Inspection on 09/06/09 for Lyme Valley House Care Home

This inspection was carried out on 9th June 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lyme Valley House Care Home 01/09/09

Lyme Valley House Care Home 27/11/08

Lyme Valley House Care Home 30/05/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Key inspection report Care homes for older people Name: Address: Lyme Valley House Care Home 115 London Road Newcastle under Lyme Staffordshire ST5 7HL     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: 0 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Lyme Valley House Care Home 115 London Road Newcastle under Lyme Staffordshire ST5 7HL 01782633407 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ravinder Singh Thiara care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: MD(E) - registerd for 2, both may be aged minimum of 60 years on admission. PD - registered for 10, 2 of whom may be aged 55 on admission. PD(E) - registered for 10, 2 of whom may be PD age 55 years on admission. The maximum number of service users to be accommodated is 26. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:- dementia, DE, 7; dementia - over 65 years of age, DE(E), 10; mental disorder excluding learning disability or dementia, MD, 2; physical disability, PD, 10; physical disability - over 65 years of age, PD(E), 10; old age not falling within any other category, OP, 26. Date of last inspection Care Homes for Older People Page 4 of 31 Over 65 10 0 26 10 3 2 0 10 Brief description of the care home Lyme Valley House Care Home is a large, Victorian house that has been extended to provide accommodation for a total of 26 people who were elderly; ten may have physical disabilities of whom two may be a minimum of 55 years on admission; ten may have dementia care needs; two may have mental health needs and be a minimum of 60 years on admission. The home is situated on a corner plot, fronting the main A34 road. There are small gardens to the front and side of the property. To the rear there is a large secure, paved patio area with raised flowerbeds; there are also car-parking facilities on site. Lyme Valley House is situated on the A34 dual carriageway and close to the market town of Newcastle-under-Lyme with its wide range of amenities and communal facilities. The A34 road is a main public transport route with access to a wide area. Communal facilities consist of three lounges, a quiet lounge (used by some as a dining area), a large, attractive heated conservatory and dining room. There are three assisted bathrooms and nine separate toilets. There is a laundry, large kitchen and office on the ground floor. The upper floor is accessed via a shaft lift, stair chair lift and staircase. There is an additional staircase that is used by staff only. Gardens are well maintained with mature planting and patio area with garden furniture and parasols for the benefit of people who use the service and their visitors. It is recommended that anyone interested in the home should contact Lyme Valley directly to find out current fees and request a Service Users Guide. It is understood that where accommodation and care needs are publicly funded the home asks for a top up of fees and people will need to clarify this prior to admission. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection for this service took place on 30 May 2007 and the home was given a quality rating of two stars (good). We carried out an Annual Service Review on 27 May 2008 which identified from information received that the quality of the service has been maintained. It is our policy to carry out a Key Inspection visit every two years for a service with a quality rating of good. This is an unannounced Key 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. The Registered Manager was present during this inspection which took place over a Care Homes for Older People Page 6 of 31 period of 8.5 hours. We looked at peoples assessments and care plans, personnel files, complaints files, medication records, health and safety records and gave a feedback session. Prior to the inspection visit the providers had completed a self-assessment tool, which is 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 made in this report. The AQAA was returned promptly and gave us a reasonable picture of the current situation within the service. We consider it could have been improved had it given more information and illustration as evidence to the statements made. A high number of people who use the service have dementia or confusion and are not able to give us a full response to some aspects of their care but all are able to tell us that staff are kind to them and help them. We spoke with several relatives on the day who are frequent visitors to the home and who are able to tell us that they are very pleased with the services provided by Lyme Valley House. They tell us they are made welcome and have observed over many months good interaction between the staff team and people who use the service. They make many complimentary comments about the level and good quality of care provided by the home. We are disappointed to find that there are issues with medication which we had to discuss with the manager. We are confident that she will work to address these issues. However, it is apparent that weekly checks of the Medication Administration Record (MAR) charts are not enough and these will need to be increased. We have made two requirements and eight recommendations as a result of this visit. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 31 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides information, including a current Service Users Guide, 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 area in the last key inspection report. The service is registered to accommodate twenty-six people. The new proprietor is currently using the majority of double rooms as singles and the home was, therefore, technically full with twenty-two people on the day of this inspection. Copies of the Service Users Guide are displayed in the home. Several people who use the service have dementia care needs that make it difficult for them to relay some aspects of their lives in the home. We have, therefore, spoken to relatives who visit regularly to obtain their views about the services provided by Lyme Care Homes for Older People Page 11 of 31 Evidence: Valley House. The registered manager informs us on the day that the service has made an application to vary the homes Conditions of Registration to provide services for twenty-two people who have dementia rather than the ten they have at present. We have informed the manager that she must take care not to exceed numbers in the present dementia category (ten) until a new Certificate of Registration is received. The service will also need to ensure that its staff team receives dementia care training and that the home is equipped with signage, colour coded areas and other relevant equipment to assist people with dementia. Training and the installation of appropriate equipment to assist people with dementia is discussed under the section for Management and Administration at the end of this report. We will liaise with the home outside of this report regarding this issue. Lyme Valley House has a current Service Users Guide and Statement of Purpose to assist people to decide whether the home will be able to meet their needs. People we spoke with on the day could not recall whether they received a Service User Guide but tell us that relatives visited to check everything out before they moved in. People who are self-funding have a Contract that outlines terms and conditions of residency. Where possible, people are invited to sample by visiting the home prior to admission. Decisions about permanent admissions are not made until the person has been in residence for some six weeks to enable everyone to consider whether Lyme Valley is suitable for their needs. A key worker (Senior Care Assistant) is allocated to each person in the home. The key worker has special responsibilities towards people and will take the lead on settling people in and ensuring that the care notes are up to date. The AQAA tells us that all potential residents are visited prior to being admitted to the home. We looked at the files of four people who reside in the home and found current care plans completed by a social worker and the Registered Manager prior to admission. Lyme Valley House does not provide intermediate care and so Standard 6 (Intermediate Care) was not assessed. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Plans provide sufficient information to enable staff to deliver a person-centred service in which people are treated with respect and their rights to privacy are upheld. We are concerned that the homes medication procedures do not demonstrate that in all cases people who use the service receive their medication as prescribed. Evidence: No requirements were made in this outcome area in the last key inspection report. We looked at the Care Plans for four people who use the service. The care plans are satisfactory with sufficient information, generated from the social work care plan and the homes own pre-admission assessment, to inform care staff how to provide for the persons care needs. Reviews of the Care Plans are carried out once a month or at point of change. We spoke with three of the four people being case tracked and four sets of visiting relatives as well as a number of other people who use the service.. We also observed staff interaction with people who use the service. Personal support is responsive to Care Homes for Older People Page 13 of 31 Evidence: peoples varied and individual needs and preferences. People tell us that staff are kind and considerate. We observe people being encouraged to be as independent as possible. Without exception, all relatives spoken with are very satisfied with the services provided by Lyme Valley. We received comments such as Mum has settled here very well. This home is much better than others mum has been in and she is much calmer and less anxious. I am very happy with the way they look after (name). It is not easy for them but they are very kind and patient with her. My relative is much better in this home. The last one he was in was nowhere near as good as this. Mum has settled well and has made a friend. It is lovely to see her relaxed and contented. Records show that people have access to healthcare and remedial services. The service ensures that people unable to leave the home receive visits from general practitioners and other healthcare professionals. The service has access to a range of pressure relieving equipment recommended by doctors and community nurses to reduce risk of pressure sores. The AQAA tells us that no one in the home has developed pressure ulcers. The administration of medication is an important function carried out by Lyme Valley Care Home. The AQAA states all staff are aware of the homes policy on administrating medication, advice can be sought from the pharmacist if needed. It also tells us medication records show effective drug administration. The majority of medication for the home is dispensed into sealed cassettes (MDS Monitored Dose System) by the pharmacist. We have concerns after inspecting the Medication Administration Record (MAR) chart which starts for a four week period from Monday 25/05/09 as we find the following: For four people who are prescribed Alendronic Acid to be taken once a week, there are five gaps in the MAR charts in relation to this medication. There is a gap on 5/6/09 for one person who is prescribed Levothyroxine. For another person prescribed Furosemide and Calcichew there are gaps on 7 and 8/6/09 for both medicines. One person is prescribed Haloperidol To be taken in a syringe. This was administered Care Homes for Older People Page 14 of 31 Evidence: from a medipot. There is no record to identify whether the general practitioner is happy for the medicine to be administered in this way. There are also gaps in the MAR chart on 30/5/09, 2/06/09 and 7/6/09. There are gaps for all medicines for two people on the morning of 9/06/09. We are able to identify from the cassettes, however, that this has been administered. The MAR charts state how the doctor wishes the medicines to be administered. The charts are important documents and must give an accurate record of how medicines have been administered. We discussed the gaps in the MAR charts fully with the manager and asked her to address the issues identified without delay. We checked and found that people responsible for administering medication (Senior Care Assistants) have attended medication training. The manager tells us that management check the medication records every week, although some of the gaps in the MAR go back two weeks. We have, therefore, made a requirement under the Management and Administration Section regarding the need for effective monitoring of medication practices. We have made requirements in respect of medication practices and recording. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a relaxed and welcoming atmosphere which encourages people to maintain control over their lives. The home offers a wholesome, appealing, balanced diet to suit individual need. Evidence: No requirements were made in this outcome area in the last Key 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. Individual rising and retiring times are accommodated. Televisions are switched on in two lounges throughout the day, although not many people are watching them. There are quiet corners where people can sit away from televisions if they so choose. People who use the service have the opportunity to develop and maintain important personal and family relationships. Relatives are observed visiting the home and being received by people who use the Care Homes for Older People Page 16 of 31 Evidence: service either in the lounge areas or their bedrooms. Relatives tell us that they are always made welcome in the home whatever time they visit. I am often offered a cup of tea, which is very welcome when I visit straight from work. One relative tells us that he visits the home a couple of times a week to have a meal with his wife. Everyone is very kind and the food is very good. One person who uses the services and their relative tells us that they regularly accompany the manager on shopping trips. There are plans to visit a garden centre to buy plants and shrubs for the recently landscaped back garden. New outdoor furniture and a gazebo are available so that people can enjoy the warm weather. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. We inspected the four-week rotational menu and find this satisfactory. There are no complaints raised about the food served other than one gentleman saying he would like a huge steak occasionally. Special diets are catered for. People are able to comment about the food served in the home as menus are always an agenda item at the Residents Meetings held at approximately two monthly intervals. We observe people eating cooked breakfasts when we arrive at the home. Care staff are sensitive to the needs of those people who find it difficult to eat and give prompts or assistance when required, making them feel comfortable and unhurried. Food for teatime is prepared by the cook, although cooked teas (e.g. beans or egg on toast) are prepared by care assistants or the manager. In the main, care staff serve sandwiches. The manager is aware of the need to provide Food Hygiene Training for those who are asked to prepare food. We inspected the kitchen with the cook. The records showed correct food storage, although some meats we see in the freezer have not been dated to show when they were packed and we recommended that they should be. There are cleaning schedules for the kitchen (night staff clean floors and surfaces). Cook cleans fridges, oven and other equipment. She also wipes down surfaces. The extractor fan is cleaned by the handyperson or proprietor. The Environmental Health Officer has inspected the kitchen since our last inspection Care Homes for Older People Page 17 of 31 Evidence: and has made recommendations for improvement. These had been implemented and the manager tells us there are plans to replace the kitchen when funds allow. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their relatives are 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 spoken with tell us they know how to complain. People who use the service tell us they would speak with staff or the manager if they are unhappy. The manager is aware of the need to protect peoples best interests. She demonstrated how she has arranged via the social worker for an advocate for one person which has resulted in an application to the Office of the Public Guardian as part of the requirements of the Mental Capacity Act. One complaint has been received by the service of which we received a copy. This is presently being dealt with by the manager. We the commission have received no complaints about the home since the last Key Inspection. The manager is aware of the protocols and procedures in respect of Safeguarding Care Homes for Older People Page 19 of 31 Evidence: Adults from Abuse. There have been no safeguarding referrals/investigations since the last Key Inspection. We have received no safeguarding alerts about the home since the last Key Inspection. The AQAA tells us that staff trained on abuse/mental capacity act. We found that Protection of Adults from Abuse is addressed at Induction and through any subsequent National Vocational Qualification (NVQ) training. Staff we spoke with confirm that they are aware of issues surrounding protection of vulnerable adults from abuse and know how to respond. 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 that 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 policies and procedures at the start of their employment. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and clean but would benefit from being upgraded to better assist and promote independence for the high number of people accommodated who have dementia care needs. Evidence: A requirement was made in this outcome area in the last Key Inspection Report as follows: 1. The registered person shall introduce a rolling programme of developments to upgrade furnishings and decor for 2007/08. We looked at the homes Maintenance Record for 2007/8/9. We saw improvements that have been made e.g. newly decorated bedrooms and some have new carpets. New carpets on the first floor corridors and in the lounges on the ground floor. New chairs have been purchased for the lounges. The garden has been landscaped and fencing has been erected to provide a secure and safe area for people who use the service. We consider that this requirement has been met. However, we are informed by the manager that there are plans to vary the conditions of registration for the home to include 22 people with dementia care needs. We have recommended, therefore, that consideration be given to the introduction of signage, Care Homes for Older People Page 21 of 31 Evidence: colour coding and other aids to living that will promote independence for people who have dementia. The conservatory is the designated smoking area for people who live in the home. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their needs will be met by a caring and dedicated team. Evidence: One requirement was made in this outcome area in the last Key Inspection report as follows: 1. The staffing levels must meet satisfactory levels to provide a good service. At the time of this inspection we consider that this has been met. We have taken into account that relatives spoken with have not raised staffing as an issue and the manager is adamant that current dependency needs of people who use the service are low. She is also adamant that there are sufficient staff in the evening to meet everyones needs. She is aware of her responsibility to ensure that there are sufficient staff on duty at all times with the skills mix to meet the needs of people who use the service. People who use the service and relatives are very positive about staff and the care and attention they provide. The AQAA tells us that the service is presently accommodating nine people who have dementia care needs, sixteen people who need help with dressing/undressing and thirteen who need help going to the toilet. The AQAA also states that no one presently accommodated needs two staff to assist with their care at any one time. Care Homes for Older People Page 23 of 31 Evidence: When there is an increase in the numbers of people with specialist needs, e.g. dementia care, should the homes application for a variation be approved, then the manager will need to undertake a review of staffing to ensure that numbers meet the emotional and personal care needs of people who use the service. We consider that the planned increase in numbers of people admitted to the home with dementia care needs will have an impact on staffing. The manager is aware of her responsibilities to ensure that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of people who use the service. We note that only two care staff are deployed from 4.30pm until 10 pm. This is a busy time of day that includes serving teas, getting people ready for bed. It is the time of day when it is acknowledged that people with dementia care needs may be restless and need increased one-to-one emotional support and attention from staff. Staffing will be monitored at the next inspection, particularly if the proposed changes to the Certificate of Registration have taken place. The AQAA tells us that the staff team consists of eleven full time and nine part time care staff (including managers). Support staff consist of two domestics who work Monday to Friday 9am to 2pm, 2 cooks (sharing the week) 8am - 2.30pm and a Maintenance Person (Handyman) who works 16 hours per week. We are told in the AQAA that there is very little use of agency or bank staff in the home with none being used in the last three months. Of the 19 permanent care workers, all have received induction training. We spoke to one care assistant who had been employed for approximately seven weeks and she confirmed that she had undertaken induction training, health and safety, moving and handling. She stated that she had Protection of Vulnerable Adult training from employment in a previous care setting but had gone through it at Lyme Valley. Eleven care staff have NVQ level 2 or above, although seven of these are senior care assistants. Of the seven seniors, one has NVQ level 4 and one is working towards this award, five have NVQ level 3 and all have undertaken Safe Handling of Medication as part of NVQ. The manager says she manages their competence as part of regular supervision which contains an element of one-to-one training. The AQAA tells us that three staff have received training in prevention and control of Care Homes for Older People Page 24 of 31 Evidence: infection. We recommend that this training is provided for the whole care staff team, particularly targetting those who have not got formal qualifications. We looked at four staff files at this inspection. We noticed that the Application Form did not have a place for the applicant to sign and date it. This means that the criminal conviction declaration has not been signed. We have made a recommendation regarding this issue under the Management and Administration Section. In one instance we do not consider that appropriate references were taken up, with one being from a friend and one following a conversation with a care home where the person had only worked for a few weeks. The manager had not contacted the care home where the applicant had worked for five years and had only left in 2008. We discussed this with the manager on the day and have made a recommendation regarding this issue. Staff files show that information concerning proof of identity and Criminal Record Bureau Enhanced Disclosures (Police Checks) has been taken up for each person. There is a record of induction training and supervision sessions that includes some one-to-one training including care plans, risk assessment, monthly evaluations, dietary needs, fire drills, moving and handling (including hoists). Two other staff spoken with during this inspection state they are happy working in the home and confirm that they are well supported by management. The manager holds a D32/33 Assessors award so that she is able to coach and assess people through the NVQ system. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed by a registered manager who is qualified and experienced. The home is run with the best interests of people who use the service in mind. Evidence: No requirements were made in this outcome area in the last Key Inspection report. The manager has the required qualifications and experience to run the home. She has extensive experience working in the care field and has been a Registered Manager for over ten years. The manager completed the AQAA, which is a legal document, and returned this to us promptly. The document gives us a general overview of the service but could be improved by providing supporting information and examples to illustrate statements made. The home benefits from the managers open and positive leadership approach. People Care Homes for Older People Page 26 of 31 Evidence: tell us that she is approachable and inclusive. We discussed the issues concerning discrepancies in the Medication Administration Records with the manager during this inspection and consider that she should introduce effective measures to ensure medication procedures and records are regularly monitored. We have made a recommendation about this. We discussed with the manager the need to ensure that the home is fully equipped to meet the needs of people who have dementia as the service has made an application to us to increase numbers of people who have dementia. She is aware of the need to ensure that appropriate signage, colour coding and equipment are available to assist people with this condition. This issue will be monitored at the next inspection. The home seeks the views of people who use the service. We looked at a small sample of Satisfaction Surveys and found these to contain positive comments about the service. We asked about how the home manages peoples finances and are told that it does not hold any monies for people prefering relatives and other professionals to take on this responsibility. We looked at a random sample of Maintenance Records and found these to be up to date. Fire records and tests are also satisfactory. The Accident Book shows appropriate recording and referral. The manager has addressed the requirements and recommendations outlined in the last Key Inspection Report of 30 May 2007. During our tour of the building we found quantities of hazardous materials stored in an insecure area. The products were removed immediately we brought it to the managers attention. There is current insurance in place. The current Certificate of Registration is displayed in the home as required by our regulations. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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) & 13(2). 17/07/2009 The service must ensure that all medicines are administered as prescribed and that there is an accurate record to confirm this. This will assure people who use the service that they will receive their medicines as prescribed. 2 9 12 Regulation 12(1)(a) & 13(2). 17/07/2009 The service must ensure that staff who administer medication are competent to do so. This will assure people who use the service that they are in safe hands. Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 15 All food stored in freezers must have the date of packaging recorded to promote safe practice for storage of food. This will protect people who use the service. The home would benefit from the introduction of signage, colour coding and aids to daily living to benefit and promote independence for those people with dementia care needs. Appropriate references should be received in respect of all applicants for employment in the care home. Two written references should be obtained for all care staff particularly from previous employment of more than three months in care settings for children or vulnerable adults. This will ensure that people who use the service are supported and protected by the homes recruitment policy and practices. The home should ensure that all care staff receive good quality training in dementia care. This will assure people who use the service that they are in safe hands. The service must ensure that it has sufficient staff on duty who can respond to the specialist needs of people who use the service, e.g. dementia care. It is recommended that a comprehensive review of staffing is undertaken to ensure that there are sufficient staff deployed at all times to meet the needs of people who use the service. All care staff should receive training in prevention and control of infection. This will assure people who use the service that their health and safety is promoted and protected. Effective measures should be introduced to ensure that medication procedures and records are regularly monitored. This will protect the health and welfare of people who use the service. The Job Application Form should require the applicant to sign and date it in order that it becomes a legal document, particularly as it contains a declaration concerning criminal convictions. This will assure people that their health, safety and welfare is being promoted. 2 19 3 27 4 27 5 27 6 27 7 37 8 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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