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Inspection on 14/03/09 for Melbourne House Nursing Home

Also see our care home review for Melbourne House Nursing Home for more information

This inspection was carried out on 14th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

People are assured that their needs will be assessed and that staff can meet these before they make a decision to move into the care home. People using the service feel that their needs are met in their preferred way. People using the service are treated with respect and their dignity is upheld. People using the service are content and settled living at the care home and are pleased with the care and support that they receive. People are supported to maintain contacts with those that are important to them. People using the service are assured that their complaints will be listened to and resolved and that they are protected from abuse. People using the service live in a well maintained, clean and comfortable environment. People using the service are supported by staff who are well trained to carry out their job role. People live in a care home where they are given the opportunity to have their say in how the service is run and managed. People using the service speak highly of staff and feel that they are listened to and respected. We saw that staff and people using the service maintain good relationships. Staff spoken with are able to discuss people`s needs and the support that they require.

What has improved since the last inspection?

Staff attitudes and the way in which they treat people has been fully addressed to ensure that people using the service are treated with respect at all times and their dignity is maintained. Complaints are now fully recorded and investigated as required to make sure that these are resolved to the person`s satisfaction. People using the service now feel that they can approach staff with any concerns that they may have. Staff who work with only a POVA 1st (a check to see if an individual has been placed on a list of people that are known to have abused vulnerable people) in place are now supervised by other members of staff to make sure that people using the service are protected from unsuitable staff. The quality assurance system has been further developed, offering people more say in how the care home is run and managed.The general management of the care home has improved of late with the appointment of an experienced acting manager and a general manager to oversee the running of the service.

What the care home could do better:

People using the service must be involved in the care planning process and plans of care and risk assessments must be in place for all identified needs. An assessment of the amount and type of manual handling equipment available must take place to ensure that sufficient is available to meet people`s needs. To ensure that people lead an active and stimulating lifestyle facilities for recreation in regard to the needs of people using the service must be provided. Sufficient staff must be available to support people using the service at all times. Documentary evidence to demonstrate that staff with only a POVA 1st in place are supervised must be available.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Melbourne House Care Home Aspley Lane Aspley Nottingham NG8 5RU     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: Karmon Hawley     Date: 1 4 0 3 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 32 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 32 Information about the care home Name of care home: Address: Melbourne House Care Home Aspley Lane Aspley Nottingham NG8 5RU 01159294787 01159294787 javid0612@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Eastgate Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 39 Number of places (if applicable): Under 65 Over 65 39 0 old age, not falling within any other category terminally ill Additional conditions: 0 2 Within the total number of beds 1 bed can be used for a named service user aged 44 years Date of last inspection Brief description of the care home Melbourne House is a purpose built two-storey building providing care for up to 38 older people with one named person who is outside the category of registration. As the category of registration for Terminal Illness is now obsolete, this is currently being addressed with the Registration Team so that a new up to date certificate can be processed. There are 3 lounges, a conservatory and a large dining room providing ample communal space. There is a lift to the second floor and the building is wheelchair accessible. The home is set within its own grounds, which are accessible to residents. Care Homes for Older People Page 4 of 32 Brief description of the care home The service is close to local amenities in Aspley, which is on the main bus route into the City of Nottingham. The adminstrator is currently waiting to hear from the City and County Council in regard to this years fees, once she has this information, this will be made availble to people on the point of enquiry. There is an extra charge for en suite bedrooms. Newspapers and hairdressing are not included in the fee. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One regulatory inspector conducted the unannounced visit over 1 day, including the lunchtime period. A review of all the information we have received about the home from the provider and the general public since the last inspection was considered in planning this visit and Care Homes for Older People Page 6 of 32 this helped decide what areas were looked at. The main method of inspection we use is called case tracking which involves selecting the care plans of 4 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The acting manager, members of staff, relatives and people who use the service were spoken with as part of this visit. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of people using the service. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. Staff at the service sent us a completed Annual Quality Assurance Assessment which outlines the developments and improvements the care home has made throughout the year. We used some of this information within the report to determine our judgements. We sent out questionnaires to people using the service, staff and relatives, however we did not receive any responses back to add into this report. What the care home does well: What has improved since the last inspection? Staff attitudes and the way in which they treat people has been fully addressed to ensure that people using the service are treated with respect at all times and their dignity is maintained. Complaints are now fully recorded and investigated as required to make sure that these are resolved to the persons satisfaction. People using the service now feel that they can approach staff with any concerns that they may have. Staff who work with only a POVA 1st (a check to see if an individual has been placed on a list of people that are known to have abused vulnerable people) in place are now supervised by other members of staff to make sure that people using the service are protected from unsuitable staff. The quality assurance system has been further developed, offering people more say in how the care home is run and managed. Care Homes for Older People Page 8 of 32 The general management of the care home has improved of late with the appointment of an experienced acting manager and a general manager to oversee the running of the service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that their needs will be assessed and that staff can meet these before they make a decision to move into the care home. The service does not offer intermediate care. Evidence: The acting manager visits people in the community to carry out a preadmission assessment to make sure that staff can meet their needs prior to making a decision to move into the care home. There is evidence of these assessments taking place within case files examined. People may also visit the care home to get a feel for what it would be like to live at the home before they make any decision to move in. Staff are informed of peoples needs before they move into the care home so that they Care Homes for Older People Page 11 of 32 Evidence: can support them appropraitely and one member of staff said,we get all the information we need when someone moves into the home. The service does not offer intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people have not always been involved in the care planning process in the past and some plans of care are not all person centred, people using the service feel that their needs are met in their preferred way. People using the service are treated with respect and their dignity is upheld. Evidence: The acting manager and registered nurses are in the process of rewriting and restructuring all care plans and risk assessments to make sure that these are up to date and person centred. To assist this process 2 members of staff are waiting to go on person centred planning course. There is evidence that some case files have been updated and within these files care plans in place are person centred and address peoples personal needs and preferences to make sure that they receive care and support as they wish. In other plans these are of an older format and remain task focussed and sometimes very brief in regard to the care and support people require, however despite this staff spoken with are able to Care Homes for Older People Page 13 of 32 Evidence: discuss the support that people require. People using the service undergo various assessments such as infection control and manual handling to determine their needs. Within some plans where these have shown that there are risks, plans of care and risk management plans have not been implemented to make sure that people are supported as required and risks are managed, however daily records show that there have been no untoward incidents occurring. Risk assessments are however in place for other identified risks such as falls and the safe use of bedrails to make sure that these are managed. Where cultural and religious needs are paramount there is evidence that these have been fully considered in the implementation of plans of care. There is evidence of daily records and reviews taking place in all plans of care, which contain specific and up to date information about peoples needs. When we spoke with people using the service and one relative it became apparent that they are not aware that plans of care are in place. This was discussed with the acting manager who stated that she is hoping to address this issue in the restructuring process. Staff spoken with are able to discuss peoples needs and the support that they require. People using the service tell us that their needs are met. Within case files examined we can see that people are supported to access specialist services such as the doctor, dietician and dentist as required. During the tour of the care home we saw that specialist equipment such as mattresses and cushions are available. A hoist is also available for people that need assistance with manual handling, however staff expressed that an additional hoist which helps people to stand rather than a full lifting body hoist would promote peoples independence; there is not enough equipment, there is only one hoist which is a full hoist, there is no standaid, therefore we take away independence of those who may just need a bit of assistance to stand. We saw staff carry out manual handling procedures and follow good practice when supporting people to move. Staff spoken with confirm that people are supported to access specialist services as needed. Care Homes for Older People Page 14 of 32 Evidence: There are allocated staff who are link nurses with the continence team, tissue viability nurse and infection control team, so that they can keep up to date with all best practice recommendations and cascade these to other staff members. One person using the service said, I can see the doctor and chiropodist when I need to. One relative spoken with told us that staff had contacted a doctor when their relative was ill and they had medication to make them better. Although staff who administer medication have been trained to do so, an update to refresh their skills has been arranged to make sure that their knowledge is up to date. Medication records show us that people receive their medication as prescribed, however there are a small number of gaps when medication has been signed for but not administered. All other necessary records to demonstrate the staff storage and disposal of medication are in place as required. One person using the service told us that the staff look after their medication and that they are happy with these arrangements. Throughout the inspection we saw that staff treat people with respect and attend to their needs as required. The acting manager is the dignity champion and ensures that staff follow good practice recommendations. Staff spoken with are able to discuss how they ensure that they maintain peoples privacy and dignity when supporting them with care; I make sure that I knock on doors before entering, that doors are closed when supporting people and covering them up when supporting them with personal care, I make sure that I offer people choices in all aspects of life. People using the service told us, the staff are friendly and respectful, they listen to you and the staff are good and respectful. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are content and settled, however there is not much available by way of activity and entertainment to ensure that they lead an active and stimulating lifestyle. People are supported to maintain contacts with those that are important to them. Evidence: Currently there is not an activities coordinator employed, however an advertisement has been placed in the local newspaper for the position. Due to this activities on offer to people using the service are limited. Outside entertainers visit the care home and staff do support people with activities when they have the time however they do feel that people need more stimulation and they told us; there are not enough activities, we do chair aerobics and sometimes play bingo and take them out for walks, and we could do with extra help as we tend to be task focussed due to time constraints. If we do have any spare time we can always get the activities trolley out. There is not enough for people to do at the moment we need a person to do this. We do take people on trips out and we had an Easter bonnet parade. One relative spoken with also stated that there is not enough for people to do and to Care Homes for Older People Page 16 of 32 Evidence: provide them with stimulation. People using the service offered the following comments about activities in the care home; I did not have an Easter bonnet, I did not want one but some of them looked lovely. I enjoy the aerobics, it makes you feel better and I can go out in the garden which I enjoy, I enjoy the aerobics and I enjoyed the Easter bonnet party, I enjoy aerobics, I cant think if there are any other activities and I enjoyed aerobics, I am not sure if there are any other activities. There are no availble records of activities taking place to support that people are receiving these on a regular basis. Throughout the inspection we saw that friendly banter between people using the service and the staff takes place, they converse freely and maintain good relationships. We watched people participate in the aerobics session before lunch, this shows us that people really enjoy these sessions and there is a total change in people when this is taking place, everyone joined in and sang along with the songs, for those who are less able, staff supported them to join in. Holy Communion is currently offered in the care home for those who wish to partake, however to further meet peoples spiritual needs the acting manager is currently in contact with local clergy in regard to arranging an in house church service. There is currently no one using the service that requires any support to access other religious denominations. So that people can maintain contacts with people that are important to them there are no restrictions on visiting and visitors may be received in private. We saw several visitors come and go throughout the day and that they are made welcome by staff. One visitor spoken with said that staff are polite and make them feel welcome when they visit, however they do not tend to really see much of the staff as they do not appear to be available all the time. Staff spoken with said that visitors are made welcome at any time and people using the service confirm this. One person told us, I can and do have visitors and they are made welcome. Staff spoken with told us that the routines of the care home are flexible and that people can spend their time, as they like. People using the service confirmed this and Care Homes for Older People Page 17 of 32 Evidence: told us that they can make their own decisions and choices about what they do. Staff have undertaken training in the Mental Capacity Act to develop their knowledge and skill in regard to ensuring that peoples rights are maintained and they are able to discuss how they use this in their practice. A wholesome, appealing and varied menu is on offer to people using the service and special diets are catered for. Staff spoken with confirm that special diet are catered for and also discussed the arrangements that are in place to meet the needs of people of an ethnic minority. People using the service told us that the food is good and that there are choices available at each meal. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are assured that their complaints will be listened to and resolved and that they are protected from abuse. Evidence: So that people know how to make a compliant if they need to the complaints policy is on display in the main entrance. The acting manager has also begun to carry out managers surgeries so that people know that she is approachable and open to discuss any concerns that they may have. Resident and relatives meetings also take place so that people can air any concerns by this way if they wish. The service has received two complaints since the previous inspection, one in relation to the upkeep and availability of wheelchairs and another in regard to a fall a person sustained and communication by a specific member of staff. There is evidence available to show us that both of these complaints have been investigated appropriately, relevant action taken to resolve issues and that the complainant has been informed of this. Staff spoken with are able to discuss how they would handle a complaint should one be received to make sure that this is dealt with appropriately. Care Homes for Older People Page 19 of 32 Evidence: People using the service told us, it is a very nice place, I can speak to staff if I am unhappy, I am happy here, there is a good atmosphere, staff are friendly and respectful, staff listen to you, I have no problems, I can talk to staff and I have no problems, if I did have or I was unhappy, I would speak to someone. Staff have been trained in safeguarding adults and are able to discuss their roles and responsibilities in ensuring that people remain protected. Relevant policies and procedures in regard to reporting any concerns of abuse are in place. Staff undertake supervision sessions to ensure that their work and development is monitored. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a well maintained, clean and comfortable environment. Evidence: A maintenance person is employed to carry out routine maintenance as required and there is evidence of ongoing maintenance when we looked around the care home. Ongoing redecoration takes place and staff said that people using the service have been involved in choosing the colour of the paint in the corridors. There are various seating areas around the care home where people may spend their time and the gardens are maintained and secure so that people can enjoy sitting out in the better weather. During the tour of the care home we saw that specialist equipment such as easy access showers, specialist baths and a hoist is available. However staff express that there is not enough manual handling equipment, which is further discussed in standard 8 of the report. All areas of the care home accessed during the day are clean and tidy. One person using the service said that they had brought in their own things to make it Care Homes for Older People Page 21 of 32 Evidence: feel more homely when they came to live at the care home. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by staff who are well trained to carry out their job role, however the deployment of staff at key times of need sometimes means that staff are to busy to ensure that person centred care is of a priority and people always receive care promptly. Evidence: During the inspection we saw that staff are available to attend to peoples needs when required with the exception of when the hand over period between each shift takes place. During the handover of the morning and afternoon shift we saw that one person began wandering in an unsafe manner, there were no staff on the floor at this time, therefore the person had to be assisted by a relative to remain safe until assistance was summoned. This was discussed with the acting manager and general manager following the incident, the general manager stated that provisions have been made to cover for this period, however not yet utilised; plans will be made to do so. Staff spoken with feel that additional staff would assist them in the process of changing care from being task focussed into becoming more person centred and allowing them to offer more quality time to people using the service; we could do with extra help as we tend to be task focussed due to time constraints, and there are not enough staff when we are getting people up in the morning, the nurses do not usually Care Homes for Older People Page 23 of 32 Evidence: help. This comment was discussed with the acting manager who stated that the management of morning medication round has been changed so that people using the service not only receive their medication at a more reasonable time, it leaves registered nurse free to assist care staff more in the mornings. The views of people using the service differed slightly in regard to staffing levels, I am settled and happy here, the staff look after me, I have been unwell but I am bit better now, the staff work very hard, they are always very busy, I get help as needed from staff, I sometimes have to wait for assistance but there are enough staff when they are fully staffed, sometimes they are short if someone off sick. This was discussed with the acting manager who stated that should staff sickness occur she tries to ensure that this is covered by another member of staff at all times possible and we saw that this does take place on the staff duty rota. One relative spoken with said, the staff are polite but I dont really see them, they are not always available, it is as if they are available when they want to be. So that new staff are aware of their roles and responsibilities when they first start employment they undertake an induction. There is evidence of staff undertaking these within staff files examined. The induction covers all the required compulsory training that staff need to support people using the service. Both members of staff spoken with confirm that they have had an induction when they first started working at the service. 15 members of staff have undertaken the National Vocational Qualification (a nationally recognised work and theory based qualification designed to enhance peoples knowledge and skills in caring for people) level 2 and a number are working towards level 3. One member of staff spoken with said that they have completed the National Vocational Qualification level 2 and have nearly finished level 3, which is good as it helps them in their work. Staff files examined show us that all the necessary documentation required by law, such as references and proof of identity are in place to make sure that people using the service are protected from unsuitable people being employed. One member of staff is currently working with just a POVA 1st (a check that is made to see if a person in on a register of known offenders that have abused vulnerable people in the past), whilst they are waiting for their Criminal Record Bureau check (a police check to see if an individual has a police caution or criminal record) to be returned. They are being supervised by other staff to make sure people are protected from unsuitable people. Although there is no documentary evidence to support this, members of staff are able to confirm that this takes place as well as the management. One member of staff spoken with confirmed that they had a criminal record check Care Homes for Older People Page 24 of 32 Evidence: before they commenced employment. Following a discussion with the acting manager the supervision policy is to be implemented and a risk assessment will take place to provide documentary evidence as required for the member of staff who is currently working with only a POVA 1st in place. A staff training matrix shows us that staff continue to undertake compulsory training to make sure that they have the necessary knowledge and skills to meet peoples needs. Following training staff complete an evaluation to show what they have learned and how they will put this into practice. One person using the service said that they feel that staff are well trained to do their job. Staff spoken with offered the following comments, I have done dementia care training which has made me see people so differently, we are not all the same, training has helped me in care delivery, I have done the Mental Capacity Act training, this has taught me about who can make decisions for people, making applications for peoples best interest and why sometimes restrictions need to be in place. I feel supported in my training and development. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a care home where they are given the opportunity to have their say in how the service is run and managed and where the general management is being improved upon to ensure quality outcomes. Evidence: The acting manager has been in post since February of this year and is in the process of applying to the Care Quality Commission to become the registered manager. She is a Registered General Nurse and has previous experience in management within a care setting. She has completed the National Vocational Qualification Registered Managers Award (a qualification which is designed to enhance management knowledge and skills). She is aware that some improvements are required in regard to the general management of the service and the documentation in use, however she feels supported in her job role and able to do this to ensure that people using the service receive quality outcomes. Care Homes for Older People Page 26 of 32 Evidence: Staff spoken with spoke highly of the new acting manager and offered the following comments; the change in management has not made a huge difference to the way that I work, the new manager has made some changes, she knows what she is on about, I feel more supported, and the manager is approachable, the staff team are getting on better and working together as a group. A relative spoken with said that they had some concerns about the general management and running of the service, however this was when the previous manager was in post; they are hoping that things will improve with the new acting manager in place. Two people using the service spoke highly of the acting manager and said that they feel the home is well run. People using the service and their relatives have a say in how the care home is run and managed by way if questionnaires and meetings and the feedback from these feed into the formulation of the business plan for the following year. The most recent questionnaires that have been returned offer mainly positive comments about the service, staff and care received. Where negative comments have been made we saw that an action plan has been drawn up to address these issues with the exception of one. The remaining issue is about people having to smoke outside. This was discussed with the general manager who stated that the provider is currently looking into this issue in an attempt to resolve it. The minutes of the latest residents and relative meeting show us that issues such as activities, menus, personal allowances and managers surgeries have been discussed. Staff meetings also take place and the last minutes of these show us that care issues, the Mental Capacity Act, manual handling issues and training have been discussed. Staff spoken confirm that meetings take place and that these are helpful. No one working at the care home is responsible for peoples personal allowances. If a cost is incurred, relatives or relevant others are invoiced for this. Accident records show us that a minimum amount of accidents are occurring in the care home and when they do staff are following the correct procedures to make sure that people receive appropriate care and attention. Registered nurses carry out security checks at night to make sure that doors are not left open and the building is secure. Care Homes for Older People Page 27 of 32 Evidence: The Annual Quality Assurance Assessment tells us that regular servicing of systems such as the fire and lift take place as required and when examining maintenance records we saw that the electrical and gas systems have been serviced and checked as required to make sure that these remain in good working order and people are protected. Staff have undertaken training in health and safety and are able to discuss the relevant issues in regard to their job role to make sure that people receive the care they require and remain safe. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk management plans must be in place for all highlighted risks. This will ensure that risks are managed and reduced and people remain safe. 01/05/2009 2 7 15 Plans of care must be in 01/05/2009 place for all identified needs. This will ensure that the needs of people using the service are fully met. 3 7 15 You must ensure that people 05/06/2009 are involved in the care planning process where able. This will ensure that people are aware that they have a plan of care and they are given the opportunity to express their needs and wishes. 4 8 16 You must assess the amount 29/05/2009 and type of manual handling equipment available to ensure that sufficient is Page 30 of 32 Care Homes for Older People available to meet peoples needs. This will ensure that there is sufficient to meet peoples needs and not infringe upon peoples independence. 5 9 13 You must ensure that all medication that has not been administered is not signed for as given. This will ensure that accurate records of medication people have taken is kept as well as ensuring peoples health and wellbeing. 6 12 16 You must provide facilities for recreation having regard to the needs of people using the service. This will ensure that people using the service lead an active and stimulating lifestyle. 05/06/2009 01/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 Keep records of activities that people have undertaken to demonstrate that these are on offer and people have participated in them if they wished to. Care Homes for Older People Page 31 of 32 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). 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