Inspection on 25/02/09 for Mount Elton

This inspection was carried out on 25th February 2009.

CSCI found this care home to be providing an Good 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.

Other inspections for this house

Mount Elton 09/03/07

Mount Elton 20/10/05

Mount Elton 03/05/05

Mount Elton 14/12/04

Mount Elton 20/05/04

Mount Elton 26/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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: Mount Elton 25 Highdale Road Clevedon North Somerset BS21 7LW     The quality rating for this care home is:   two star good 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: Patricia Hellier     Date: 2 6 0 2 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 31 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 31 Information about the care home Name of care home: Address: Mount Elton 25 Highdale Road Clevedon North Somerset BS21 7LW 01275871121 01275343245 menh@fsmail.net 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) : Churchill Property Services Limited care home 24 Number of places (if applicable): Under 65 Over 65 24 old age, not falling within any other category Additional conditions: 0 24 Patients aged 50 years and over, and 1 Nursing Patient in Bedroom 5 until vacated Manager must be a RN on Parts 1 or 12 of the NMC register Staffing Notice dated 06/01/2000 applies Date of last inspection Brief description of the care home Mount Elton is a converted Victorian house situated on the Clevedon hillside providing nursing care for up to 24 older people. The home is well maintained, comfortably furnished and has a homely atmosphere. Accommodation is provided in 12 single and 6 double rooms, arranged over 3 floors. Eight of the single rooms, and two of the shared rooms have en suite facilities. These are individually decorated in keeping with the character of the building. Many rooms enjoy panoramic views over the surrounding countryside. A passenger lift and built in ramps offer access to all areas of the home. The grounds are well maintained, and are used for a variety of social events over the year. The home has been suitably adapted for the current resident client group with handrails in corridors and grab rails in toilet facilities. The home has a nurse call bell Care Homes for Older People Page 4 of 31 Brief description of the care home system throughout. There is a Registered Nurse on duty at all times. An Activities coordinator is employed one day a week and provides a varied programme of creative activities for groups and individuals according to need. The fee range was stated as 565.00 pounds up to 575.00 pounds. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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 key inspection took place over nine hours on two days. The manager, Karen Jacob, who is in the process of applying for registration with the Commission, was present throughout the inspection of the home. Before the inspection we reviewed all correspondence and regulatory activities since the last key inspection. Following the draft Annual Service Review last year and providers response a random inspection was undertaken to ascertain the outcome for residents. The findings of this inspection were that the outcomes for residents were good, and that difficulties relating to the change in management were being addressed. We reviewed the completed Annual Quality Assurance Assessment (AQAA), from the Care Homes for Older People Page 6 of 31 provider together with the last inspection report we also sent confidential surveys to people who use the service and had the following responses: Resident surveys x7; Staff surveys x3; Healthcare Professional surveys x2. During the inspection we spoke with the manager, the administrative manager, eight residents, three relatives, and six members of staff. We observed care provision and practices and reviewed documents relating to care, recruitment and health and safety. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 of 31 Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide is comprehensive and provides prospective residents with information to make an informed choice. The homes assessment process is thorough and person centred, to ensure the home can meet the needs of prospective residents. Prospective residents and relatives are encouraged to visit the home to assess suitability. Evidence: We saw that prospective residents continue to receive an introductory pack, which includes the homes Service User Guide. This provides them with a lot of information about the services and facilities that are available. The Statement of Purpose should be updated to include current information about the Regulator of services - the Care Quality Commission. A recently admitted resident, and their relative, told us they had received good information about the home and its daily programme. Care Homes for Older People Page 11 of 31 Evidence: All residents were aware they had a contract of residency and were happy with the provision that they receive. Three residents files were inspected and showed that all privately funded residents receive a contract of Conditions of Admission and Terms of Business. Those who are publicly funded receive a copy of the Terms and Conditions document which forms the contract agreement. While these contracts provide opportunity for clear information about the breakdown of fees, outlining the contributions to be made and by whom to make up the weekly chargeable amount, this had not been confirmed. Thus residents and their relatives were not clear about the contribution amounts. Care needs are well met through a full, person centred assessment process and the completion of the care plan from this information, as evidenced in the four care plans inspected. The assessment information clearly documents all aspects of physical, mental, social and emotional needs providing staff with a good knowledge base from which to provide person centred care. A plan of care to meet the new residents needs is developed from the assessment information. The assessment includes all the elements listed in the standard. The assessment was seen for one recently admitted resident, which contained the key details for person centred care, and the outcome of the assessment. However it did not state whether the home felt they could meet the needs or not. It is required that this is documented, and written information sent to the prospective resident, or their relative, confirming this. The resident when spoken with told us the staff are kind: they know what I need and look after me well. Care practices observed showed the staff are fully aware of the residents needs as stated in their assessments. Prospective residents are encouraged to visit the home and assess the quality and facilities of the home for themselves. In the AQAA we are told month-long trials are encouraged if prospective residents are uncertain. Several respite clients have become permanent residents. Two people spoken with told us I am very happy at Mount Elton. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive care that is person centred and meets their health and social care needs. Residents are not always protected by safe practices in the management of medicines. Residents dignity and respect is maintained by kind and caring staff. Evidence: Individual records are kept for each of the residents and include details of personal preferences and interests, reflecting a person centred approach. Three care plans were inspected and all reflected clearly, current identified health and social care needs. Actions to meet identified needs were recorded and regular evaluation noted to ensure provision of appropriate care for residents. Relative involvement was seen in two of the care plans inspected in relation to consent the use of bed rails. Four residents spoken with told us their care needs had been discussed with them and specific arrangements made to meet their individual needs. Care plans and activity records inspected verified this. Good practice was seen in one care record in relation to communication with people with visual impairment. Care Homes for Older People Page 13 of 31 Evidence: In the three care plans inspected there was clear and informative information about choices and preferences for daily life and food. Two of the care plans contained good information about the individuals life history, family and contacts. The information also described the persons hobbies, sociability and preferred activities, to enable staff to provide person centred care. In one care plan the recognition of areas of psychosocial needs had been well documented and developed to assist staff in understanding and meeting the needs of the residents. Staff when interviewed were able to tell us about the physical care provision and the psychosocial needs of these residents, and how best to meet them. All care plans contained manual handling, nutrition, falls and pressure sore risk assessments, with the outcomes being used to inform the provision of care. Other personal and environmental risk assessments were present to ensure the safety of the resident while promoting independence within the individuals capability. Good practice was seen in the manual handling risk assessment of one care record, which described how manual handling practices may be affected by the individuals of mood and behaviour. Pressure relieving equipment was seen in use in a number of areas in the home and staff were able to describe the principles of pressure relief management, for the benefit of residents. In one file management of the pressure sore had been clearly described, and the wound care chart gave full and clear information about the size and management of this wound. It also contained information about the progress of the wound. All identified risks had been translated into the care plans to meet the needs identified and reduce the risk for the safety and well-being of the residents. Daily records were up-to-date and written in a respectful manner with clear documentation of visits from other professionals, demonstrating good interprofessional working. We observed staff talking with residents in a respectful and sensitive manner. All staff spoken with displayed a good knowledge of individual needs and it was apparent that they were very committed to giving residents what they needed. Residents told us it is a nice home, we are well looked after. The staff are always kind and approachable - nothing is too much bother. I am very happy here. We are very pleased with the new matron and she takes part in everyday jobs and helps us. One relative praised the home for the way in which their mother is cared for they have all the specialist equipment needed to help mum, and she is very happy. Feedback received from staff surveys told us they feel that the home creates a very Care Homes for Older People Page 14 of 31 Evidence: relaxed family atmosphere, and provides a high standard of nursing care. Feedback received from Healthcare Professionals told us there is good communication between senior nursing staff and GPs. Very impressed with the care, skills and knowledge of the staff. Provide a friendly caring environment with good communication and concern for people in the home. The management of medicines is satisfactory, in the main, and good practice was observed in the dispensing and disposal of medication, during the lunchtime period. Medication Record Sheets (MAR) showed no gaps and clearly recorded when medication had been refused or omitted for some reason. It was not possible to follow an audit trail of medicines entering and leaving the home. This gives room for potential mismanagement of medicines to the detriment of the health and well-being of residents. All residents spoken with felt that kind and caring staff respected their dignity and privacy. One resident stated they always knock on the door: and another said they are always polite and ask what I would like. One incident of poor practice was observed when a carer walked into a residents room without knocking and spoke in a sharp voice. We were told, and observed later in the inspection, that this is due to language difficulties. We observed that portable screens are used in shared rooms, but not all shared rooms have their own set of screens. This could potentially mean that the residents dignity is compromised, and not respected. It is recommended that all shared rooms have their own screen facilities, to promote and safeguard the dignity of residents. The home has an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. The staff team is international and has experience of equality and diversity issues. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs of residents, as and when they should arise. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a social activity programme to provide variation and interest during the week. Residents right choice and control over their lives is respected, and encouraged. Residents are provided with a choice of nutritious meals to meet their needs: and know their relatives and friends are welcomed. Evidence: Time was spent with residents in the communal areas of the home. Residents were happy to chat about daily life at Mount Elton and the care and service they receive. One resident told us the staff are very kind and do all they can for you. Another resident told us staff are very busy but they help you when they can, they are sometimes slow to respond. Residents appear to be happy and content. Feedback from residents surveys told us you have to request help through other residents, and the call bell is not always working , and observation during the inspection confirmed this. In discussion with the staff we are told the call bell system is checked weekly and records inspected confirmed this. On the day of inspection the call bells in the communal area were working effectively. Staff also told us the call bell in the communal areas is given to the most alert resident, who is able to call for help for any resident when needed. Care Homes for Older People Page 16 of 31 Evidence: The manager informed us that activity provision has been limited in recent months, due to staff shortages. She told us a member of staff has now been allocated hours for this provision, and a programme of events and activities is being planned. A poster displaying forthcoming activities was seen in the hall area of the home. Feedback from residents told us activities are few and far between: there is a musical afternoon once a month. More gentle exercise might be a good idea. Also quizzes and craft activities. I understand chair exercises might be starting soon. Records inspected showed a variety of activities had been provided in recent months. All residents spoken with enjoy the outings arranged at varying times in the year. Residents told us they are able to arrange the day as they see fit. Spiritual needs are catered for by local clergy visits and other spiritual leaders as requested. Residents are able to personalise their bedrooms and have their aides to daily living to maintain a level of independence. One communication aid was seen in use, and a large button phone was also seen. Specially adapted plates and cutlery was seen in use to assist residents in eating their meal. Residents told us food is good on the whole. Two residents told us if they do not like the menu an alternative is offered. Feedback from residents surveys told us sometimes puddings are too much milk based. In discussion with the cook we were told she discusses menu choices for the next day with all residents, on a daily basis. Residents and relatives confirmed this. On the day of inspection residents were seen eating lunch in the lounge area, which was of concern to us as they effectively remained in one room throughout the whole day. In discussion with the manager we were told the dining room is in the conservatory and it has been very cold in recent weeks, so meals have been taken in the lounge. We plan to start using the dining room again now the weather is warmer. Menus showed a varied, balanced and nutritious diet. The meal on the day of inspection reflected this. An inspection by the Environmental Health Officer (Food) was undertaken last December and the home was awarded four stars, indicating a good standard of practice. Recommendations from this inspection have been implemented. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their concerns will be listened to by a caring staff team. The home has good systems in place of the protection of vulnerable adults. Evidence: The home has a comprehensive complaints procedure and all residents receive a copy on admission. A copy is also displayed on the noticeboard in the hall. It is recommended that timescales for response to a complaint are included in the procedure to provide clear information to the complainant. All residents and relatives spoke with during the inspection were aware of the complaints policy. There have been no complaints since the last inspection. Residents stated that if they were not happy about anything they would speak to a member of staff or the manager. Staff and residents spoken to, say the new manager is very approachable and understanding. Two residents said Ive nothing to complain about its a lovely home. Facilities to maintain a record of complaints received, with actions taken and outcomes are available, to ensure issues raised inform the running of the home for the residents benefit. Residents are on the polling list and are facilitated to make use of the postal vote if they so wish. Care Homes for Older People Page 18 of 31 Evidence: Residents are protected through a comprehensive policy and procedure for responding to allegations of abuse, together with the Local Adult Protection (No Secrets in North Somerset) guidelines. The home also has a Whistleblowing policy and staff said they would report any concerns to the manager. Staff said they had never seen any signs of abuse in the home, and demonstrated a good understanding of what abuse is. Staff said they have received training in the recognition and handling of abusive situations for the safeguarding of residents. This was verified during inspection of training records. Residents are therefore protected from abuse by good care practices. Care plans inspected showed that consent to the use of bed rails had been obtained from a relative of the resident, where the resident was considered as not being able to consent themselves. There was no evidence to suggest that these residents lacked capacity, or that their liberties had been considered under the Mental Capacity Act 2005. Where people are assessed as lacking capacity to give consent; consent should be obtained either through the use of an IMCA or via a multidisciplinary approach, and not just from a relative. It is recommended that policy guidance is sought and implemented to safeguard residents. The manager told us that training about the Mental Capacity Act 2005 is now being provided, as two of the registered nurses have undertaken training to be Mental Capacity Act specialists. However a programme for the provision of this training was not available. It is required that this is provided within the next two months, to ensure the safety and protection of residents. All residents spoken with told us the staff are kind and do their best. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with homely, safe and comfortable surroundings. Residents benefit from the clean and well presented home which has suitable equipment to maximise resident independence. Robust infection-control practices are followed for residents protection. Evidence: Mount Elton is a large Victorian home on the hillside above Clevedon. It has extensive and well maintained grounds which are accessible to residents and their families. The outside of the home is looking shabby and in need of attention, and the driveway requires repair. This does not present a particularly caring or welcoming environment, and does not do justice to the respect afforded to residents within the home. The home is nicely decorated and well maintained with a welcoming atmosphere, and has homely communal spaces. Residents rooms are personalised and comfortable. The decor fixtures and fittings are in good order. In the AQAA we are told we have redecorated the sitting rooms and upgraded the bedrooms as they became vacant in the last 12 months. Residents and relatives spoken with told us the accommodation was nice, and they liked the outlook and gardens. Maintenance and refurbishment plans and records are kept to ensure the homes Care Homes for Older People Page 20 of 31 Evidence: environment is maintained at a satisfactory standard for the comfort of residents. Also the home has aids and adaptations to assist staff to appropriately care for residents and meet their needs in a safe and comfortable manner. There is a shaft lift connecting all floors. On the day of inspection this broke down twice, but was repaired within a short space of time. The lift is old and small and does not provide for good practice when moving residents around the home, as staff are unable to take a wheelchair with footplates in it, thus residents feet are left dangling. The repair/ replacement of the lift is required to provide a safe and reliable service. The home has grab rails situated at relevant points to assist residents mobility around the home in a safe manner. The home was clean and free from offensive odours throughout. The laundry facilities were well organised, the requirements and recommendations from the last key inspection have been implemented. Staff interviewed and observed demonstrated good understanding of infection control procedures and practices, and maintained a clean and hygienic environment. The home has good facilities for ensuring that staff can maintain handwashing practices between caring for residents. The home has a fire alarm system, detection equipment and fire extinguishers that are all well maintained. Further issues regarding fire protection are discussed in the Management and Administration section of this report. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by a sufficient number of competent, trained staff. Residents are protected by safe recruitment practices. Evidence: The staffing rota for the two weeks prior to the inspection were reviewed. Staffing levels appear to provide sufficient care staff to meet residents needs. Times of greater activity, and therefore an increased need of staff have been recognised, and an extra person rostered to work these hours, known as the twilight shift. This is good practice and is to be commended. A good team of ancillary staff supports care staff. In discussion with residents they told us the staff are very good and come when you need them. Another comment received from three residents told us you sometimes have to wait as staff are slow in answering the bell, as they are probably with somebody else. Recruitment procedures are satisfactory. Two recruitment files were inspected one contained all required information and the second lacked an application form. The latter had been recently recruited through an employment agency and we were informed that the application form was still with the agency. It is recommended that all required documentation is kept in the home. All staff interviewed stated they had contracts of employment and job descriptions, this was verified in their personnel files. Care Homes for Older People Page 22 of 31 Evidence: Newly appointed staff confirmed they had completed a brief induction programme and evidence of this is seen for staff in their personnel files. These records had been signed and dated by both the employer and the new employee thus ensuring the employee has understood the induction and feels able to work safely in providing care for residents. The home provides mandatory training with clear records of attendance and renewal dates to ensure staff knowledge remains current for the well-being of residents. Nursing staff told us they had received update training and this was verified in the records inspected. This ensures that residents are cared for by staff with current best practice knowledge and skills, for their safety and well-being. Staff when interviewed confirmed they had received training in all mandatory topics, and some specialist areas. They demonstrated a good knowledge and understanding of these topics for the safety and well-being of residents. Staff spoke of the high priority given to training by the management. Although the home views training as important it has less than 50 of care staff with a National Vocational Qualification (NVQ) level 2 or above. It is currently facilitating some staff in obtaining this qualification to ensure residents needs are met by wellqualified, competent staff. All observed interactions between staff (except the one mentioned in the Health and Personal care section) and residents were kind and thoughtful, demonstrating good rapport and understanding between them. Residents commented that the staff are kind and helpful. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager provides clear leadership and guidance to staff to ensure residents receive consistent care. There is no formal system to ensure residents can be confident that the management process consults with them over the running of the home. Residents can be confident that monies held for them by the home are wellmanaged. Health and safety issues in the home are monitored and addressed in a timely way for the protection and safety of residents. Evidence: The manager is a qualified nurse with many years experience in a variety of areas, and holds a management qualification. She is currently in the process of registering with the Commission as manager. She gives clear leadership, guidance and direction to staff, and residents feel she is approachable and seeks to ensure all their needs are met. Residents told us they like the new manager saying the new matron takes part in everyday jobs. She is very approachable. Another resident told us we are very pleased with the new matron, she is on the ball and gets things done. All six staff Care Homes for Older People Page 24 of 31 Evidence: interviewed stated they felt well supported by an approachable manager. Policies, and practice guidance, are provided in the home. These ensure staff are provided with current good practice advice for the benefit of residents. Staff are aware of the policy folder and can access it as needed. From the information provided on the AQAA we noticed that a number of policies are out of date and in need of review. This is recommended to ensure current good practice guidance to all staff, for the safety and well-being of residents. The manager and staff seek to listen to comments from residents,visitors and relatives and to incorporate these views into the running of the home. Formal systems for this are not in place at present, however the manager is aware of the need for this and is currently developing a system. This will ensure that all residents, and their families, have a say in the running of the home and are kept informed, and consulted, on new developments within the home. Residents and relatives spoken with told us they are always encouraged to express their views. One resident told us the manager is very proactive and helpful in many ways. The management of residents of monies by the home were inspected. No cash is held by the home as all residents have an account of extras for which they are billed monthly. Supervision for staff has been minimal since the last key inspection. This does not provide monitoring of practice to ensure staff competency in practice, for the benefit of residents. Evidence was seen that annual appraisals are currently being undertaken for all staff, to identify training and development needs to ensure they have the skills and knowledge to meet residents needs in a person centered manner. The manager informed us that she is planning to implement a system of regular supervision for all staff within the next three months. A maintenance man is employed and ensures that all aspects of the home are safe and well maintained for the protection of residents. Records inspected indicated regular safety and fire checks are carried out. Staff spoken with confirm that regular fire instruction and drills has taken place. Records indicating regular maintenance to gas and water systems were seen together with servicing records for all equipment. During the inspection a number of fire doors were wedged open, and would therefore be unable to close should the fire alarms sound. This does not adequately protect residents should a fire occur and a requirement for a safe system to protect residents Care Homes for Older People Page 25 of 31 Evidence: has been made. The manager told us that the home was due to have an inspection from the Fire Safety Officer in two weeks time. We are confident that any other serious issues of concern regarding fire will be raised during this inspection, and requirements for actions to maintain the safety of residents, if required, will be made. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 5A The registered person must provide to each resident a statement about the fees and how they are to be made up Fee amounts should be shown in the fee breakdown information to ensure people have the full information in respect of charges 02/04/2009 2 9 13 The registered person to 13/04/2009 ensure a safe system for the management of medicines entering and leaving the home. To provide a clear audit trail to ensure medicines are not mismanaged and residents are protected. 3 17 13 The registered person shall make arrangements for the protection of residents from abuse Residents who are not able to consent to the use of 13/04/2009 Care Homes for Older People Page 28 of 31 bedrails and other forms of constraint should be provided for under the provisions of the Mental Capacity Act 2005. 4 19 23 The registered person should ensure that the premises are kept in a good state of repair externally and internally. To ensure residents safety especially in relation to the lift. 5 36 18 The registered person shall 30/04/2009 ensure that persons working at the care home are appropriately supervised. To ensure residents are cared for and protected by competent people 6 38 23 The registered person shall ensure that there are adequate systems in place to contain fire To ensure that residents in rooms with doors that are wedged open , or do not close flush to frame are protected 13/04/2009 23/04/2009 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 1 The registered person to ensure that the Statement of Purpose and Service User Guide contains current information about the regulatory body. Page 29 of 31 Care Homes for Older People 2 3 4 3 9 10 The registered person should write to prospective residents to confirm that the home can meet their needs. The registered person to ensure that the homely remedies policy is current and agreed by the local doctors. The registered person to ensure that all shared rooms have their own screens to ensue the protection of residents privacy at all times. The registered person should ensure that timescales are included in the complaints policy to provide clear information to the complainant. The registered person should decorate and repair the outside of the home to show respect for residents living there and to reflect the standard inside the home. 5 16 6 19 Care Homes for Older People Page 30 of 31 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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