Inspection on 20/05/09 for Palatine Lodge

This inspection was carried out on 20th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Palatine Lodge 26/11/08

Palatine Lodge 02/01/08

Palatine Lodge 11/07/07

Palatine Lodge 19/09/06

Palatine Lodge 23/02/06

Palatine Lodge 11/10/05

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Manderley Residential Care Home 17/19 Palatine Square Burnley Lancashire BB11 4JF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Playfer     Date: 2 0 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Manderley Residential Care Home 17/19 Palatine Square Burnley Lancashire BB11 4JF 01282431450 01282431450 manderleymanager@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dr Morgiana Muni Nazerali care home 15 Number of places (if applicable): Under 65 Over 65 0 0 0 dementia learning disability mental disorder, excluding learning disability or dementia Additional conditions: 15 15 15 The registered person may provide the following categories of service only: Care home only - Code PC, To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia- Code DE Mental disorder, excluding learning disability or dementia - Code MD Learning disability - Code LD of the following age range: 55 years and above The maximum number of people who can be accommodated is: 15. Date of last inspection Brief description of the care home Manderley Residential Care Home is a large two storey Victorian style property, situated close to Burnley town centre and bus stops. The home is registered to provide accommodation and personal care to a maximum of 15 older people with a dementia, mental disorder or learning disability. Accommodation consists of 11 single and two double rooms. The upper floor is accessed via a stair lift. There is equipment and adaptations available to assist people Care Homes for Older People Page 4 of 30 2 6 1 1 2 0 0 8 Brief description of the care home with mobility problems. Communal space is provided in two living rooms and one dining room. All rooms are linked to the call system. On the day of the inspection the scale of fees ranged from £372.00 to £432.50. There were no additional charges. Information was made available to people by means of a statement of purpose and service users guide. The service users guide was usually given to prospective residents and/or their relatives on viewing the home or at the point of assessment. Inspection reports can be viewed in the home or obtained from the Commissions website on www.cqc.org.uk Care Homes for Older People Page 5 of 30 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: A key unannounced inspection, which included a visit to the home was conducted at Manderley Residential Care Home on 20th May 2009. The inspection was carried out by one inspector, however, the report refers to we as it was written on behalf of the commission. The previous key inspection of this service was conducted on 26th November 2008. Following the last key inspection, the registered provider submitted an improvement plan, which set out their planned action to meet the legal requirements set out in the inspection report and the timescales by which the requirements would be met. A meeting was also held with the registered provider in February 2009 to discuss the improvement plan and the continued absence of a registered manager. The latter Care Homes for Older People Page 6 of 30 remains a concern to us and we will continue to closely monitor the management of the service. At the time of this inspection, there were eleven people accommodated in the home. During the visit we spent time with the residents, looked round the home, read some of the residents care records and other documents and talked to the staff and the area manager. We also consulted our records about the service and information we have received over the last six months. As part of the inspection process we used case tracking as a means of gathering information. This process allows us to focus on a small group of people living at the home, to assess the quality of the service provided. The registered provider was not requested to submit an AQAA (Annual Quality Assurance Assessment) prior to this inspection because a full AQAA had been received within the last seven months. What the care home does well: What has improved since the last inspection? Since the last inspection, there have been various developments within the home to improve the service. All the previous legal requirements were met and the area manager has worked closely with us to ensure that we have been notified of all significant events and incidents that occurred in the home. This has meant that we have been able to track the progress made to implement the improvements and we have been assured that the residents well being has been monitored and safeguarded. A brochure has been produced, which provided current and prospective residents with an overview of the services and facilities available in the home. The brochure was easy to read and was illustrated with photographs of the interior and exterior of the home. This meant residents who were unable to view the home prior to admission could gain Care Homes for Older People Page 8 of 30 an impression of the home from looking at the brochure. Records had been maintained of medication entering and leaving the home and protocols had been drawn up for the administration of homely remedies. This meant that medication could tracked and staff were aware of the parameters of giving non prescribed medication. A new programme of activities had been introduced, to enable the residents to pursue a range of leisure interests of their choice. All specific incidents affecting the well being of the residents had been discussed with the commission and Social Services had been contacted for advice as necessary. This meant that the residents welfare was appropriately safeguarded. Various improvements had been made to the premises to aid the comfort of the residents. For example, five bedrooms had been redecorated and new carpets fitted. Wherever possible the residents had been involved in making the choice of colour schemes and soft furnishings. This ensured that the bedrooms were decorated in accordance with the residents personal taste. A lounge had also been redecorated, new curtains had been put up and a new television with Sky TV had been purchased. This enabled the residents have a greater choice of television channels. The area manager had ensured that the residents clothes were ironed after they had been washed. This meant the residents were appropriately assisted to maintain a dignified appearance. Improvements had been made to the recruitment process to ensure that the necessary records and checks had been collated in line with regulatory requirements. This meant that staff had been thoroughly checked before commencing work in the home. An annual development plan had been produced based on the outcomes of the quality monitoring systems. This was linked to the improvement plan submitted to the commission by the registered provider following the last key inspection. The annual development plan set out the current situation within the service and highlighted the planned areas for development over the forthcoming year. This meant the residents and their families could be assured that the registered provider was aware what improvements needed to be made and had a plan of how this was going to be achieved. What they could do better: Some aspects of the care planning process required attention. For instance, following appropriate consultation with the residents, the care plans must be kept updated in line with changing needs and circumstances. This is to ensure that staff have up to date guidance about how best to meet the residents needs. Further to this, all risks must be assessed and fully documented. This is to ensure that an unnecessary risks are identified and so far as possible eliminated. Accurate records must be maintained of all prescribed medication. This is to ensure the Care Homes for Older People Page 9 of 30 residents are administered their medication in line with the prescribers instructions and their well being is fully safeguarded. The home has been without a registered manager since October 2005, which means there has been no one to take legal responsibility for the day to day running of the home. Several people have been appointed as acting manager during the this time. This has meant that the residents and staff team have had to continually adjust to different styles of management. An application must therefore be made to register manager to ensure there is a suitably qualified and experienced person to carry out this role. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 30 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 30 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 assessment process ensured the residents needs and wishes were properly considered and planned for before they moved into the home. Evidence: Current and prospective residents were provided with written information in the form of a service users guide and a statement of purpose. The service users guide was dated 2009-10 and was presented in an easy read format with pictures used to illustrate the text. Residents spoken to were familiar with the guide and confirmed that a member of staff had explained the contents to them. Since the last inspection, a brochure had been produced, which provided the residents with an overview of the services and facilities available in the home. Copies of previous inspection reports were accessible for reference purposes in the hallway. This meant the residents and their families were provided with and had access to suitable and relevant information to help them understand what amenities and services were provided in the home. Care Homes for Older People Page 12 of 30 Evidence: New residents were issued with a contract, which was looked at in detail on the previous inspection. This set out the rights and obligations of the residents and the role and responsibility of the registered provider. It also included details about what was included in the fee. The contract was presented in a clear format and was jargon free. This ensured that the residents and their representatives were aware of the terms and conditions of residence and knew what they could expect from the service. The personal files of three residents were looked at in detail as part of the case tracking process. Two of the residents had moved into the home since the last inspection. The records showed that a full assessment of needs had been carried out prior to admission. The assessments were detailed and included information about the residents personal, social, cultural and healthcare needs, for instance past and present medical conditions. The assessment also sought details about peoples daily living needs including dietary needs and preferences, hobbies and interests and preferred routines. Wherever practicable, the prospective resident and/or their families had been involved in the assessment process, to ensure their views and wishes were considered and documented. This meant that the area manager could be confident that staff had the necessary skills and knowledge to meet the assessed needs of people wishing to move into the home. The assessment information was made available to the staff team, so they were aware of the residents needs and preferences. Following the assessment of needs a letter was sent to prospective residents and their families to confirm that the residents needs could be met in the home. This meant residents could be assured that the home was a suitable place for them to live. The area manager confirmed that prospective residents were invited to spend as much time as they wished in the home prior to making the decision to move in. This enabled the person to meet other residents and staff and experience life in the home. Following admission, the contract stated that a trial period of four weeks was offered to every new resident, so both parties could make sure the placement was successful and the residents individual needs could be met. Care Homes for Older People Page 13 of 30 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. Whilst the residents and their families were involved in the care planning process, the care plans had not always been updated to reflect current needs and circumstances. Some medication was not recorded and handled in a safe and consistent manner. Evidence: We looked in detail at the personal files of three people, to assess the quality of the care planning documentation. All three people had a care plan, which was based on their assessment of needs. The records were split into two sections with one file containing the care plan and associated risk assessments and the second file comprising of health and physical care charts and other records. Two residents had a person centred plan, which provided guidance for staff on the residents needs and wishes. Whilst these plans contained useful and informative information for the staff about the residents personal preferences, we noted they were written in the first person. This meant there was the potential for staff to misinterpret the residents thoughts and behaviours, especially those residents with limited verbal communication skills. The third personal file contained a different style of care plan, which again Care Homes for Older People Page 14 of 30 Evidence: provided useful information about the residents needs. However, this plan had been developed while the resident was receiving day care and had not been updated, following a change to respite care. This meant that the staff had limited written information within the care plan about the residents needs and preferred routines during the evening and night. The plans were supported by records of personal care, which provided information about changing needs and any recurring difficulties. The records had been made on a daily basis, to ensure staff were provided with ongoing details about the residents well being. Charts had been maintained for personal care and hygiene and all had been fully completed. This meant it was possible to determine the frequency and type of care provided to each resident. Wherever possible the residents and/or their families had been consulted during the development and review of their care plan. A relative spoken to confirmed she had discussed her mothers plan with the area manager and had been given the opportunity to add information. Written records seen on two of the personal files demonstrated that the care plans had been reviewed each month or more frequently in line with changing needs. Healthcare needs were considered during the assessment process and included within the care plan documentation. Residents had access to health care services and all were registered with a GP. Medical records maintained on each residents file demonstrated that specialist advice was sought as necessary from health care professionals, such as the District Nursing Team and Doctors. All residents were supported as necessary to attend medical appointments and charts had been maintained to monitor the residents weight, to ensure any significant fluctuations were noted and acted upon. Risk assessments had been carried out as necessary, to underpin risks identified within the care plan. These included moving and handling, pressure sores, falls and nutrition. Individual risk assessments had also been carried out in relation to specific healthcare conditions such as chest pains. The risk assessments were supported by risk management strategies, which provided staff with guidance on how to manage and reduce any identified risks. This meant the staff were able to respond consistently and safely to any identified risks. However, a risk assessment was not seen in respect of one persons unsettled behaviour. These difficulties had also not been added to the care plan. This meant there was the potential for staff to respond to this type of a behaviour in an inconsistent manner. The residents spoken to felt the staff respected their right to privacy and confirmed that personal care was carried out appropriately. The residents were aware of the Care Homes for Older People Page 15 of 30 Evidence: various changes in the management and staff teams, which had been ongoing for sometime. However, the residents said the staff were mostly alright and some were very nice. The staff were observed to generally interact with the residents in a positive manner and they referred to the residents in their preferred form of address. However, on the day of inspection the level of social interaction at lunchtime was limited with some residents, which meant they were not fully consulted about their meals or given timely assistance. This situation was addressed by staff when it was pointed out and there was a good level of interaction and support at the tea time meal. Policies and procedures were in place to cover the management of medicines and were available for staff reference in the staff station in the hallway. The home operated a monitored dosage system of medication, which was dispensed into trays by a local Pharmacist. Since the last inspection, records had been maintained of medication entering and leaving the home and protocols had been drawn up for the administration of homely remedies. Appropriate records were maintained in respect of receipt, administration and disposal of medication. However, there were two tablets found in an unmarked dosette box in the medication trolley and not all prescribed medication had been entered onto the current medication administration record for two residents. This meant that the residents may not have been given all their prescribed medication. In addition, we received a recent notification from the home informing us that staff had omitted one type of medication for one resident for one day without authority. This error was discovered at a Care Programme Approach (CPA) meeting with other professional staff. It is important that staff maintain accurate medication records at all times, in order to safeguard the well being of the residents. Care Homes for Older People Page 16 of 30 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 residents were able to exercise choice and control over their lives and were supported to maintain good contact with their family and friends. The residents were provided with a nutritious and varied diet. Evidence: The residents preferences in respect of social activities were recorded and considered as part of the assessment and care planning processes. Since the last inspection, a variety of activities had been introduced to enable the residents to pursue a range of leisure pastimes of their choice. A record of activities had been made for each resident in their individual files, which enabled staff to plan group activities, which the residents enjoyed. The activities included, exercise superstars which were weekly individual or group exercise sessions, foot therapy and aromatherapy care, jigsaws, arts and crafts, playing cards and singing. Information about forthcoming activities was displayed on a notice board in the dining room. The residents and a relative spoken to confirmed activities were available to join in every afternoon and they could participate as they wished. The residents were supported to continue with their chosen form of religious worship Care Homes for Older People Page 17 of 30 Evidence: and such choices were recorded within the care plan documentation. A representative from a local church visited the home for prayers and communion once a month. The routines were flexible and were primarily designed to meet the needs of the residents. The residents spoken to said they had a choice in the times they got up and went to bed. One person said, I can go to bed whenever I like. This meant that the residents were able to influence their lifestyle and choose their preferred routines. The residents had the opportunity to develop and maintain important personal and family relationships. There were no restrictions placed on visiting times and residents were able to receive their guests in private, should they wish to do so. Refreshments were offered to visitors, to ensure they felt welcome in the home. A relative spoken to during the inspection was satisfied with the quality of care. The person commented I have no complaints whatsoever, the care is excellent and the staff are very caring. Most of the residents spoken to said they liked the food provided. There was a choice of food each meal time and residents were asked prior to each meal what choice they wished to make. The food was mostly homemade and breakfast was served throughout the morning to suit the preferences of the residents, who wished to have a lie in. The menu was displayed on the residents notice board in the dining room. During lunch time, we observed that two residents were not given appropriate assistance to eat their meal and there was very little interaction between a member of staff and the residents. One person was not spoken to for an hour and was not offered any dessert, even though another resident in the same room was given a pudding. When this situation was pointed out to the staff on duty, it was immediately addressed and the area manager agreed to discuss this further with the staff. The residents were given a good level of assistance at tea time and staff actively engaged in conversation with all the residents. The meals served on the day of inspection were plentiful and well presented. Drinks and snacks were served throughout the day and at other times on request. Jugs of water and juice were left around the lounges, to ensure that residents benefited from good hydration. Care Homes for Older People Page 18 of 30 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. The residents had access to a clear complaints procedure, which meant they were able to voice their views and any concerns. Policies and procedures were in place to respond effectively to any allegations or suspicions of abuse. Evidence: Arrangements were in place to ensure the area manager and staff listened to and acted on the views and concerns of residents. This was achieved during daily conversations, one to one discussion, satisfaction questionnaires and residents meetings. The residents spoken to said they felt comfortable about expressing their views and were aware of whom to speak to in the event of a concern. The complaints procedure was included in the statement of purpose and service users guide. The area manager explained that the residents had also been given a laminated easy read version of the complaints procedure. The procedure seen in the service users guide contained the necessary information and included the relevant telephone numbers should a resident wish to raise a concern. The registered provider had received one letter of concern and one complaint since the last inspection. The latter had been directed through the commission and concerned the care of a resident. The complaint was investigated under the homes complaints procedure and a full report of the investigation was sent to the complainants and the Care Homes for Older People Page 19 of 30 Evidence: commission, within the designated timescale. The policies and procedures for safeguarding vulnerable adults were available and provided guidance for staff should they suspect or witness any harmful practice. These issues were incorporated into the induction training and staff received specific tuition as part of their NVQ training. In addition, all the staff had recently (April 2009) undertaken a full day of training on the Protection of Vulnerable Adults. The staff also had access to a whistle blowing procedure, which provided staff with information about how to raise any concerns about harmful practice to the relevant authorities. Since the last inspection, all specific incidents affecting the well being of the residents had been discussed with the commission and Social Services had been contacted for advice as necessary. There were established arrangements in place to safeguard the residents financial affairs and the area manager operated a thorough recruitment procedure, to ensure the residents were protected from unsuitable people. Care Homes for Older People Page 20 of 30 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 residents were provided with a clean, pleasant and well-maintained home, which promoted their comfort and independence. Evidence: Manderley Residential Care Home is a mature property set in its own grounds in a residential area in Burnley. The town centre is approximately half a mile away. The gardens are maintained by a gardener and could be used by the residents in fine weather. There were plans to upgrade the back garden at the time of the inspection. Accommodation was provided in 11 single rooms and 2 double rooms, none of the bedrooms had an ensuite facility. Screening was available in shared rooms. Communal space was provided in two lounges and a dining room, all of which could be used for various recreational activities. A stair lift was fitted to the stairs to ease access to the first floor. The residents had free access around the home and could choose where they wished to spend their time. Arrangements were in place for general repairs and maintenance and a record was maintained of the work carried out. This meant that any routine problems with the building could be promptly rectified. Care Homes for Older People Page 21 of 30 Evidence: It was evident from a partial tour of the building that the residents had personalised their rooms with their own belongings and decoration was a good standard throughout. The residents were satisfied with their rooms, which one person described as, nice and comfortable. Since the last inspection, various improvements had been made to the premises to aid the comfort of the residents. For example, five bedrooms had been redecorated and new carpets fitted. One resident said she had enjoyed choosing the colour scheme and soft furnishings for her room and she was very pleased with the result. A lounge had also been redecorated, new curtains had been put up and a new television with Sky TV had been purchased. This enabled the residents to have a greater choice of television channels. Appropriate aids and adaptations were provided to assist the residents mobility. This included various pieces of equipment for safe moving and handling. Assisted baths, raised toilets and grab rails were also available, to promote the residents independence. The home was clean and odour free at the time of the inspection. The residents said a good level of hygiene was maintained at all times. There was a separate laundry facility, which had sufficient and appropriate equipment to meet the laundry needs of the residents accommodated in the home. Since the last inspection, the area manager had ensured that the residents clothes were ironed after they had been washed. This meant that the residents were appropriately assisted to maintain a dignified appearance. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements, recruitment and training were designed to meet the residents needs in an effective and safe manner. Evidence: A staff duty roster was drawn up in advance and provided a record of the number of hours worked by the staff in the home. The roster demonstrated that there were at least two care staff on duty throughout the waking day with senior staff as well as additional ancillary and administrative staff on duty until 5 oclock. The residents were supported at night by one member of staff on waking watch duty and one member of staff on sleeping in duty. There was always a senior person on call. All staff who provided personal care were aged over 18 and all staff left in charge of the building were aged over 21. A recruitment and selection procedure was available and a checklist was used to track documentation required for the recruitment of new staff. Since the last inspection, improvements had been made to the recruitment process to ensure that the necessary records and checks had been collated in line with regulatory requirements. The files of two members of staff were looked at in detail. It was evident that both applicants had completed an application form, provided a full working history and had attended the home for an interview. CRB (Criminal Records Bureau) and POVA (Protection of Care Homes for Older People Page 23 of 30 Evidence: Vulnerable Adults) checks had been obtained prior to the applicants commencing work in the home. This meant that new staff were fully checked prior to working in the home. Arrangements were in place for all new employees to undertake induction training, which incorporated the Skills for Care common induction standards. The latter provided underpinning knowledge for NVQ level 2. According to information supplied by the area manager, seven out of thirteen care staff had achieved NVQ level 2 or above, which equated to 54 of the overall staff team. In addition four members of staff were working towards this qualification. This meant a majority of the staff team had achieved the necessary qualifications to enable them to carry out their role effectively. Staff attended both internal and external training courses and had at least three paid days training a year. Training certificates seen on the staff files demonstrated that the staff had received recent training on stoma care, moving and handling, confusion and dementia, medication administration and first aid. It was noted staff discussed their individual training needs during their supervision sessions and there was an overall staff training plan. This meant the area manager could readily identify future training needs for individual staff and for the staff team as a whole. Care Homes for Older People Page 24 of 30 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. Whilst there were systems in place to promote the residents health and safety, a series of management changes impacted on the continuity of leadership within the home. Evidence: Since the last inspection, there had been further changes in the management of the home. Three people had undertaken the role of acting manager and all had left within a short time. This meant the staff and residents had to continually adjust to changing management and leadership styles. Overall, the home has been without a registered manager since October 2005. The area manager had supervised and supported the various managers and had taken over the day to day management of the home following the departure of the last acting manager. A deputy manager had recently been appointed. The area manager has the necessary qualifications to run a care home including NVQ level 4 in Management and the Registered Managers Award. She also has many years experience of managing a care service. Care Homes for Older People Page 25 of 30 Evidence: There was a programme in place for staff supervision and the topics discussed during supervision were recorded on a suitable format. In addition staff were given the opportunity to attend regular formal staff meetings and handovers. This meant that staff were able to share experiences and discuss future developments. The service had been awarded with an Investors in People Award in 2007, which is a professionally recognised quality assurance award, and had Preferred Provider status with the Local Authority. Residents meetings were held at regular intervals, which provided the residents with the opportunity to express their views and opinions in a formal setting. Satisfaction questionnaires had been distributed to the residents in November 2008 and the results had been collated and analysed. The area manager had established various audit tools to monitor the operation of the home, which included admission checklists and a staff training matrix. Since the last inspection an annual development plan had been produced, which was linked to the improvement plan submitted to the commission by the registered provider following the last key inspection. The annual development plan set out the current situation within the service and the planned areas for development over the forthcoming year. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. A random check of the records and monies deposited on the premises was found to be correct. This meant the residents financial affairs were safeguarded. There was a set of health and safety policies and procedures, which included the safe storage of hazardous substances and infection control. Staff received health and safety training, which included moving and handling, food hygiene, first aid, fire safety and infection control. Documentation seen during the inspection and information supplied at the previous inspection indicated that the electrical, gas and fire systems were serviced at regular intervals. The fire log demonstrated that the staff had received instructions about the fire procedures during their induction. Appropriate arrangements were in place to record accidents and incidents in the home. This ensured that the residents condition was closely monitored following an accident or incident. Since the last inspection, the area manager had ensured that the commission had been notified of all events and incidents listed under the regulations. This has meant that we have been able to track progress made in the home to improve the service and we have been assured that the residents well being has been monitored and safeguarded. Care Homes for Older People Page 26 of 30 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 27 of 30 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 7 15 Following appropriate 19/06/2009 consultation with the residents, the care plans must be updated in line with changing needs and circumstances. This is to ensure that staff have up to date guidance about how best to meet the residents needs. 2 8 13 All risks in respect of the 19/06/2009 residents behaviour must be assessed and fully documented. This is to ensure that any unnecessary risks are identified and so far as possible eliminated. Accurate records must be maintained of all prescribed medication. This is to ensure the residents are administered their medication in line with the prescribers instructions and their well being is fully 10/06/2009 3 9 13 Care Homes for Older People Page 28 of 30 safeguarded. 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 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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