Inspection on 25/08/09 for Malmesbury House

This inspection was carried out on 25th August 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Malmesbury House 29/08/08

Malmesbury House 30/08/07

Malmesbury House 15/05/06

Malmesbury House 02/11/05

Malmesbury House 18/04/05

Malmesbury House 11/01/05

Malmesbury House 20/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Malmesbury House Malmesbury House 18 Beauchamp Road East Molesey Surrey KT8 0PA     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: Patricia Collins     Date: 2 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 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 35 Information about the care home Name of care home: Address: Malmesbury House Malmesbury House 18 Beauchamp Road East Molesey Surrey KT8 0PA 02087830444 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): mail@gajraj1.freeserve.co.uk Mrs Mary Gajraj,Dr H Gajraj,Dr N Gajraj Name of registered manager (if applicable) Patricia Eileen McIlvenna Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users ot be accommodated is 19 The registered person may provide the following categories of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission ot the service are within the following category Dementia (DE) Old age, notr faling within any other category (OP) Date of last inspection Brief description of the care home Malmsbury House is a care home providing personal care and accommodation for up to 19 older people, the majority of whom have dementia as their primary condition. Care Homes for Older People Page 4 of 35 Over 65 0 19 19 0 0 5 0 9 2 0 0 8 Brief description of the care home The building is a large detached property situated in a quiet residential area. The community amenities and shops of West Molesey are conveniently nearby. The accommodation is arranged on three floors, accessible by a passenger lift. Most bedrooms are of a good size and for single occupancy and have en suite facilities. Some bedrooms have doors opening onto the enclosed garden or balconies. The home is set in spacious, well-maintained grounds and provision includes a furnished courtyard. There is a spacious, well furnished conservatory and assisted bathing and toilet facilities. A car park is provided at the front of the premises. Fees rates are 591 pounds per week for respite care and 550 to 650 pounds for permanent placements, other than those funded by Local Authorities, for which contractual fees apply. Care Homes for Older People Page 5 of 35 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: Date of last key inspection: 5th September 2008. This unannounced inspection visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. It was undertaken by one inspector, beginning at 06:50 hrs and finishing at 12:50 hrs. The visit was facilitated by the home manager. The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). All available information has been taken into account when forming judgments about how well the service is meeting the National Minimum Standards (NMS) for Older People. This includes accumulated evidence and our knowledge and experience of the home since its last key inspection. Also survey feedback from two people using this service, a staff member and health care professional. Care Homes for Older People Page 6 of 35 Each year providers registered with the CQC must complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and send this to the CQC. The AQAA provides quantitative and numerical information about their service, requiring assessment of the same against NMS outcome areas, demonstrating both areas of strength and where improvements can be made. The homes AQAA was received on time, was clear and validated by evidence. This was used to inform judgments about the service. The inspection process incorporated discussions with people using this service. We viewed the premises and garden and gathered information through discussions with the manager and individual members of staff. Documents sampled included records specific to care including social care, risk and other assessments, complaints, staff recruitment, induction and training, maintenance, fire safety, catering and quality assurance. Observations included assessment of catering standards and practice at lunch time, of the frequency and quality of staffs interactions with people using services, of care delivery and medication administration. Care Homes for Older People Page 7 of 35 What the care home does well: The home has a clear admission criteria. The admission policy ensures nondiscriminatory practice. Human rights and diversity issues are equal in importance to other issues in assessment and admission procedures. Some people using services spoke of their experience of moving into the home. One person told us she had been happy for a relative to view the home and make decisions about its suitability on her behalf, adding, I am glad I came here, I would recommend the home to anyone, if you have to live in a home. A person on respite care said, I wasnt offered opportunity to visit the home before moving in, my son made the arrangements. I am still finding my way round, but everyone is helpful and kind. Observations during the visit confirmed attention to the personal appearance and standard of dress of people using services. Those consulted and able to participate in the inspection process, mostly were satisfied with services received. Comments included, Everything here is good, nice room, nice girls (clarified to mean staff), nice food. Im not sure if Im going to stay here for ever but so far cant fault it here. The girls (meaning staff) are all very good. Its okay here but have to put up with others, this gets me down (referring to other people using services). The person who made the latter comment confirmed he can use his room at any time and the pleasant second lounge overlooking the garden if he wishes to sit quietly, without being disturbed. Survey responses from two people using services stated, They take good care of us, also, They provide a friendly environment. Need to exercise more discipline with staff; there are some misunderstandings owing to language and background differences. Most of the young staff do not achieve the required efficiency when dealing with the elderly and infirm, most of whom have no knowledge of differences in lifestyle evolved over the last half century. Elderly people find life intimidating if they are not consulted before being told by staff to move from their chair without first being given a reason. Staff need better communication. Staff receive equality and diversity awareness training during their induction and there is an ongoing programme for this training. Practice observations during the visit found staff to be attentive to the needs of people using services, addressing them in a polite, ageappropriate manner. An observation of individual staff being indiscreet and not respecting the dignity of people using services specific to toileting routines was raised with the manager. The home promotes and maintains the health of people using services, ensuring access to health care services to meet individual needs. In response to our survey a mental health professional stated, The home is managed and run to a good standard. Staff are always knowledgeable of residents care needs and are tactful. The home is good at liaising with the general practitioner and other disciplines, professionals, families and carers. The home is good at meeting residents needs in an appropriate manner and care staff are very dedicated and committed to the delivery of individualised care. The home is clean and hygienic, comfortably furnished and mostly well maintained. There is an effective complaint procedure. An activities programme provides suitable stimulation and visitors are encouraged. A wholesome appealing diet is provided, offering choice of meals and ensuring dietary and food preferences are met. Care Homes for Older People Page 8 of 35 What has improved since the last inspection? What they could do better: Evidence suggests that prospective people using services should have needs assessments before moving into the home. The same standard of risk assessment should apply to those admitted for respite care. Whilst noting there is a programme of routine maintenance the inspection highlighted long-term outstanding work for repair or replacement of essential kitchen equipment and to enable use of the bathroom on the first floor. The records viewed did not indicate planned remedial action in these matters. Shortfalls were identified in staff recruitment vetting procedures; also failure to ensure volunteers organised through a local voluntary organisation who have unsupervised access to people using services outside of the home, have relevant checks carried out by the Criminal Records Bureau (CRB). The need for other orientating information in the environment was evident. Individuals were observed asking each other if anyone knew the day and date and what was for lunch. There is a need to display this type of information prominently in the home, to meet the communication needs of people using services. Staff need to wear their name badges, noting a person on respite care experiencing difficulty in recalling their names. Care Homes for Older People Page 9 of 35 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 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admission assessments are carried out by the homes management after admission following consultation with relatives and relevant professionals to form opinion whether the home can meet individual needs.Evidence suggests that needs assessments should be carried out before admission. Intermediate services are not provided by the home. Evidence: We spoke with a number of people using services about their experience of moving into the home. One person stated she visited the home before admission and staff gave her information she needed to decide if the home would be right for her. Another person said she had been happy for a relative to view the home and make decisions about its suitability on her behalf, stating, I am glad I came here, I would recommend the home to anyone, if you have to live in a home. A person who moved in very recently for respite care stated, I wasnt offered opportunity to visit the home before moving in, my son made the arrangements. I am still finding my way round, Care Homes for Older People Page 12 of 35 Evidence: but everyone is helpful and kind. The home has a clear admission criteria. Service provision includes respite care, subject to vacancies. An intermediate care service is not offered. The admission policy ensures non-discriminatory practice. Human rights and diversity issues are equal in importance to other issues in assessment and admission procedures. The homes policy is for people considering using this service to be invited to move in on a trial basis before they and/or their representatives make a decision to stay. During this period their needs are fully assessed. Evidence suggests that prospective people using services should have needs assessments before they live at the home. The home manager emphasised that admissions do not take place without first widely consulting relatives, hospital staff and other professionals, to be assured the home can safely and appropriately meet the needs of people referred. Usually pre-admission procedures involve obtaining a written summary of a care management (health and social services) assessment for people referred and funded by local authorities, where these exist. At the time of the inspection visit this was not available for inspection for a person recently admitted for respite care. The manager was not involved in this admission, which took place whilst she was on leave, though she expressed confidence this would have been obtained. We examined admission assessment documentation for four people using services. The assessment tools had been further developed and improved since the last inspection. These promote a person-centred approach to identifying individuals strengths and their holistic care and support needs. The scope of risk assessments has been extended since the last inspection and these are more comprehensive. The need to ensure the same standard of risk assessments apply for all people admitted to the home was discussed. On examination of the admission assessment records of a former respite user whose placement broke down earlier this year, shortfalls in assessment and risk assessment was apparent. Though the manager had consulted this persons representative to establish whether there had been any significant change since the last respite stay, it later emerged that there had been changes that had not been disclosed. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is based on their individual needs and medication practice is overall safe. The principles of respect, dignity and privacy are mostly put into practice. Evidence: At the time of the visit sixteen people were using the homes services and one other was in hospital. Discussions with night staff on arrival confirmed people using services are monitoring throughout the night, ensuring their safety and their needs are met. Two people using services were supported in getting up and dressed before the day staff arrived. Observations during the visit confirmed good attention to the personal appearance of all people using services. The manager reported improvements in the laundry system. Improvement was observed in care planning and risk assessment practice. The scope of risk assessments had been further extended, using validated tools and their use underpinned by relevant staff training. Dietary and nutritional assessment had led to improved first line dietary interventions and timely referral for specialist assessment, Care Homes for Older People Page 14 of 35 Evidence: where necessary. It was now possible to monitor the weight of all people using services since obtaining suitable scales. Staff had been instructed to report all variations in the weights of people using services to the manager. A key worker system operates and key workers have delegated responsibility for carrying out monthly evaluation of care plans. We sampled five care plans and noted progress in working towards a person-centred care planning system.There is management recognition of the challenges faced by the multi-cultural staff team, for whom English is not their first language, when recording care plans and related care records. The manager personally monitors care plans and review records, ensuring needs are recorded and any change in needs receives an appropriate response. The homes care planning process is now more inclusive, people using services being involved in decisions relating to their care and lifestyles, within individual levels of capacity. The care planning process also now addresses the impact of the environment on people with dementia. There has been attention to signage in the environment to aid orientation around the home for people who need these cues. However, the need to provide additional orientating information in the environment was identified. This was on the basis of observation of three people using services asking each other if anyone knew what day it was and the date? Also what was for lunch? Consideration could be given to displaying this type of information prominently in the home, to meet the individual communication needs of people accommodated. Though it is acknowledged the menu is displayed in the dining room the print font size is small and the information not accessible. At lunchtime the person who was receiving respite care was asking staff their names and said she was having difficulty in remembering the same. Only one staff member was wearing the name badges supplied. The home manager has formed positive links with the medical practice, the nursing service, pharmacist supplier and specialist health and social care professionals, since taking up post. She reported receiving good external professional support. This included professional input to meet assessment obligations under the mental capacity act. Arrangements are in place to ensure input from domiciliary dental, chiropody, audiology and opthalmic services. A survey questionnaire completed by a mental health professional stated, The home is managed and run to a good standard. Staff are always knowledgeable of residents care needs and are tactful. The home is good at liaising with the general practitioner and other disciplines, professionals, families and carers. The home is good at meeting residents needs in an appropriate manner and care staff are very dedicated and committed to the delivery of individualised care. The records sampled demonstrated the homes management is diligent in ensuring prompt referral for assessment by health and para-medical professionals. Also at ensuring attendance at follow - up appointments. Though the manager had agreed with the family of a person using services to accompany her to a Care Care Homes for Older People Page 15 of 35 Evidence: Programme Planning meeting on the afternoon of the visit, it was understood that a voluntary service was routinely used to provide volunteer escorts to and from appointments. The volunteers are not known to people using services. The home may wish to reconsider this change in light of feedback from a professional on the benefits of staff fulfilling this role. A letter on file from a medical consultant included the statement, It was helpful to have the senior care assistant present throughout the assessment as she was able to provide relevant information. We were informed by the annual quality assurance assessment (AQAA) that the manager and staff are committed to providing a safe and homely environment where choice, dignity and respect is foremost in the delivery of person centred care. At the time of the visit comments from various people using services included, Everything here is good, nice room, nice girls (clarified to mean staff), nice food. Im not sure if Im going to stay here for ever but so far cant fault it here. The girls (meaning staff) are all very good. Its okay here but have to put up with others, this gets me down (meaning other people using services). Survey responses from two people using services stated, They take good care of us, also, They provide a friendly environment. Need to exercise more discipline with staff; there are some misunderstandings owing to language and background differences. Most of the young staff do not achieve the required efficiency when dealing with the elderly and infirm, most of whom have no knowledge of differences in lifestyle evolved over the last half century. Elderly people find life intimidating if they are not consulted before being told by staff to move from their chair without first being given a reason. Staff need better communication. The managers attention has been drawn to this information. The AQAA told us that the manager has undertaken equality and diversity training since the last inspection. Staff files demonstrated other staff had also received this training and this is being cascaded throughout the team. Practice observations on the day of the visit found staff to be attentive to the needs of people using services, addressing them in a polite, age-appropriate manner. Observations of individual staff being indiscreet and not respecting the dignity of people using services whilst assisting them to and from the toilet, was discussed with the manager. The home has an efficient medication policy supported by procedures and practice guidance. Medication training for staff now includes a competency assessment element. Regular management audits are recorded for monitoring compliance. Shortfalls in medication practice receive a prompt response, enhanced by the recent development of checking medication records at each shift handover. We looked at the medication records of three people using services during the visit and mostly practice and recording was satisfactory. A medication omission by a senior care assistant at the time of the visit, was brought to her attention by the person using services, Care Homes for Older People Page 16 of 35 Evidence: affected by the error. This was rectified in consultation with the manager who stated her intention to retrain the staff member concerned, who had clearly not followed the correct procedures. Medication storage was satisfactory at the time of the visit. Discussions with the manager confirmed medication risk assessments had been carried out and most people lacked capacity to self-administer their medication. Those who were able to do so preferred staff to assume this responsibility. Care Homes for Older People Page 17 of 35 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. People use the service are supported to exercise choice and control in their daily lives, within individual levels of capacity. They may receive visitors at any time and their social, cultural, religious and recreational needs are met. Evidence: Practice observations were carried out mid-morning when staff were serving tea and biscuits in the lounge and dining room and at lunch time. During the morning the atmosphere was appropriately stimulating, staff taking time to frequently interact with individuals whilst undertaking their duties.Staff were friendly and patient in their approach, speaking slowly and simply, allowing people time to process what they said and waiting for their response. The service actively supports people to be as independent as they can be, within individual levels of capability. We observed individuals to have access to their bedrooms throughout the visit. Staff were observed to respect the autonomy of individuals at all times. A television and music centre is available in communal rooms. The home has sought the views of people using services and their relatives or representatives and Care Homes for Older People Page 18 of 35 Evidence: considered their varied interests and preferences when planning the social care programme and menus. Resident and relatives meetings are held, the latest one attended by the provider. Other opportunities for people using services and their representatives to express their views about service provision include a quality survey and use of the suggestion box located in the entrance hall. Social life at the home is organised respecting the differing expectations, diverse needs and capabilities of people using services. The monthly activities programme was displayed in the entrance hall. A therapist continues to provide two activity sessions each week, one of bingo with prizes and a seniorcise class to music. A Holy Communion service takes place at the home each week and a hairdresser visits. Other external input provides a creative art club; also a person visits regularly to play the piano, providing a group social activity in which people using services are encouraged to sing-a-long to music they know and enjoy. Care staff are encouraged to contribute to this programme and new developments include a knitting circle and a proposed talk about China and Chinese culture. A wide range of books is supplied by a mobile library and regularly changed. A person using services stated her preference to read these than watch television. Staff said they did not support people using services in the use of any community resources but sit out in the garden with the them, when it is sunny. Visitors are welcome to visit at any time and a number of people using services stated to go out regularly with their families.A new development is a planned day trip to Brighton in September for some people using services,supported by staff and some relatives. The home has hired suitable transport and driver for this outing. Two cooks are employed, working on opposite days, covering the week. They prepare lunch and the evening meal. Night staff were observed to prepare and serve breakfasts to people using services in their rooms. The records sampled confirmed they had been consulted about their preferred time of having breakfast and about the content of the meal. At the time of the visit night staff had prepared porridge made with milk for some people and others had a range of cereals, most also had toast and preserves and a cup of tea. One person was observed to have a cooked breakfast, which is his preference. The evening meal left prepared by the cooks is heated up and served by care staff; they are also responsible for ensuring dishes are washed and the kitchen and dining room left clean and tidy. The cooks are responsible for kitchen and food hygiene. Since the last inspection the home has been awarded a 4 Star rating for the standard of food hygiene by the Environmental Health Department. Immediately after the last inspection the quantities of food cooked was reviewed and increased. The manager took over responsibility for ordering food and this was stated to be working well.At the time of the visit the larder and freezer was sufficiently stocked to enable the menu to be followed. Portion sizes are served in accordance Care Homes for Older People Page 19 of 35 Evidence: with the individual wishes of people using services. The varied four-week menu displayed in the dining room is prepared by the provider. Suggestions for menu changes from people using services and their relatives are passed to the provider for her consideration. The menus include a daily choice of meals and are flexible, according to individual requests and preferences of people using services. Special diets are catered for and at the time of the visit the needs of a person with diabetes and preferences of a person who does not eat meat were being accommodated. Special foods are bought in fresh as requested by people using services. Comment has already been made on the need to display the days menu in a more accessible format. The kitchen was clean and organised when viewed and the cook busy preparing the three course lunch. This comprised of asparagus soup or orange squash, home-made chicken casserole or steamed fish with potatoes and other fresh vegetables followed by home-made sponge pudding with custard or mousse. Observation of maintenance records confirmed the hot plate and grill in the kitchen were not working and it was understood they had not worked for some time. Discussions with the cook confirmed the lack of these appliances caused operational difficulties when preparing and serving meals. Examples included plates being too hot when taken out of the oven where they are placed to warm them, because the temperature cannot be reduced or this will spoil the meal. Whilst waiting for the plates to cool so as not to be a safety hazard to people using services, food sometimes also goes cold. The grill is also essential to the smooth running of the kitchen, based on all available information. A requirement has been made for repair or replacement of this equipment. The presentation of dining tables was of a high standard and staff were sensitive to the needs and dignity of people using services when assisting them with meals. They were also observed to be diligent in ensuring food supplements were given out to named individuals and in monitoring and recording food intake. Care Homes for Older People Page 20 of 35 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 are able to express their concerns and have access to an effective complaint procedure. Robust procedures are in place for responding to suspicion or evidence of abuse or neglect. Evidence: The home has an open culture that allows people using services to express their views and concerns in a safe and understanding environment. The complaint procedure is clearly written and displayed in a public area and in all bedrooms. Discussions with people using services during the visit confirmed they would report any complaints or concerns to the manager and were confident that she would act on them. The complaint records demonstrated that all complaints are taken seriously by management and action taken is fully recorded.The home learns from complaint in order to improve its services. Evidence of this was seen in improvement in standards of personal hygiene, laundry and catering. Policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. The need to obtain an up to date copy of Surreys multi-agency safeguarding procedure was discussed with the manager. There is a clear system for staff to report concerns about colleagues and management which ensures concerns are investigated in accordance with local policies and procedures. The manager had received safeguarding adults training since the last inspection and is Care Homes for Older People Page 21 of 35 Evidence: clear when an incident needs to be referred to the Local Authority, as part of the local safeguarding procedures. There have been no safeguarding referrals since the last inspection. The Skills to Care Common Induction Standards have been implemented at the home, since the last inspection, ensuring new staff are informed of how to recognise and respond to abuse and neglect. Seven staff have completed certificated safeguarding adults training and this training is being rolled out to the remainder of the team. The home fully respects the human rights of people using the service. Individual assessments had been carried out, as required with support from the Social Service Deprivation of Liberty Team. The homes policies and practices regarding personal money belonging to people using services ensure this is securely stored and accounted for. Care Homes for Older People Page 22 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and hygienic, enabling people who use this service to live in a safe and and comfortable environment, which encourages independence. Some shortfalls in maintenance of equipment and facilities were identified. Evidence: The car park at the front of the home was tidy on the day of the visit and the enclosed garden to the rear of the home was maintained to a high standard by the homes maintenance/gardener. The entrance hall was welcoming with an attractive floral arrangement and flowers were placed in other communal areas. The environment was mostly well - maintained, comfortably furnished and tastefully decorated to a high standard. Bedrooms are all single occupancy and at the time of the visit, were personalised with possessions and items of furniture brought in by people using services, in agreement with management. Bathrooms and toilets were fitted with appropriate aids and adaptations. Shortfalls in maintenance were identified. Specifically in relation to kitchen equipment referred to earlier in the report and a bathroom out of use on the first floor. The same bathroom could not be used at the time of the last inspection. Then it was understood that consideration was being given to converting this area into a wet room/shower facility. There was no indication in the records viewed including the reports of the providers monthly visits of an action plan to repair the bath or replace it with a shower. People using services accommodated on this floor currently use bathrooms on other floors. A person on this floor said this was Care Homes for Older People Page 23 of 35 Evidence: inconvenient. A requirement has been made for suitable bathing facilities to be provided on this floor. All areas were clean and hygienic and odour control was mostly satisfactory. The floor covering had recently been replaced in one bedroom to improve odour control. People using services said there is always plenty of hot water and the temperature in the home is comfortable.The home provides specialist aids and equipment suitable to meet the needs of of people using its services. This includes two adjustable hight beds. The home also can access suitable pressure relieving mattress and other equipment through the district nursing service, if required. Shared areas provide a choice of comfortable communal space. There has been investment in an ongoing upgrading and refurbishment programme in recent years. Since the last inspection the safety of the premises had been improved by securing the fire exit door on the first floor and a bedroom door leading to a flat roof, in consultation with a fire safety specialist. The homes management is aware that the decor in some bedrooms is in need of refreshing and for some curtains in communal areas to be replaced. Care Homes for Older People Page 24 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment practice need to be more robust to ensure the safety of people using services. Staff are trained, skilled and in sufficient numbers. Evidence: The home employs a small staff team, enabling continuity of care by staff who know the people using services very well. There has been some turnover in staff since the last inspection. The manager said the staff teams multicultural composition overall works well, though it can be a barrier to the pace of improvement in record keeping due to the number of staff for whom English is not their first language. To overcome this barrier the manager maintains a close overview of care records. Staff on duty at the time of the visit had adequate command of the English language to support their communication with people using services. Equality and diversity awareness is part of the staff induction process and stated to be discussed at staff supervision sessions. There is also a programme of formal equality and diversity training being rolled out to the team. Comments in a survey from a person using services identified shortfalls in the practice of some staff. This information suggested these staff may have unmet training needs, to ensure effective communication with people using services. The manager has been made aware of this feedback. The homes atmosphere was warm and friendly during the visit. Staff were kind and caring in their approach and professional in their conduct and appearance. Those consulted expressed the view that staffing levels were adequate, though one staff member commented in our survey Care Homes for Older People Page 25 of 35 Evidence: that the home should employ a kitchen assistant. This carer expressed the view that it wasnt hygienic for care staff to undertake catering and kitchen tasks in addition to carrying out personal care duties. The staff rotas sampled evidenced the increase in care staffing levels after the last inspection had been consistently sustained. The home has an equal opportunities policy. The manager said this underpins staff recruitment, induction and training practice. We sampled the files of two care assistants employed since the last inspection.These records demonstrated some improvement in recruitment practice by ensuring medical declarations are sought for prospective employees. Shortfalls in recruitment practice however were evident by the failure to obtain a written explanation of gaps in employment, for one worker and to ensure the employment history is complete with dates of starting and leaving previous posts. Both workers had been employed in care homes in the UK, though details of this home not specified in their application forms and references not sought for their last period of employment. Because of the insufficient information in their application forms it was not clear if references from the last employers should have been taken up. For one of these staff the home did not take up its own references but instead relied on those sought by a language school. The outcome of these deficiencies in recruitment practice could pose a potential risk to people using this service. Also discussed was the need to retain recruitment interview records and for compliance with the Criminal Records Bureau (CRB) policy for recording, storage and disposal of CRB disclosures. Though noting the manager was not involved in the recruitment of these staff, she was advised to ensure all statutory recruitment checks are in place before permitting new staff to work at the home. Concerns were also identified at the failure to protect people using services by ensuring volunteers supplied by a local voluntary organisation have Criminal Record Bureau (CRB) checks carried out. They are organised by the home for the purpose of providing an unsupervised escort service for people using services to attend appointments in the community. The manager confirmed these volunteers will no longer be used for this purpose unless they have undergone all required vetting procedures. The staff induction programme had improved since the last inspection, covering the Common Induction Standards. The home manager invested time in identifying the training needs of the staff team when she first took up post and reinstated the staff training programme. It was evident that she is highly committed to developing staffs skills and competencies, recognising this to be key to good quality care. The home manager is an accredited National Vocational Qualifications (NVQ) assessor. At the time of the inspection, the home had exceeded the national minimum standard for numbers care staff with qualifications in health and social care at NVQ level 2 or equivalent. Other staff were working towards this qualification. The manager has a Care Homes for Older People Page 26 of 35 Evidence: training for trainers certificate in dementia care and dementia training has been delivered to most of the team since the last inspection. The records sampled demonstrated a rolling programme of statutory training for all staff. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a qualified competent registered manager and the management and administration of the home is discharged responsibly within the limitations of her direct control. Shortfalls in staff and volunteer recruitment and vetting procedures have the outcome of not protecting people using services.Quality assurance systems are inclusive and the money of people using services, handled by the home, is safeguarded. Evidence: The conduct of the home is directly overseen by one of three business partners. We were told by a staff member, The provider and her daughter visit the home regularly, keeping an eye on things, they sometimes do spot checks at night. The management structure does not include a deputy or assistant manager post. Senior care assistants are designated shift leaders and have specific designated responsibilities. The manager has the required qualifications and experience and has worked at the home since April 2008. She was registered in December 2008 and has Care Homes for Older People Page 28 of 35 Evidence: achieved substantial improvement in the homes management and general operation, in the areas within her direct control. Comments in a survey questionnaire received from a member of staff included, The manager has greatly improved the way the home is run, the staff, residents and their families are a lot happier with the care home now. The manager was observed to be focused on person centred thinking, with people using services and their advocates shaping service delivery. Observations and discussions with individual staff members during the visit confirmed the manager possesses good people skills, creating a positive atmosphere. She promotes continuous service development through effective staff direction, leadership, training and enthusiasm for the role. A staff member told us at the time of the visit, The manager is brilliant, she has achieved so much in a very short time, I have learned so much from her, she is such a good role model. Much has improved here and its so good to have management consistency, if something needs attention she gets on a deals with it . At the time of this inspection the manager was working out her notice and leaves in October. A staff member said in the survey received, I am very concerned that our manager is leaving. I am worried the home will go back to the way it was before if we dont have a proper manager on site. To date we have not been informed by the provider of the proposed interim management arrangements, pending recruitment of a new manager. The storage of money on behalf of some people using services was secure at the time of the visit. Records are maintained of all financial transactions regarding this money. The home works towards a clear health and safety policy and staff are aware of the policy and trained to put theory into practice. The manager ensures so far as reasonably practicable the health and safety of people using services and of staff. To improve the safety of a domestic worker with limited comprehension of the English language, information about cleaning and other products subject to Control of Substances Hazardous to Health Regulations (COSHH) had been interpreted into the first language of the worker, to ensure her safety. There has been further investment in safety, security and fire systems since the last inspection. Additional risk assessment tools have been introduced though the need to ensure these are used for all respite users identified. The homes quality assurance and auditing systems enable continuous self-monitoring, based on seeking the views of people using services and their representatives. Survey questionnaires and meetings with people using services and their relatives/representatives are part of this process. The provider and the service manager tend to visit the home when the manager is not on duty, communicating with her by leaving messages and by telephone. There is a structure for one to one meetings between the manager and the service manager. A new development since the last inspection has been the implementation of monthly statutory visits carried out by the provider. The reports of these visits demonstrated Care Homes for Older People Page 29 of 35 Evidence: the visits incorporate an audit of standards as well as covering statutory areas required by the regulations. The provider may wish to reconsider the content of these reports, as some information may be more appropriately included in the managers one to one supervision records. Improvements in the homes management and operation are acknowledged in the body of this report. However deficiencies in maintenance of equipment and potential risk to people using services by shortfalls in staff recruitment practice, also failure to ensure correct vetting procedures for volunteers with unsupervised contact with people using services, this group of standards is assessed as overall adequate. Care Homes for Older People Page 30 of 35 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 31 of 35 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 3 14 The home shall not provide 30/09/2009 accommodation to prospective people using services unless, so far as it shall be practicable to do so, the needs of the person have been assessed by a suitably qualified or suitably trained person and the registered person has obtained a copy of the assessment. This will ensure people admitted to the home will have their needs met. 2 19 23 The registered person must 30/10/2009 ensure the hot plate and grill in the kitchen is maintained in good working order. This will ensure the smooth operation of the kitchen. 3 21 23 The registered person must ensure the bath on the first floor is maintained in working order. 30/10/2009 Care Homes for Older People Page 32 of 35 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 This will ensure bathing facilities available within close proximity of first floor bedrooms. 4 29 19 The registered person must 18/09/2009 ensure staff recruitment and vetting procedures include obtaining a full employment history and relevant references. Also a written explanation regarding any gaps in employment. This will ensure the safety of people using services. 5 31 12 For the registered person to ensure the home is conducted to make proper provision for the health and welfare of people using services. Specifically for volunteers with unsupervised access to people using services to have relevant Criminal Records Bureau (CRB) checks. This will protect people using services from the risk of abuse. 14/09/2009 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 34 of 35 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. 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