care home. People who use the service will then know the name of the proprietors and what services they may expect. It is recommended that consideration be given to securing the side and rear area of the home with the installation of gates/fences. This will promote security and privacy for people who use the service. It is recommended that the home informs the Care Quality Commission when remedial works have been carried out to provide safety alarms on entrance and exit doors in the home. It is recommended that all staff who have responsibility for food preparation have up to date Food Hygiene Certificates. It is recommended that appropriate personal protective equipment is provided for people entering the kitchen area. In this instance disposable caps. This will promote hygiene Page 30 of 32 2 19 3 19 4 5 38 38 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 in the food preparation area. 6 38 It is recommended that tea making facilities for staff are provided outside of the main kitchen. This will reduce the risk of cross-contamination. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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