Inspection on 07/01/09 for Oakcroft Nursing Home

This inspection was carried out on 7th January 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakcroft Nursing Home 27/03/08

Oakcroft Nursing Home 15/05/07

Oakcroft Nursing Home 15/01/07

Oakcroft Nursing Home 19/05/06

Oakcroft Nursing Home 03/03/06

Oakcroft Nursing Home 05/09/05

Oakcroft Nursing Home 31/03/05

Oakcroft Nursing Home 09/11/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oakcroft Nursing Home Oakcroft 41-43 Culverley Road Catford London SE6 2LD     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: Sean Healy     Date: 0 9 0 1 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 35 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 35 Information about the care home Name of care home: Address: Oakcroft Nursing Home 41-43 Culverley Road Oakcroft Catford London SE6 2LD 02084615442 02086980636 oakcroftnursing@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Moore Name of registered manager (if applicable) Cecilia Gwendoline Henry Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category of service only: Care home with nursing (CRH - N) 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 - Code OP Physical disability - Code PD Date of last inspection Brief description of the care home Oakcroft Nursing Home provides care for up to 28 older people and caters for respite stays as well as long-term care. The manager is experienced in the field of providing nursing care has taken up the post of manager. There has also been a substantial change in the care and nursing staff and the staff and management are well regarded by residents and families. Care Homes for Older People Page 4 of 35 care home 28 Over 65 28 0 0 28 Brief description of the care home The home is a detached house with three storeys close to Catford train station and local shops and services. The area is also well served by buses to central and south London. There is accessible off road car parking space for up to 6 cars at the front of the building. On the day of inspection there were 3 vacancies according to the homes current registration. Double rooms were now being used as singles to provide more privacy for residents. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide, which are given to all service users. The recent CSCI report is kept in the lobby area of the home open for viewing. A reference is also included in the homes newsletter. At 7/1/09 the weekly fees are #599 per week for private and publicly funded residents. These fees cover all of the homes charges including food. Residents have to pay extra for other personal expenses such as hairdressing, transport, and personal shopping. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality Rating for this service is 1 Star. This means that the people who use this service experience adequate quality outcomes. The inspection was unannounced and was completed over two days on the 7th and 9th January 2009. The homes manager facilitated it. Two care staff and one nurse spoke with the inspector and their comments are included in this report. Four staff employment files were examined to check whether they had been properly recruited trained and supervised. The inspection was supported by an Expert by Experience and a range of residents and Care Homes for Older People Page 6 of 35 some relatives gave their views on the home. Five residents files were examined to see whether they had been fully assessed and that care plans and reviews happening. Comments and information are included in the report. One healthcare professional who was visiting also gave her views. A visiting health care professional who visits the home weekly and knows the residents well gave her views on her experience of the home. Comments from the Lewisham adult protection team were also considered. There were three residents vacancies reduced from eight at the last inspection. The inspection involved a tour of the premises and examination of a range of management documentation. What the care home does well: What has improved since the last inspection? What they could do better: Residents need to have complete written contracts showing current fees and who should pay them so that the residents are aware of their rights and responsibilities. The home needs to have a better written description for each resident with dementia support needs of how they are affected by the dementia and how and when to provide support and activities. Care Homes for Older People Page 8 of 35 Risk assessments need to be reviewed every month so that staff will always know how to safely support residents. Concerns about residents safety need to be reported immediately to CSCI (CQC) so that they can make sure action is happening to protect residents. All staff training in how to protect residents and report concerns needs to be brought up to date. The home needs to always check the police records for staff before employing them. All care and nursing staff need to have supervison more often so that they will always know how they are doing and how best to support residents. The owner needs to do monthly checks to make sure that all the important management work is being done. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. All residents have adequate written assessments of their care needs in place and improvements have been made in areas regarding social and leisure needs and information about the care of dementia. Residents have written contracts in place but these need to be updated. Intermediate care is not provided. Evidence: There have been significant improvements made to the homes care assessment process and in the assessments carried out. All residents now have care assessments in place and these are being used to plan care and support for residents. Care Homes for Older People Page 11 of 35 Evidence: At the last inspection the home had started admitting residents with a diagnosis of dementia. As the home is not registered for dementia the inspector asked that they would not admit any new residents with a diagnosis of dementia without first formally agreeing with the social services whether the residents support needs were such that they would present the home with significant problems in providing a service such as risk of injury or of leaving the home without support. A Requirement was made for the home to clarify this during the referral process and they have now done this meeting the requirement. A visiting healthcare professional that works closely with the home in provision of care for the elderly said that none of the current residents have complex needs and felt that the home is able to provide for their needs. Inspection of five residents care assessments showed that the main care needs of these residents were older persons or nursing care needs. Four new residents admitted had dementia care needs but these did not present any concerns and were well managed by the home. The manager now discusses and agrees the implications of individual residents behaviours when carrying out an assessment with relevant social workers and healthcare professionals. Where dementia is a consideration during the referral process the home now ensures that a formal agreement is reached with the commissioning agent stating that the resident does not have complex support needs resulting from dementia. Care assessments now include more information about residents social leisure and exercise activities as requested at the last inspection. The home completes a Life Review assessment with the resident and family following admission which includes the persons health care support preferences - likes and dislikes and social leisure and religious interests. Care assesments examined showed theses areas are included. The homes assessment system includes a section which clearly assesses the abilities and wishes of residents in relation to the management of their finances and benefits. The home does not manage the benefits or bank accounts for any residents. Residents either do this themselves or have family or a solicitor do this for them. This has now been clarified by all of residents or their representatives in the completion of a letter sent to them by the home. Copies of this letter are held on the residents files. The home provides contacts for residents showing the service they can expect but a numer of these showed fees that were now outdated and were not dated and signed by residents concerned. In all cases the room to be occupied by the resident was not stated in the contract. The home must ensure that all residents are in posession of contacts which are dated and signed and which include all information required including current fees and rooms to be occupied. (Refer to Requirement OP2) Care Homes for Older People Page 12 of 35 Care Homes for Older People Page 13 of 35 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents health and social care needs are set out in an individual care plan but these do not yet fully meet dementia care needs and risk assessment reviews. Residents health care needs are being fully met. They are offered the opportunity to be responsible for their own medication and are protected by the homes policy and procedures for managing medicines. Residents are treated with respect and their right to privacy is upheld. Evidence: There was a requirement made at the last inspection to include more specific details regarding what is meant by dementia for each resident in their individual care plan. This was to be supported by written direction for staff in how to provide the support. There was also a requirement made to include relevant activities specific to individual Care Homes for Older People Page 14 of 35 Evidence: dementia care residents needs in their care plans. Good work has been done to improve care plans for new residents who have moved into the home but more detail about how the dementia affects these residents and how best to support them including guidance for staff is needed. I examined five residents care plans and risk assessments. The description of residents dementia care needs has been improved in their care plans and discussion with a visiting healthcare professional and with relatives and residents suggests that the activities being offered to residents now have much improved but that this is not reflected as well as it could be in individual residents plans or in the written guidance for staff regarding the individual support needed for some residents with dementia care needs. The home must include more written guidance for staff in care plans regarding how and when to support residents with dementia to engage in activities appropriate to their needs. There is now more detailed information in residents care plans about the activities that residents now want to take part in but this is not detailed regarding residents dementia care needs. For example the activities offered to these residents do not specify when it is best to offer the activities so that the individual resident is most able to respond and participate. (Refer to Requirement OP7) One resident said they enjoy handcrafts and music. The care plans now show the improvements in activities that have happened for most residents although more work is needed. Two nursing staff now have some training in writing care plans so that they are easier to read and so that residents or relatives can read them. There are plans for more nursing staff to have this training. Examination of records kept regarding the activities that residents engage in and discussion with the manager and staff showed that the records kept about residents participation in activities offered have not been consistently completed by staff. This can cause a problem in monitoring progress of residents for whom it is important to get regular exercise. It is recommended that the home look at the possibility of improving these records using an activities tick chart system to enable staff to complete them quickly and accurately. (Refer to Recommendations OP7) Two visitors said that they are involved in their relatives care planning and commented that activities have improved for their relatives and that there are now meetings between the homes management and the residents and relatives which they find very helpful. One said the home has done much to improve her mothers health and quality of life and that the staff are very good in helping her with her personal care and eating. She said she is very happy with the care provided. This was the general view reflected in comments received from five other residents in response to the CQC inspection surveys. Care Homes for Older People Page 15 of 35 Evidence: Risk assessments were examined on care plans of five residents. These were well written and reflected a range of appropriate areas of risk usually regarding moving and handling support wandering and eating support needs. There is a record of these assessments being reviewed but not as regularly as each month as is required. The home must ensure that risk assessments be reviewed each month and that a record of these reviews are kept showing where changes have been made. (Refer to Requirement OP7) As at the last inspection there is a range of health care professionals involved in the provision of specialised support for the home. All residents are registered with a GP dentist chiropodist and optician with some receiving support from the district nurse and psychiatry. There is also involvement from the Care Home Support Team regarding nursing and dementia care needs. A continuing support nurse visits a number of times weekly and commented that she is happy with the improvements in care and with the staff an management response to intervention plans and for information needed. Records showed weekly visits from GPs. Nursing care is provided at the home and all nursing staff are in charge of medication management and nursing care issues while leading the shift. There is always at least one nurse available and the homes manager is a qualified and experienced nurse. There have been few hospital admissions and tissue viability issues are well managed. The homes medication policy is up to date and includes the sections required by the commissions pharmacy inspector. Residents medication needs have also been reviewed. Medication is supplied to the home by Lloyd chemists and the majority of residents who use medication use a blister pack system which is easier to administer. All staff receive management of medication training by the home and residents abilities to self-medicate is assessed as part of the assessment process. I examined five residents files including medication administration recording and found that these were satisfactory. All residents need support in personal care and examination of five randomly chosen residents files showed that there is a personal care plan on file for each resident. Residents commented positively about how they are supported in personal care by staff. Any exceptions to this are responded to by the manager. One was discussed at the inspection by the Expert by Experience and the manager responded positively and addressed the residents concerns. Care Homes for Older People Page 16 of 35 Care Homes for Older People Page 17 of 35 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. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The homes approach to activities has improved but there is more work needed to improve individual activities for residents. Residents maintain good contact with families friends and others from the community and are supported to exercise choice and control in their lives. Residents are provided with a choice of varied and nutritious meals Evidence: All residents have assessments and care plans that clearly state their interests and preferred activities. These include education training and leisure activities. Care plans reflect these activities and these include residents views on desired new activities. The home carries out its own assessment of residents interests and past experiences with residents and families as part of the admission process and records this on a life plan. I examined five residents files and each had a life plan showing interests such as watching TV listening to music having Sunday lunches in pubs, walks in the park, sewing and crochet and playing cards or dominoes. These assessments of activities are Care Homes for Older People Page 18 of 35 Evidence: not yet adequately transferred onto all individual residents care plans and there is a requirement made under Standard 7 of this report to do so. (See Requirement OP7) It was apparent that staff are now engaging residents in more activities such as games and exercise in the home. There is more verbal communication between care staff and nursing staff and this has lead to developments in activities for residents which are not yet reflected in the homes care plans or individual activities records. A visiting healthcare professional also expressed this view and said that while further improvements are needed the staff and management are listening and are working on the necessary improvements. Two visiting relatives and three residents said that they are asked about activities and that the staff and manager are now listening and making changes. At the last inspection they said that things have changed for the better and there are monthly meetings with the management and the residents and relatives and now things are much better. This inspection has showed continuing improvements. There is now much more involvement of health care professionals in the home and this is resulting in better quality of care for residents. There had been improvement in the activities for residents in group activities. Comments from residents and the health care professional reflected this and also that this might not yet be reflected in the homes care plans and records which is important to address so that activities for individuals will also show similar improvement. All residents religious preferences are included in their care assessments and there is involvement from church representatives in the home. This was reflected in the five residents files examined and in comments from residents and families. All residents have their own room where they can receive visitors in private. Residents are encouraged to bring personal possessions into the home including furniture and pictures. Residents rooms are personalised with their own pictures and family photos displayed. The home does not have any restriction on visiting times and two relatives who were visiting said that they are welcomed and offered the opportunity to have a meal with their relative. The comments from all who spoke to he inspector and the expert by experience reflected that the food is very good and that they see the management on each visit and attend monthly meetings at the home where they are able to express any concerns. Residents and their families are responsible for the management of their benefits and bank accounts. The responsible individual and manager said that family who hold money for some residents are very good at providing the necessary items needed by the resident and in providing funds for spending when requested. Day-to-day spending Care Homes for Older People Page 19 of 35 Evidence: needs for these residents are catered for and written clarification is included in their care plans showing the process for providing this money for these residents when needed. The home operates a four-week rolling menu and the meals offered appeared to be varied and nutritious. They also included meals for vegetarians and people from other cultural backgrounds. Residents are assisted to complete a form every day to indicate their choices of meals. Residents who spoke to the expert by experience and to me said they were happy with the meals provided. Menus are kept and two main meal menus are offered daily but the chef said residents could have what they want if it is available. The cook is well aware of any cultural needs of the residents and keeps a record of allergies and special diets for residents who need it. The residents and visitors spoken to were very complimentary about the cook and about the food provided. Care Homes for Older People Page 20 of 35 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents records and the complaints record show that complaints are taken seriously. The homes policies procedures and action in relation to incidents show that residents are protected from abuse but that improvements are needed in reporting and staff training. Evidence: There is a complaints policy for the home which was updated in 2007 and relatives who were asked said they would know how to complain. Surveys returned to CQC from five residents also showed they were happy that they knew how to complain and felt management would take appropriate action. Relatives also said that they meet at least monthly with the homes management and see the manager and sometimes the owner on each occasion when they visit. Two complaints had been made since the last inspection and had been properly recorded and investigated. The complaints record showed that complaints were clearly summarised with details of investigations recorded in a complaints file. Four staff training records showed that staff are properly trained in management of complaints. The homes vulnerable adults policy had been updated in 2007 and covered all Care Homes for Older People Page 21 of 35 Evidence: necessary areas. There have been three adult protection issue reported to social services since the last inspection. These were appropriately investigated by the home in liaison with social services and appropriate action was taken to resolve any areas of concern. As a result of one of these the home reviewed the policy regarding the use of bedside rails so that now these are removed from the bed when a resident leaves and only replaced if the new residents assessment of needs requires it. Two of the adult protection situations were not reported to the Care Quality Commission (CQC/CSCI) in a timely manner and I found that safeguarding training for two nurses whose files I examined was not up to date. Given their supervisory role in the home it is important that this is addressed. (Refer to two Requirements OP18) Care Homes for Older People Page 22 of 35 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable clean well-maintained and safe home. Their need for increased communal space is now met. Evidence: There have been significant improvements made to the fabric and facilities in the home which have direct benefits for residents. All residents who participated in the inspection process and their relatives said they are pleased with the improvements made especially with the prospect of using the newly built conservatory attached on to the living room and dining area. These improvements have shown serious commitment on behalf of the provider and manager to improving the residents comfort and space in the home. Improvements include a newly built conservatory which is almost ready for use by the residents. This will provide alternative space for relaxation and socialising and residents are very pleased with this prospect. A ramp has been created to the side exit to increase wheelchair accessibility. The lounge has been rearranged for residents comfort and privacy and 14 of the 20 residents rooms have been redecorated giving individual residents choice of colour for their own rooms. All bedrooms are now single Care Homes for Older People Page 23 of 35 Evidence: bedrooms and work has also been done on the respite room. New curtains and carpet have been provided throughout the home and there is a decorating and maintenence programme in place outlining further work to be done. Eight new beds and six new wheelchairs have been purchased and armchairs and footstools have been replaced with new ones. There are plans to provide grip bars for residents in their rooms where needed. (Occupational Therapists have been involved in carrying out assessments) The home is now of a good standard and all health and safety and fire safety equipment and systems are in place and in good working order. There are three bathrooms, one on each floor and two of these have toilets. There are four other separate toilets and all are in good condition. There are four mobile hoists and one standing hoist in use all of which are maintained under contract. The home now has high standards of cleanliness and Dept of Health guidelines for control of infection are applied. There are adequate numbers of cleaners employed and there are no unwanted odours in the home. Overall the home is now well maintained clean very comfortable to live in. Care Homes for Older People Page 24 of 35 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by an adequate amount of staff with a good level of NVQ training. The home has a thorough recruitment procedure but staff CRB checks need and training need improvement Evidence: The rota showed that the home deploys an adequate number of nursing and care staff on duty at all times of the day and night. There are at least one and usually two registered nurses and four care workers on shift during the daytime until 3 pm after of which there is one registered nurse and three care workers until 9 pm Night times are covered by one registered nurse and one care worker. There is an out of office on call support provided mainly by the homes manager. Cooking cleaning and maintenance are catered for by separate other staff. The files of three staff who had been recruited in the last six months were checked and showed that recruitment information is well organised with a good system for recording application and interview information CRB checks references received health clearance checks start dates and induction schedules. There was a good induction records in place for all of these staff and the manager and staff members were signing Care Homes for Older People Page 25 of 35 Evidence: off this induction. However there were eight care staff found to have been working under false working documentation since the last inspection and all of these were dismissed. The home has done well to recruit to these posts and this explains some of the gaps in supervision and training found at this inspection. The home historically has not been ensuring that all new staff were CRB checked before being employed and although this did not apply to the staff recently employed the homes management must ensure that staff are only employed following a fully enhanced CRB check. (Refer to Requirement OP29) The number of care staff with NVQ level 2 training exceeds 60 which is a good level of qualified staff. Examination of four staff files, two of which were nursing staff, showed that staff induction is now consistently happening in accordance with Skills for Care standards. Generally the files showed a good range of appropriate training is also in place for care staff and nursing staff. Training recorded included continence management fire safety medication communication and food hygiene. However there are gaps in training staff receive in the safeguarding and protection of residents and a number of the training records showed that the staff in question had not had this training including some staff nurses who are responsible for supervision of some care staff. The homes management must ensure that all nursing and care staff have complete stand alone training in the safeguarding of adults in accordance with the local authorities and homes policy. (Refer to Requirement OP30) It is recommended that all staff have an individual training plan in place showing the training they have had and the training planned for their future development (Refer to Recommendation OP30) Care Homes for Older People Page 26 of 35 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and competent to run the home. Some good quality assurance systems are in place which ensure that the home is run in the best interests of the residents. Residents financial interests are being effectively safeguarded. The home has adequate health and safety policies and systems in place and these are well managed. Evidence: There was a requirement made at the last inspection for the provider to submit an application for registration of a manager with CSCI (CQC). This has now been done and this requirement is met. The manager is very competent and experienced and is a qualified nurse with long Care Homes for Older People Page 27 of 35 Evidence: standing management experience. She is a qualified Level 4 NVQ assessor and a moving and handling trainer and has been working hard on updating the physical environment. Many improvements have been made to the fabric of the home. Staff comments were very positive regarding the support they get from the manager and all staff that spoke with me said they feel the manager has made significant improvements and is approachable and helpful. Residents who spoke with the expert by experience and with me said that they felt the manager and owner were available and easy to speak with and that the homes management was good. The atmosphere in the home and the morale of staff is good. Comments from residents and families about the owners responsiveness and commitment to the care of residents were very positive. The manager has now applied to registered with CSCI. The manager is a qualified NVQ4 assessor and has enrolled on an NVQ 4 qualification course. The on call system has been put on a formal footing and has been explained to staff at the home. Staff were able to tell me that they know the managers number and are always able to call her when they need to and do so. The registered provider provides support when the manager is not available. The previously established deputy manager role, which had been introduced since the last key inspection, has been removed. This was an important support for the manager providing more management presence in the home in the managers absence and could also have provided help with the on call system. It is a continuing recommendation that this decision be reviewed again. (Refer to Recommendation OP31) The owner has put in place a formal and methodical quality assurance audit system and has begun the process of carrying out a full audit of all of the homes quality assurance systems. This is done by carrying out sections of the audit monthly and producing a report after a 12-month cycle. This is a detailed system and the owner feels it is very useful and helps him to focus on individual areas which need active attention. Consultation with residents and families has been and this was supported by comments received from residents and families. Surveys of residents views are now happening every few months and meetings with residents take place at least quarterly. Typed minutes are distributed to residents and families showing the issues discussed and the results of the surveys. Residents and relatives are invited and attend relatives/residents meetings every couple of months and have completed surveys. They receive feedback on survey findings at these meetings. Care Homes for Older People Page 28 of 35 Evidence: At the last inspection the registered provider attends the home a number of times a week and does complete written reports on the checks that he does. There was a requirement made at the last inspection for this system to be expanded to include checking care plans risk assessments medication and finances to ensure that should the management of the home does not deteriorate. This has now been done. However the owner does not complete monitoring reports on a monthly basis and this must be addressed as there were only reports available on a 2 month frequency basis at this inspection. (Refer to Requirement OP31) The home has an Annual Development Plan in operation. The current plan is for 2009 and includes significant improvements to the environment. (See Standard 19) Residents money is well managed and protected and the home is not responsible for any residents bank accounts or benefits. Residents and their families are responsible for the management of their benefits and bank accounts. There are clear written agreements in place for these residents showing how their money is managed where families have responsibility. Health and safety is generally given due care and attention by the homes management. There is a health and safety policy and appropriate systems being used for training staff checking fire equipment storing dangerous liquids and substances carrying out risk assessments and doing regular health and safety checks within the home. The fire officer for the LFEPA, has previously been involved in inspecting the home and the home meets all fire safety requirements. All of the staff files examined showed that appraisal is now happening. Supervision frequency however needs to be improved to an acceptable level as none of the files examined showed formal supervision to be happening 6 times a year. (Refer to Requirement OP36) Care Homes for Older People Page 29 of 35 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 30 of 35 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 5 The registered provider and 24/11/2009 manager must ensure that all residents are in posession of contacts which are dated and signed and which include all information required including current fees and rooms to be occupied. This is to ensure that residents are fully aware of their rights and obligations and that their rights are protected 2 7 13 The registered provider and manager must ensure that risk assessments be reviewed each month for all residents and that a record of these reviews are kept showing where changes have been made. This is to protect residents from risk or harm 24/11/2009 3 7 15 The registered provider and manager must include more 24/11/2009 Care Homes for Older People Page 31 of 35 written guidance for staff in care plans regarding how and when to support residents with dementia to engage in activities appropriate to their needs. This is so that residents with dementia can receive support from staff individual to their care needs and at a time when they are best able to participate 4 18 18 The registered provider and manager must ensure that nursing staff and care staff receive training in the protection of vulnerable persons and that this is recorded on individual staff training records This is to ensure staff are aware of their responsibilities regarding the protection of residents 5 18 13 The registered provider and 24/11/2009 manager must report all instances of safeguarding to the Care Quality Commission promptly This is to ensure that that residents sfaeguarding processes are monitored adequately 6 29 19 The registered provider and manager must ensure that all staff have fully enhanced CRB checks carried out prior to commencement of employment 24/11/2009 24/11/2009 Care Homes for Older People Page 32 of 35 This is to protect the safety and wellbeing of residents 7 30 13 The registered provider and manager must ensure that all nursing and care staff have complete stand alone training in the safeguarding of adults in accordance with the local authorities and homes policy. This is to protect the safety and wellbeing of residents 8 31 26 The responsible individual must ensure that management monitoring visits take place every month and that a written report about findings is prepared and available at the home for inspection This is to ensure that the quality of care and supervision of staff is constantly monitored by the provider 9 36 18 The registered provider and 24/11/2009 manager must ensure that all care and nursing staff receive formal supervision at least 6 times a year and that written records of these are maintained This is to ensure that staff are made aware of their responsibilities and d performance 24/11/2009 24/11/2009 Recommendations Care Homes for Older People Page 33 of 35 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 7 The registered provider and manager should look at the possibility of improving the daily records for residents taking part in activities possibly using an activities tick chart system to enable staff to complete them quickly and accurately. The registered provider and manager should arrange that all staff have an individual training plan in place showing the training they have had and the training planned for their future development The registered provider should consider appointing an asistant manager with care planning supervision and computer skills to make the management structure more robust 2 30 3 31 Care Homes for Older People Page 34 of 35 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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