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Inspection on 01/04/09 for Mount Pleasant, St Agnes

Also see our care home review for Mount Pleasant, St Agnes for more information

This inspection was carried out on 1st April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

People who use the service, who we spoke to, said they were happy living in the home. They said staff were caring and supportive. From our formal observation we concluded that people were content and well cared for within the timeframe of the exercise. Food provided is to an excellent standard. There is a genuine choice and people`s needs and wishes in this area are catered for.

What has improved since the last inspection?

The registered provider has made significant improvements to the service since the last key inspection in October 2008. This includes the operation of the medication system, improvements to the facilities and decoration of the building, improvements to staff recruitment, induction and training, improvements to health and safety precautions, improvements to policies and other documentation. We are also pleased to see the registered provider has been much more active in responding to statutory requirements issued.

What the care home could do better:

Although all people living in the home have a care plan, and these are reviewed; further development is required to information contained in care plans to guide staff. Some development is still required to the home`s adult safeguarding procedure. However, we do not have any concerns regarding abuse of people living in the home. Improvement is also required to the home`s quality assurance policy. We will continue to actively monitor standards in the home e.g. requesting the provider to complete an Improvement Plan regarding outstanding requirements, and we will complete a random inspection before the next key (full) inspection. This will help to check improvement is being sustained. We are however very pleased with the improvements which have occurred at this service, and it is clear people involved have worked very hard to achieve this improvement.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mount Pleasant, St Agnes Rosemundy St Agnes Cornwall TR5 0UD     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: Ian Wright     Date: 0 1 0 4 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 33 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 33 Information about the care home Name of care home: Address: Mount Pleasant, St Agnes Rosemundy St Agnes Cornwall TR5 0UD 01872553165 01872553776 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) : Mrs Susan Ann Sear,Mr Godfrey William Sear care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Additional conditions: 0 To accommodate one named service user under the age of 65 years (62 years) Date of last inspection Brief description of the care home Mount Pleasant is located near the centre of St. Agnes. The registered providers are Mr G Sear and Mrs S Sear. Mount Pleasant provides accommodation and personal care for up to 22 older persons. The accommodation is on one level; there is full access around the home for people who use the service. There are 20 rooms of which 18 are for single occupation and two shared rooms. The majority of bedrooms have an en-suite toilet and washbasin facilities. Communal areas and rooms are decorated and furnished to a satisfactory standard. The kitchen area is clean and organised. The house is set in well laid out gardens, with pleasant views of the town and countryside. There is satisfactory parking for visitors. The home is close to local amenities with access to transport links into the main city of Truro. Care Homes for Older People Page 4 of 33 1 4 1 0 2 0 0 8 Brief description of the care home The range of fees at the time of the inspection were £308-£410. A copy of this and previous inspection reports is available from the Care Quality Commission via our customer services team or website. Alternatively the registered provider should be able to provide a copy. Care Homes for Older People Page 5 of 33 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 key inspection took place in six hours in one day. All the key standards were inspected. The methodology used for this inspection was: (1)To case track three people using the service. This included, where possible, meeting and discussing with the people their experiences, and inspecting their records. (2) Discussion with staff about their experiences working in the home. (3) Discussion with other people using the service, and their representatives. (4) Observing care practices for example by carrying out a formal observation exercise. Care Homes for Older People Page 6 of 33 (5) Discussing care practices with management. (6) Inspecting records and the care environment. (7) Competing a postal survey of staff, people who use the service and external professionals who work with the service. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report.) 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 33 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 9 of 33 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. Information provided to people who use the service (e.g. regarding services offered) is to a satisfactory standard. For example all people who use the service receive a statement of terms and conditions of residency or contract when they move to the home. This ensures people are aware of their rights and responsibilities. Pre assessment procedures are satisfactory and should assist the registered provider to be clear whether they can meet a persons needs before admission is arranged. Evidence: We inspected files for three people, who had moved to the home, since the last inspection in October 2008. The registered provider and / or a senior member of staff visited these people before admission was arranged. Pre admission assessments were documented and contained on peoples files. We were able to inspect contracts for people admitted to the service. These seem to Care Homes for Older People Page 10 of 33 Evidence: be to a satisfactory standard, and we were told a copy is provided to the person using the service and / or their representative. Care Homes for Older People Page 11 of 33 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. Generally people appear happy with their support and care, although we have been concerned about the care of some people who used the service in the past.Although people have care plans, some of these currently do not satisfactorily detail peoples care needs and review does not occur each month. The management of medication is satisfactory. Evidence: A care plan is contained on each service user file we inspected. There is evidence these are reviewed. Care plans are accessible to staff. People who use the service, who we spoke to, were generally positive about the care they received. However, we still think the system needs further improvement. For example: (1) Care plans need to provide sufficient detail to guide and inform staff regarding care required. (2) Care plans should be completed in consultation with the person and/or their representative. The care plan should be signed by the person and/or their representative. (3) Social / leisure choices and preferences need to be recorded. (4) Care Homes for Older People Page 12 of 33 Evidence: Baths / showers should be recorded e.g. in daily notes. (5) Some of the phraseology used by staff in care plans and notes should be more objective. For example one comment was a person sometimes can be lazy eating which we would regard as judgemental and negative, and there does not appear to be any guidance for staff regarding what they need to do to assist the person. The inspector discussed what improvements are required to the care planning system with Mrs Sear and the assistant manager. The management said they do want to improve the system and will be looking at how this can be achieved. We inspected the medication system. Storage of general prescribed medication is satisfactory. Medication records are appropriately maintained. Storage and recording of controlled drugs is satisfactory. We suggested the medication trolley should not be stored in the dining room as it detracts from trying to create a domestic type setting. Staff, who administer medication, appear to have received formal training regarding medication. We spoke to several people who use the service who were complimentary about the care they received. People said they felt their privacy and dignity was respected by staff. People said they were always referred to by their preferred name. We did however note people were at times referred to by pet names such as dear. Although we understand why staff do this, and that it may be appreciated by the person concerned, we trust this has been agreed with the person concerned. We completed a Short Observational Framework for Inspection exercise at the home. This methodology was developed by the Commission for Social Care Inspection (which was the regulatory body which existed prior to CQC) and Bradford University, which has an specialist academic interest in dementia care. We use the tool primarily in homes which accommodate people with dementia or severe learning disabilities. Although this home does not cater for people with these needs, the tool is useful to observe other vulnerable people in care settings. The methodology used for SOFI is for the inspector to, for example, sit in one of the communal settings in a care service. Subsequently the observer records at five minute intervals whether people using the service appear contented, whether they are engaged in some form of activity, and whether staff positively work and communicate with them. The observation is carried out for a two hour period. Our observation was carried out in the main lounge of the home, between 11am and 1pm. Although there was no planned activity during the time period, the people observed were engaged with their own personal activity (e.g. reading) and /or talking Care Homes for Older People Page 13 of 33 Evidence: with each other or staff. Others may have been asleep at times, or sitting quietly. People seemed generally content. The hairdresser visited the home, and some people had their hair done during this period. For the majority of time people appeared to be positive in mood, with a minority of people asleep for some of the time of the observation. Staff were not present for significant periods of time, although they were engaged in appropriate care tasks around the home. It was safe to leave the group in the lounge alone, and we did not believe people to be neglected in any way. When staff were present, interactions with people using the service were generally positive, and we had no reason to have any concerns regarding staff attitudes towards people using the service. In the past year we have had some concerns regarding the care of some people using the service. Some of these concerns centred around some of those with complex needs. We have been involved in the investigations of these matters and discussed these matters in depth with the registered provider. These matters were investigated via the local authority safeguarding procedure. Information regarding these matters are contained in previous inspection reports 2007 and 2008. These reports are available from us. The key learning for the provider is to ensure: (1) Pre admission assessment procedures remain thorough and the home only admits people for whom it can meet their needs (e.g. in line with groups it is registered to provider care for, and in terms of the numbers and skills of staffing). (2) If and when people become ill or develop higher needs; and the home is finding it difficult to meet those needs (e.g. in terms of the numbers and skills of staffing), appropriate links are made with district nurses, other health staff and the Department of Adult Social Care). Subsequently, multi disciplinary team care packages would need to be developed, so the persons needs can be appropriately met. If the registered provider does not believe they are getting a satisfactory response from statutory services, such concerns should be put in writing to the appropriate authority, and copied to the relevant care manager and CQC. If it is not possible for the persons needs to continue to be met at the home, an alternative placement needs to be sought by the multi disciplinary team. The person concerned (and their representatives) need to be involved throughout the process. (3) Any concerns should be discussed with the link inspector at CQC, who may be able to provide suitable guidance. (4) Suitable care planning and review needs to be maintained by senior care staff. Care Homes for Older People Page 14 of 33 Evidence: These matters have been discussed fully with the provider by the commission, local authority personnel and also other personnel from health services, who were involved in the Adult Safeguarding process. We completed a survey of people using the service, external professionals, and staff. We received an excellent response; the majority of people were very happy with the service. Respondents included external professionals such as the GP who said they had no concerns about the operation of the service. Care Homes for Older People Page 15 of 33 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. Routines, food and opportunities meet the needs of the people living in the home, although there could be further development of activities available to people living there. Evidence: People using the service, who the inspector spoke to, said they could get up and go to bed when they wished. Routines in the home appear relaxed. There was a nice friendly atmosphere in the home on the day of the inspection. There are not many structured activities available in the home. The registered provider has said it is difficult to motivate people to participate in these. The registered provider should however persist in trying to find meaningful activities; for example some people may wish to help in the garden or with small household tasks such as laying the table, and this should be encouraged. It would be good if staff can have time to spend with people using the service; for example reading the paper with them, chatting with them etc. For example our SOFI observation (See Health and Personal Care section of report) tended to show staff Care Homes for Older People Page 16 of 33 Evidence: were just in and out the lounge, rather than there being time to spend with people. Staff members said they do try to get people to participate in doing things. Books are available in the home if people want to read. There is a religious service once a fortnight. People who did not wish to have any organised activities appeared happy to organise their own time. Our SOFI observation showed people seemed content during the observation period. Some people receive regular visitors, and some people go out with relatives. People are very positive about the food provided. This appears to be to a high standard. There is always two options of main meal at lunch time, and people living in the home were very complementary about the standard of food. There is also a choice of evening tea, and people appear to have hot and cold drinks / snacks available to them. Tea and coffee making facilities, and fresh fruit were available in the small lounge. We regard standards in the area of food and meals as excellent. Care Homes for Older People Page 17 of 33 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. The registered provider has a satisfactory complaints policy, although some minor amendments need to be made. The adult safeguarding procedure needs improvement, and the previous requirement is renotified. Improvement in this area should help to assist in giving people who use the service more confidence about how adult safeguarding processes are managed by the registered providers. We hope the registered provider has learned from previous complaints and safeguarding concerns, but we will continue to actively monitor the home to ensure complaints and safeguarding issues are managed appropriately. Evidence: The registered provider has a complaints policy. This is generally satisfactory; although it now needs updating to give details of how to contact the Care Quality Commission. We also suggest the complaints procedure issued to people who use the service (e.g. as part of the service user guide) contains details of relevant social service department complaints procedures. If people receive funding via the local authority (or health authority) they have a statutory right to use these procedures. The adult safeguarding policy has been rewritten. However it still fails to address the issues raised in our last inspection report dated 14th October 2009. For example we made a statutory requirement for the registered provider to develop the policy so it is more robust. It needs to detail reporting procedures (e.g. outlining Cornwall Council as Care Homes for Older People Page 18 of 33 Evidence: the coordinating agency for investigations, including contact addresses and phone numbers for appropriate agencies). This requirement is therefore renotified. An adult safeguarding conference was held in February 2009 to discuss previous concerns particularly in regard to two people who used the service (for example see inspection report dated 14th October 2009). There have not been any further adult safeguarding alerts, concerns or complaints regarding this service since the last inspection. The safeguarding conference concluded that: (1) The registered persons needed to attend adult safeguarding training (which they have done). (2)The council continue to provide on going assistance to the home to bring about improvement, from its specialist improvement team (which is ongoing). (3)The registered provider should seek help and advice from various agencies (as outlined in the Health and Social Care section of this report). This is still on offer if their are difficulties in providing support and care for people accommodated at the home. We assessed training records for eight staff. Five of these staff have attended adult safeguarding training. The registered provider needs to continue to ensure other staff attend this training, as it becomes available. All staff files assessed contained a Protection of Vulnerable Adults First check (to ascertain people employed are not on a list of people unsuitable to work with vulnerable people). Staff also have a full Criminal Records Bureau check (to ascertain staff do not have any criminal convictions etc. which would deem them unsuitable to work with vulnerable people). Care Homes for Older People Page 19 of 33 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. Mount Pleasant provides a satisfactory environment for the people living there. Evidence: The building was inspected. There is suitable shared space, for example, a large lounge and dining room. There is also a small quiet area with seating, and this area also includes fresh fruit, and tea/ coffee making facilities which people using the service can access. Communal lounges are generally pleasant and homely. Toilet and bathroom facilities are suitable in size and facilities provided. The registered provider said she will continue to upgrade the facilities e.g. new carpets and improved decorations, as finances allow. Bedrooms are decorated and furnished according to individual tastes. Some have been refurbished since the last inspection. People who use the service said they were able to bring their own furnishings and belongings with them when they moved in. The building seems maintained to a satisfactory standard. There was a problem where some of the double glazed window panes needed replacing and this has been done. The home was warm on the day of the inspection. Radiator covers need to be fitted, as outlined in our random inspection report dated 27th January 2009. The registered provider said she would ensure this matter was addressed, and was currently looking Care Homes for Older People Page 20 of 33 Evidence: for a suitable supplier. We previously received concerns that there was an inadequate supply of hot water, but this problem now seems rectified. For example, when we asked them, none of the people who work or live in the home expressed any further concerns to us about this matter. Thermostatic valves have been fitted to all hot water taps. We advised the registered provider to check water temperatures, at regular intervals e.g. weekly/ monthly, and record the temperature to ensure the valves are working correctly. The building was generally clean and hygienic on the day of the inspection. A cleaner is employed at the home. Laundry facilities appear adequate, although floor covering needs replacing. The registered providers have stated in the Annual Quality Assurance Assessment (AQAA), returned to CSCI dated 08/09/08, that the laundry flooring would be replaced in the next 12 months with a washable surface. Care Homes for Older People Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels appear satisfactory to meet the needs of people currently accommodated at the home. Staff were viewed positively by the people we spoke to. Recruitment and training records are now to a good standard. The registered provider needs to develop a proactive approach to ensure these standards are maintained. Good quality recruitment and training standards help to ensure people who use the service receive good quality care from people who are deemed fit, skilled and knowledgeable to work with vulnerable people. Evidence: On the day of the inspection there were three care staff on duty from 07:00 to 14:00, and two care staff on duty from 14:00 to 21:00. A cleaner is employed and was on duty during the morning of the inspection. A cook was on duty in the morning, and a second cook was on duty from 16:30 to 20:30. An administrator has been employed and works during the day. One waking night member of staff is on duty from 21:00 to 07:00. The registered providers live in the neighbouring bungalow. The record of staff hours (recorded in the house diary) appears to show there is satisfactory staffing levels provided for the people currently accommodated. Personnel records were inspected for eight staff (i.e. staff on duty during the 24 hour period on the day of the inspection). Recruitment and personnel records were Care Homes for Older People Page 22 of 33 Evidence: satisfactory. For example all files contained an application form, most people had two references (for example for all people employed since the last inspection) and a Criminal Records Bureau check (CRB). People employed since the last inspection had a Protection of Vulnerable Adults First check (POVA First). Only some people had evidence of their identity (although this must have been seen when a CRB was applied for). A copy of this needs to be kept on file. All people had a self declaration of medical fitness as required by the regulations. We looked at whether staff had a National Vocational Qualification in care. According to the records assessed, four people had a copy of an NVQ certificate in care on file. The registered provider has said people can obtain an NVQ 2 in care when they come to work at the home. We checked records of training staff have received. By law staff require the following training: (1) Regular fire training in accordance with the requirements of the fire authority. (2) There must always be at least one first aider on duty (at appointed person level) (3) All staff must have manual handling training and regular updates of this (e.g. annually) (4) All staff must have basic training in infection control. (5) Staff who handle food receive food hygiene training. (6) All staff must have an induction and there needs to be a record of this. In regard to the thirteen records assessed: (1) All but one member of staff had a record of fire training. (2) Seven people had a valid first aid certificate. On the day of the inspection there was satisfactory first aid cover during the day, and at night. (3) All staff had received manual handling training in either 2008 or 2009. (4) Four staff had a record of receiving infection control training. One person is booked to do this training shortly. The other staff still need to receive this training. (5) Six people had food hygiene training. The other staff need to receive this training Care Homes for Older People Page 23 of 33 Evidence: as necessary (i.e. if they handle food). (6) Staff who have commenced employment since the last inspection have a record of formal induction since they commenced employment. We received one comment in a questionnaire from a professional that it would be helpful if staff received some training regarding mental health and /or dementia. We agree this would be useful if people living in the home develop / have a diagnosis of these conditions. Care Homes for Older People Page 24 of 33 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. There has been significant improvement regarding the registered provider complying with the Care Homes Regulations 2001. This is very encouraging, but the Commission will continue to monitor compliance with the regulations based on previous concerns about the home. We need to be sure, for example via the registered providers own quality assurance procedures, that in future the registered provider will continue to monitor and ensure current standards are maintained, and there is a process of continuing improvement. Health and safety standards have improved considerably and now meet required standards. As long as these standards are maintained people who use the service can be assured they live in a satisfactorily managed and safe home. Evidence: The registered providers have owned and managed the home for nearly 20 years. Mrs Sear said she has attended a City and Guilds Advanced Management course, and an accountancy training course. Mr Sear is from an electrical engineering background. Since the last inspection there have been some developments regarding the day to day Care Homes for Older People Page 25 of 33 Evidence: management of the home. An Assistant Manager is employed and another person has been employed as an administrator. We note significant improvement regarding standards in the home since the last key inspection in October 2008. The majority of the Care Home Regulations 2001, National Minimum Standards, and statutory requirements issued at previous inspections have now been complied with. We are very pleased with this outcome. However, this does follow a period where the home has been part of the Commissions Regional Improvement Strategy, and where we have had to take some enforcement action. We hope the registered provider will continue to ensure appropriate compliance with the standards and regulations. We have made it very clear to the registered provider that the Commission cannot tolerate the on going operation of poor care services. We hope the registered provider will be proactive in ensuring standards are maintained. We have completed an internal management review of the service since this inspection. We have agreed we will continue to monitor the home to ensure the registered provider continues to comply with the regulations. We have also said to the registered provider, if they need to contact us regarding advice about the regulation they can do so and we will try and assist. We inspected the registered providers Quality Management Policy. This still requires amendment. For example it needs to clearly state what the processes are at the home. As stated above, we hope the registered provider will now ensure compliance with the regulations and will monitor this. The policy needs to state how the registered provider will ensure the maintenance of appropriate standards. We note the registered provider surveyed stakeholders in June 2008, and results of this survey were positive. Our own survey results were also positive. We are encouraged by this. We assessed arrangements regarding the management of the finances of people who use the service. Records kept for the management of individual monies are satisfactory. For example receipts are provided for any expenditure completed on behalf of people using the service. Monies kept on behalf of people using the service are kept individually. We were told no valuables are kept on behalf of people who use the service. The registered provider has a health and safety policy. There is also a fire risk assessment. Testing of fire extinguishers and the fire system appears to have been completed appropriately by external contractors. In regard to fire precautions Care Homes for Older People Page 26 of 33 Evidence: emergency call points are tested weekly. Suitable checks have been completed on fire doors and fire drills have been completed appropriately. Emergency fire lighting is regularly completed. Records of fire training of staff is satisfactory. An external health and safety audit was completed in March 2009. This was a positive report. There is significantly less recommendations in the report compared with the previous audit in February 2008. The environmental health officer has visited regarding food hygiene standards (March 2009), and health and safety standards (November 2008). The results of the reports are satisfactory. Any requirements appear to have been addressed. We checked there is a satisfactory supply of protective clothing available for staff. We were told latex gloves are provided in the office, and in the bedrooms of people using the service who require personal care. Disposable aprons are provided. Most staff have infection control training, although as noted in the staffing section, some staff need to receive this. Portable electrical appliances were last tested in August 2007. These need to be tested at least every two years in line with Health and Safety Executive guidelines, and preferably annually. The electrical hardwire circuit has been tested in January 2009. This is deemed satisfactory by the contractor. There appears to be suitable precautions regarding the prevention of legionella. Moving and handling equipment has been tested and is satisfactory. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 Care plans must contain 01/02/2009 suitable detail to inform and direct staff to provide care to people using the service. Care plans need to be reviewed at least monthly. (Previous timescale of 01/08/08 not met Second Notification) Detailed care plans, which are regularly reviewed, assist care staff to provide appropriate levels of care for people who use the service. 2 18 13 The registered provider must 01/02/2009 have a suitable adult safeguarding policy. Matters outlined in the report must be addressed. Previous timescale of 01/09/08 not met. Second Notification Having an appropriate policy will help to give people who use the service, and other stakeholders, more assurance that agreed multi agency procedures will be followed when necessary 3 25 12 Fit radiator covers to storage 01/07/2009 heaters This will help to ensure the risk of scalding is minimised Care Homes for Older People Page 28 of 33 4 33 24 Further develop the quality 01/02/2009 assurance system to monitor standards in the home for example regarding care planning, medication, staff recruitment, staff training, health and safety etc. Measures taken should be included in the quality assurance policy. Previous timescale of 01/09/08 not met 2nd Notification This will help improve service quality and help minimise risks to staff and people who use the service Care Homes for Older People Page 29 of 33 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 Care plans must contain suitable detail to inform and direct staff to provide care to people using the service. Care plans need to be reviewed at least monthly. (Previous timescale of 01/02/09 not met. Third Notification.) Detailed care plans, which are regularly reviewed, assist care staff to provide appropriate levels of care for people who use the service. 01/08/2009 2 18 13 The registered provider must have a suitable adult safeguarding policy. Matters outlined in the report must be addressed. (Previous timescale of 01/02/09 not met. Third Notification) Having an appropriate policy will help to give people who use the service, and other stakeholders, more 01/08/2009 Care Homes for Older People Page 30 of 33 assurance that agreed multi agency procedures will be followed when necessary. 3 25 12 Fit radiator covers to storage 01/07/2009 heaters This will help to ensure the risk of scalding is minimised 4 30 18 Complete planned training, and ensure all staff training, required by regulation, is maintained. This will help to ensure people who use the service are supported by suitably trained and skilled staff 5 33 24 Further develop the quality 31/08/2009 assurance system to monitor standards in the home for example regarding care planning, medication, staff recruitment, staff training, health and safety etc. Measures taken should be included in the quality assurance policy. (Previous timescale of 01/02/09 not met 3rd Notification) This will help improve service quality and help minimise risks to staff and people who use the service 01/08/2009 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 9 The medication trolley should be stored in the office Page 31 of 33 Care Homes for Older People 2 16 Details of local authority complaints procedures should be included in the homes complaints procedure / individual service user guides. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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