Inspection on 19/03/09 for Montague House

This inspection was carried out on 19th 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Montague House 02/11/09

Montague House 15/04/08

Montague House 25/04/07

Montague House 28/11/06

Montague House 08/05/06

Montague House 17/10/05

Montague House 11/05/05

Montague House 19/01/05

Montague House 11/08/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Montague House Montague House 10 Brockenhurst Road Ramsgate Kent CT11 8ED     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: Christine Grafton     Date: 1 9 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: Montague House 10 Brockenhurst Road Montague House Ramsgate Kent CT11 8ED 01843591907 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) : Mr Roy Edward Howse care home 19 Number of places (if applicable): Under 65 Over 65 19 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Montague House is a detached two-storey building with 19 bedrooms. 18 bedrooms have ensuite facilities of a toilet and washbasin; all rooms have a call bell and television point. There is a stair lift to the first floor. There is a large garden to the front and rear of the building, providing a number of areas for residents to sit, with an off-street parking area to the front. The home is located in a quiet residential area of the town, close to the cliff top promenade. The nearest shops and amenities in the town centre are within easy reach. Montague House admits people with low to medium dependencies and does not accept people who are wheelchair dependent for mobilisation and cannot stand without lifting equipment to move them. The home does Care Homes for Older People Page 4 of 32 Brief description of the care home accept people who use aids such as walking sticks and walking frames. The staff team work a rota that includes one person on waking duty and one person on duty sleeping in at night. Information provided by the manager in March 2009 indicates that the fees range between £320:63 to £489:00 per week and additional charges are made for hairdressing, chiropody and newspapers. 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: This report takes account of information received since the last inspection that took place on 15 April 2008 and included a visit to the home. An unannounced visit took place on 19 March 2009 2008 between 09:20 hours and 17:20 hours. The visit included talking to the manager, staff, residents and observing the home routines and staff practices. Some records were looked at and we looked round the home. Information sent to us by the manager prior to the visit, in the form of the homes annual quality assurance assessment, AQAA, has been used and information from the previous inspection referred to. At the time of the visit there were 16 residents living at the home. Care Homes for Older People Page 6 of 32 Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? They now have a designated person to do activities with residents on two days each week to provide more stimulation. The redecoration and refurbishment of the home has continued. Some bedrooms have had new carpets and furniture that have made them look homely. The heating system has been improved and several radiators replaced. More radiators have been guarded to reduce the risk of burns. This has helped to make sure that residents live in a comfortable and safe environment. More cleaning hours have been allocated so that the home can be kept clean and hygienic. Staff have attended various training courses to develop their knowledge and skills to meet the needs of people living in the home. The manager has regular supervision meetings with each staff member to monitor their performance and identify any development needs. The manager has started to keep interview records when she recruits staff. This shows that interviews are thorough and helps to protect residents. They have made changes to some of their records to make them easier to follow Care Homes for Older People Page 8 of 32 through. What they could do better: The statement of purpose and service users guide need reviewing and updating to make sure people have correct information about the home. This should be done every year and when changes occur. The pre admission assessments need to be consistently recorded and the documentation should have enough detail of the persons needs. This is important for the home to make a judgement as to whether it can provide the right care for the person. Care plans must cover all needs identified in the assessment and contain details of actions to minimise risks. The instructions for staff must be detailed enough to enable them to care for people safely. Residents daily records and care plan review records must be more detailed to make sure that there are no gaps in information. This is important so that all significant information about residents care that staff pass on verbally is consistently recorded, otherwise it could get overlooked. Some other aspects of the homes record keeping in general need to be better recorded and these are things that the management should look at as part of the homes internal quality monitoring systems. The manager should make sure that regular medication audits and staff medication competency assessments take place so that any errors are promptly picked up and any training needs identified. This is to ensure that residents medications are handled in a safe way. Whilst in the main residents are treated with respect for their privacy and dignity, staff need to be vigilant to make sure that continence aids are discreetly stored. Handling of confidential information needs to be reviewed and action taken to make sure that verbal information about residents does not get discussed in communal areas within the hearing of other people. The duty rota for persons working in the home should be legible and provide an accurate record of hours actually worked by staff. This is one of the management records that are required to be kept and need improvement. A staff training matrix needs to be devised to identify what staff mandatory training has been completed, where there are gaps and when refreshers are due. This will help to make sure that training is prioritised and planned according to skill deficits and potential needs. This needs to be supported by making sure that staff training files contain evidence of all courses completed. Care must also be taken to make sure that staff files contain all the required information including two references. This is to show that rigorous Care Homes for Older People Page 9 of 32 recruitment procedures are being followed to protect residents. The homes quality monitoring systems need to be improved to make sure that the quality of service provided to residents is continually reviewed and prompt action taken when deficits are identified. This is to make sure that the home is run in the best interests of residents. This must include a monthly visit by the provider and copies of such visit reports must be kept available for us to see. There were gaps identified in some mandatory health and safety training, for example, fire safety, moving and handling and first aid. This must be addressed to keep people safe. Procedures for maintaining hygiene are generally adequate, but some practices need reviewing and action taken to make sure that hand washing facilities are readily available in all places where needed to prevent the risk of infection spreading within the home. 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 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 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into the home are given adequate information to decide if it is right for them. There is a process to assess the needs of prospective residents. This should provide staff with enough information about the person, so that they will be able to give the right care. However, this is not being consistently completed before admission, so people cannot be confident that their needs will be met when they move into the home. It is not the general policy of the home to admit residents for specialist intermediate care, so standard 6 was judged as not applicable at this inspection visit. Evidence: People considering moving into the home can read about it in the homes statement of Care Homes for Older People Page 12 of 32 Evidence: purpose and service users guide. The manager gives each new resident their own copy of this combined document when they move in. This shows what the home has to offer and gives an indication of the daily routines and lifestyle. At the last inspection some of the contents were not up to date and the manager had stated she would review the document. This has not happened and some further minor amendments are now also needed. It is important that the document is dated and reviewed at least once a year, so that people know they are being given the information that reflects the current situation. We looked at four care plans, including those for two people admitted since our last visit. At the last inspection, we saw that the assessment process had been developed to make sure relevant details had been recorded prior to admission. This included obtaining a copy of the care management assessment for people referred by social services, plus the manager visiting the person to do her own assessment. However, the homes pre admission assessment documentation we saw at this visit was not being consistently recorded prior to admission. It contains only brief details and does not give an indication as to whether the home can meet the persons needs. An assessment is then completed following admission and a care plan is drawn up. This contains brief details covering most of the things specified in the national minimum standards, but some aspects are not detailed enough to provide a complete picture of the persons needs. Some needs that became apparent from talking to staff had not been recorded. For example we were told that one persons main problem was confusion, but there was nothing about this in the homes care plan. Another persons care management assessment identified a religious need, which had not been written in the homes assessment, or care plan and there was no evidence that this was being met, although the manager stated that it is. It is important that this gap in the record keeping is addressed so that staff have ready access to all the information they need to provide the right care. Care Homes for Older People Page 13 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. People living in the home benefit from having a plan of care that provides staff with most of the basic information they need to care for them. However, they cannot be sure that all their needs will be identified and met and that all risks are minimised. The homes medication policies and procedures need tightening to fully protect peoples safety. People can be confident that staff will understand their needs and will treat them with respect. Evidence: Individual care plans are in place for each resident. Generally the information in them is adequate. The AQAA told us that they have continued to improve their care plans to make sure that each residents health care needs are met. It does not state how this has been done. We were told that the care plan files were being reorganised to make them easier to follow through. The ones we saw that had been arranged in the new Care Homes for Older People Page 14 of 32 Evidence: way were well ordered. All aspects of daily living are covered, but this is mainly addressed in a tick box format and there is limited guidance for staff on how to meet residents needs, for instance, where certain risks are apparent. This is particularly important for example, where a person has an indwelling catheter, or where they have to have daily insulin injections for their diabetes. These carry certain risks that staff need to be aware of. The records should show more about the staff actions needed to address these health care needs. Care plans and some basic risk assessments have been written for these needs, but do not give enough information. The case tracking for one persons care, that included discussions with them and a staff member, indicated a risk that had not been recorded in the care plan. The staff member gave a good description of what to do if a certain medical situation occurred and an entry in the daily records confirmed what was said. This showed that an incident had been dealt with safely, with appropriate medical intervention. However, gaps in certain elements of the record keeping pose the risk of some care needs not being met, if staff do not pass on the information verbally. There is evidence that care plans are being reviewed each month with individual review records for each need recorded. Whilst this shows where some changes have occurred, there are things that are being missed because not all needs identified in the various assessments are being followed up in the care plan. For example, a persons constipation had not been recorded, although staff knew about this, the doctor had been consulted, the district nurse involved and staff were monitoring it. The quality of the daily records is another area that the manager has identified in the AQAA that could be done better and she has stated that information should be recorded in more detail. This is evident in entries that included a significant number of bland statements that say little about how the person has been, such as, seems fine and no problems. Record keeping overall is an area that needs to be developed and we were told that five staff had recently enrolled on a report writing course. We spoke with four residents who indicated that the staff are kind and caring, giving them the assistance that they need. Discussion with two members of the care staff confirmed that they have a good understanding of residents needs. They gave us a lot more verbal information about the people being case tracked than we were able to gain from reading the care plans and talking to those residents. This is good because it means that they understand them and know how to support them. Staff say they exchange a lot of information verbally. There has been a stable staff team that know the residents well, so this works, as long as staff remember what they have been told, Care Homes for Older People Page 15 of 32 Evidence: as otherwise, if it has not been written down, there is a risk that some things might be forgotten. Medication storage and procedures were seen to be appropriate at the last inspection. We saw that there is still adequate storage and procedures in place for the safe administration of medicines to residents. Records include having a staff signatures list, photo identification, medication administration record (MAR) sheets and keeping a list of up to date medications in the individual care plans. MAR sheets were generally well maintained, but there were a few discrepancies in the recording that were drawn to the managers attention. It was also noted that some residents did not have photo identification with their MAR sheet. We were told that medications are only administered by staff that have been trained and we saw some training records to support this. However, some staff are due for refresher training and there is no system to check staff competency in administering medications. We discussed with the manager that the homes quality monitoring system should include regular medication audits and staff competency assessments should be recorded. These should be done for all staff at least annually to complement the refresher training and are a way for the manager to test out if staff are putting what they have learnt into practice. A staff member gave examples of how they maintain peoples privacy and dignity. This was confirmed in observation and discussion with residents. The hairdresser was at the home during the morning of the visit, which several residents were appreciative of. We discussed with the manager that continence aids should be discreetly stored in residents bedrooms to maintain dignity. The homes telephone is situated in the dining room and a conversation about a residents health was overheard. This does not ensure confidentiality of personal information. Staff say they have to use this telephone, as the managers office is kept locked when she is off duty. Residents also sometimes receive their personal phone calls here. We discussed with the manager having a telephone extension put in the staff office for privacy, or considering having a telephone with a mobile hand set that can be taken to residents to receive calls in private in their bedroom. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being provided with some opportunities to take part in activities to stimulate them. They are encouraged to keep in contact with families and friends and enjoy their food and the choices available to them. Evidence: Some information about residents past interests, likes and dislikes has been recorded in their care plans, including their religious needs. The AQAA states that they continue to meet peoples religious needs and have regular visits from vicars and priests. Peoples religion is routinely recorded, but the care plan does not show if a persons religious need was being fulfilled, as was the case already identified under section one, Choice of Home. Information about peoples social needs has not been consistently obtained and some care plans lack personal profiles, or have had these completed only briefly. Care plans do not cover all equality and diversity issues, such as race, culture, gender and sexual orientation, but age and disability needs are covered in a general way. Such information would assist staff in meeting residents social needs. One good example of a life history was seen and this practice should be developed. Care Homes for Older People Page 17 of 32 Evidence: The manager has identified in the AQAA that social activities within the home are very limited, but she is clearly trying hard to address this. A person is employed to work two days a week to do activities with residents and has been given more hours for this. On the morning of our visit she was doing bingo and softball with some residents. During the afternoon a film show was put on by a monthly visiting entertainer. Residents say they have lots of visitors to the home and this was evident in the visitors book record. The AQAA indicates that visitors are always welcome, regardless of the time of day or night. A staff member spoke about getting to know relatives and friends as an important part of their work to support and reassure residents. People say they enjoy good food. The cook knows residents food likes and dislikes and is aware of their nutritional needs. She goes round each morning and tells each resident what is on the menu and offers them two alternatives. Each days menu is displayed in the dining room. Menus have been changed and the dining room tables rearranged as a result of listening to residents. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns and complaints will be listened to and acted upon. The homes procedures and practices to safeguard people from harm are adequate, but need to be strengthened to show that people are fully protected. Evidence: The residents that we spoke with say that staff listen to them if they need to talk about anything that might be troubling them. They also commented that the manager is approachable and they are confident to approach her if they have a concern. The AQAA indicates that there have been only two minor complaints since the last inspection that were resolved. Information from a care manager indicated that a concern was looked into under the social services protection of vulnerable adults procedures and the alert has been closed. As a result of this, some recommendations were made regarding the homes record keeping that will be followed up by the local authority contracts officers. This inspection has also identified weaknesses in this area and a requirement has been made. At the last inspection we spoke with the manager about developing a staff training matrix to identify where there are gaps in staff mandatory health and safety training and where refreshers are needed. This has not been done and although the AQAA Care Homes for Older People Page 19 of 32 Evidence: states that all staff have now received training on the protection of vulnerable adults, we found through auditing of care staff training files that there was no evidence to support this in four cases. Observations of staff interactions with residents confirmed that they listen to residents and they were supportive and encouraging in their attitudes. A staff member had a good understanding of the procedures to follow if any form of abuse is suspected. They also spoke about treating people as equals. They had just started an equality and diversity course, which they were finding interesting and stimulating. 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 living in the home continue to benefit from the ongoing improvements to the environment, which is comfortable and homely. Practices to maintain hygiene and prevent the spread of infection in the home are adequate, but need strengthening to fully protect people from the risk of harm. Evidence: The home was seen to be clean, light and fresh smelling. Since the last inspection, the cleaners hours have been increased to allow more time for carpet cleaning and other cleaning tasks. This was seen to be having a beneficial effect. Bedrooms are individual, personalised and homely, with all but one having an ensuite toilet facility. Residents that we spoke to said how much they like their bedrooms and several have brought items of their own furniture in with them. Since the last inspection several areas of the home have been redecorated and some new furniture provided. The AQAA indicates that several radiators have been replaced in the older part of the building, some new washbasins have been fitted in some ensuite toilets and some taps replaced. The continuing improvements were observed on a tour of the home. We saw that two bedrooms have been redecorated and refurbished, with new carpets, curtains and furniture. Care Homes for Older People Page 21 of 32 Evidence: There are still some carpets that are showing signs of wear in corridors that will need replacing. The dining room carpet is badly worn with wear and tear from chairs being moved up to the table in one place. These will need to be added to the homes improvement plan, to make sure that the dining room remains homely and safe. A new boiler has been added to improve the heating system. All radiators have now been guarded, or are of the low surface temperature type, and pipe work covered to reduce the risk of burns. Currently the bathroom is being redecorated and the manager stated that new flooring is to be added. This was pointed out at last years inspection as in need of replacement, as it is coming apart at the seam and poses a safety risk. Most areas of the home were seen to be pleasant and hygienic, but there were some things we saw that do not help to control the spread of infection in the home. At our previous visits to the home, including the last inspection, we have highlighted poor practices to prevent the spread of infection in the home. Things had significantly improved at our last visit, but we did still have to remind the manager about making sure there are suitable hand washing and drying facilities provided throughout the home to protect residents and staff. At this visit we observed a lack of such facilities in areas where they should be provided, such as the first floor shower room, the laundry room, bathroom and in bedrooms where personal care is provided. Some of these areas had no suitable hand drying facilities and others also had no liquid soap. Discussion with staff about infection control procedures and practices together with observation of laundry facilities and procedures, found that overall, the improved procedures set up and evident at the last inspection are still being followed. However, the lack of suitable hand washing and drying facilities in certain areas does not encourage staff to wash their hands near the source of dealing with soiled items. This means that they have to move to another area of the home to wash their hands, which is unsafe. 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 living in the home benefit from the stable staff team that know them well and understand their needs. Staff training continues to be developed and people are protected by the homes recruitment practices. Evidence: Residents that we spoke with at this visit were again appreciative of the stable staff team. They feel that staff understand them and know what to do if they are unwell. Staff and residents that we spoke with felt that generally there are enough staff on duty. At the time of our visit there were 16 residents. The manager has introduced more robust dependency assessments for each resident, but it was unclear how these are being used to influence staffing levels. Staff rotas were being displayed in the kitchen. Rotas had been typed and copied via a fax machine. This made them unclear and it was not easy to analyse them during our visit. For this reason we asked for copies of the current weeks rota plus, the two weeks planned rotas that were also displayed. The manager was unable to provide these during the visit. We therefore had to spend some considerable time trying to obtain the information we needed to make a judgement about this outcome group (see Management and Administration section to follow). Care Homes for Older People Page 23 of 32 Evidence: Our observations and discussions with people indicate that for the current number of residents and their dependencies, staffing numbers are sufficient. However, the layout and spread of the building needs to be considered when reviewing staffing levels, as during afternoons, weekends and evenings, when there are sometimes only two carers on duty, plus someone to work in the kitchen, this means that if a carer is attending to a resident in the back of the building, there is only one carer to supervise residents in the lounge. Information from a relative indicated that at times they had been kept waiting at the front door to be let in and that also sometimes there had been no staff available in the lounge areas. The AQAA indicates that staff have continued to do more training and that one more staff member has completed their National Vocational Qualification (NVQ) in care level 2. At the last inspection the manager did not have a method to identify which staff need to complete mandatory training courses or indicate when refreshers are due. There is still no staff training matrix, so we had to look through individual staff training files to assess the level of staff training. This took an unnecessary long time for us to do. We found that while staff have attended various short courses throughout the year, there is no staff training plan based upon development needs. Some good things were noted, such as the five staff doing an equality and diversity course and four staff are currently doing a palliative care course. However, we found that a number of staff need to update some of their mandatory training courses and complete some that they should have already done. There have recently been two new staff recruited and the manager stated that they are working through the Skills for Care induction programme. We looked at two staff files including one for a new staff member. We saw that they contained most of the required information, including application forms, full employment histories and interview records. Evidence was seen that criminal records bureau checks (CRB) had been obtained before staff start work. Whilst two references are generally obtained, the new staff members file only had one reference. The manager stated that they did get two references and she thought the missing one might have been filed away separately by the provider. The manager needs to make sure that staff files contain all the required documentation. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home where their best interests are promoted. However the current quality monitoring processes need strengthening to make sure people can be confident that their health and safety is fully protected. The home does not have a robust quality assurance system. Some of the shortfalls identified in this inspection should have been picked up if regular audits had been carried out internally by the management. Evidence: The manager has been in post a number of years and has the necessary management qualification. She continues to attend short courses to update her knowledge. She works split shifts alongside staff and the rota indicates she does four days a week working from 08:00 to 13:00 and 15:00 to 19:00, plus one 17:00 to 1900 shift. We were told that she generally comes in about 10:00 hours and does not always stay until 19:00, although she indicated she works flexibly to see night staff on some Care Homes for Older People Page 25 of 32 Evidence: occasions. The AQAA provides limited detail particularly regarding supporting evidence for things they do well and how they are going to improve things they have identified they could do better. We discussed the importance of this document at the last inspection, but this years AQAA contains less information than the last one. It did not contain enough supporting evidence for the planning and carrying out of the site visit. We therefore had to spend more time checking things for ourselves because of the missing information. The manager understands equality and diversity issues and person centred planning to some degree, but has difficulty in translating theory into practice to make a difference to the outcomes for residents. At the last inspection we discussed with the manager that the homes quality monitoring processes needed to be formalised and an annual development plan implemented. The manager stated that the provider does have a plan but there was no evidence of this. She also stated that the provider does monthly visit reports, but again copies of these were unavailable. The manager informed us that she holds monthly residents meetings and gives out questionnaires to residents and their families every six months and holds staff meetings approximately every nine months. However, there were no records of these available. We were told that action had been taken as a result of listening to people, but the results of the questionnaires have not been summarised into a report and there is no written action plan that could be reviewed and updated as things change. The provider does carry out several regular health and safety checks of the building and some records were seen. However, the manager does not carry out regular quality monitoring checks of all the care management side of things, such as the medications and other care records. This is important so that discrepancies can be picked up promptly and dealt with to ensure safety. The manager does now carry out regular staff supervision meetings, which she has found useful in identifying and following up some issues. Practices already identified in this report, for instance, staff going into the kitchen for administrative tasks, telephone conversations being overheard and the poor quality of some records are things that should be followed up within a robust quality assurance system. The manager stated that the home does not handle residents monies and instead, invoices relatives for things such as hairdressing and chiropody. Care Homes for Older People Page 26 of 32 Evidence: The AQAA indicates that the majority of the homes maintenance and equipment services have been completed and we saw evidence that the homes fire and electrical systems have been serviced. We saw evidence that the majority of staff have undergone training in safe working practices. However, we found that fire training updates are needed for all staff, there was no evidence of moving and handling training for at least two carers and one night carer has no evidence of first aid training. Infection control procedures need reviewing and action taken to ensure adequate hand washing facilities and infection control practices. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Each residents care plan 19/05/2009 must set out in detail the action which needs to be taken by staff to ensure that all aspects of their health, personal and social care needs are met. So that staff have all the written information available to them to give residents the right care. 2 8 13 Where any risks are identified to a residents health or welfare, the care plan must contain guidance for staff that clearly describes the actions to be taken to reduce risk. For example, where a person has insulin injections, an indwelling catheter, or where a person is known to have black outs. To make sure that staff know what to do to maintain residents health and safety. 02/05/2009 Care Homes for Older People Page 29 of 32 3 33 24 There must be a system for 19/05/2009 evaluating the quality of the services provided at the home, to include the regular monitoring of care practices, medications, staffing, record keeping, the environment, complaints, safety procedures and obtaining the views of residents, their representatives and any other stakeholders. Any deficits identified must be actioned and records kept. This must include a monthly visit by the provider and copies of regulation 26 visit reports must be kept available for inspection at all times. This is to make sure that the home is run in the best interests of residents. 4 38 18 Make arrangements for all 19/05/2009 staff working at the home to be provided with all their outstanding mandatory health and safety training for example, fire safety, first aid and moving and handling. Confirmation of training dates to be provided to the commission. To ensure that staff have received appropriate training for the work they are to perform and to keep people safe. Care Homes for Older People Page 30 of 32 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 9 To carry out regular medication audits and staff medication competency assessments. This is to make sure that any errors are promptly picked up and actions taken so that residents medications are handled safely. To consider providing a telephone in the newly created staff office so that staff do not have to make phone calls about residents care in the dining room where they may be overheard. This is to make sure residents privacy and dignity is maintained. To develop more person centred care plans to include a personal profile for each resident and more about equality and diversity issues. To make sure that residents experience the lifestyle that matches their expectations and preferences and satisfies their social, cultural, religious and recreational wishes and needs. 2 10 3 12 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. 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