Inspection on 20/10/09 for Oaklands Country Rest Home

This inspection was carried out on 20th October 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Oaklands Country Rest Home Oaklands Country Rest Home Gilsthwaite Lane Kirk Hammerton York YO26 8DS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 2 0 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Oaklands Country Rest Home Oaklands Country Rest Home Gilsthwaite Lane Kirk Hammerton York YO26 8DS 01423330609 01423331111 oaklands@mmcg.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Maria Mallaband Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodateed is: 44. The registered person may provide the following category of service only: Care home with nursing - Code 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. Date of last inspection Brief description of the care home Oaklands Country Rest Home is owned by Maria Mallaband Limited. It is classed as a new service due to a change in company arrangements. It is registered to provide care for up to forty four older people, who may have nursing needs as well as personal care needs. The home is situated approximately ten miles west of York, close to the village of Kirk Hammerton. There are gardens attached to the home. There is also car parking space for visitors. Care Homes for Older People Page 4 of 33 Over 65 44 0 Brief description of the care home Services are provided within a two storey building, which has previously been extended to include a purpose built annexe. There is passenger lift access to all first floor areas. We were told on the day of the site visit that weekly fees range from £386 to £700. Prices are reviewed annually. People pay extra for the provision of clothing, hairdressing, newspapers and magazines, personal toiletries, eye testing, dentistry and chiropody, personal taxis, long distance telephone calls, alcohol and cigarettes. People get a copy of the service users guide, which explains what the home provides, before they move in. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key inspection included a review of the following information to provide evidence for the report: Information that has been received about the home since the last inspection. A self assessment, called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys, completed and returned by seven people who live at the service, three staff and four health or social care professionals. A site visit to the home carried out by one inspector over approximately eight hours, on 20 October 2009. Care Homes for Older People Page 6 of 33 During the visit to the home, we spoke to several people who live there, some staff and the registered manager. Four peoples care plans were looked at, two in detail. We also looked at some records that are kept at the home to show how it is managed and maintained. We observed care practices where appropriate, and spent time watching the general activity, so we could get an idea what it is like to live at Oaklands Country Rest Home. The registered manager was available throughout the day, and was provided with feedback at the end. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Although regular staff know people well, they could be more consistent in writing down peoples needs, and risks to them. This would help staff who do not know people so well to provide safe, consistent care. It would also make it easier to monitor risks, and to know when to contact other professionals for advice. People and their family could be included in the upkeep of their care plan. Doing so may help people feel involved more in their care, and in decisions about how this is to be provided. Some improvements could be made to the way staff manage medication to reduce any unnecessary risks to people. As well as taking action in house, staff could let the appropriate organisations know more quickly, if they believe someone at the home may not have been treated properly. This would help those responsible for investigating such allegations to do their job promptly, whilst information they may need is still fresh in peoples minds. Training and equipment could always be in place for staff to help promote good infection control. An action plan could be in place to make sure that there will be sufficient established nursing staff available to meet the needs of those people admitted for nursing care in both the short and the long term. Fire doors could always be kept shut, to reduce the risk to people from the spread of Care Homes for Older People Page 8 of 33 fire. 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 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 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 10 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. Peoples needs are assessed before they move to the home, to make sure their needs can be met there. Evidence: Staff undertake an assessment of peoples current needs before they are offered a place at the home. As part of this assessment, they visit the person, and also collect information about them from other professionals who have been involved in their care, such as their care manager, or hospital staff. This information is used to decide whether the home will be able to successfully care for the person concerned. People are also invited to look round the home, which allows them to see for themselves whether they like it. This means people get the chance to meet people already living at Oaklands Country Rest Home, and staff who may be involved in their care, if they decide to move there. Care Homes for Older People Page 11 of 33 Evidence: People are also provided with written information about the home, which they can keep, and read at their leisure. This helps those who are unable to visit, the chance to see what the home offers, and whether it will be suitable for them. Seven people living at Oaklands Country Rest Home returned their surveys. All agreed that they received enough information before they moved in, to help them decide whether the service would be the right place for them to live. The home does not provide intermediate care. Therefore standard six is not applicable. However, people sometimes stay there for short breaks. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are seen as individuals, who have different needs, but this is not always reflected in their care plans. Evidence: Once people are admitted, staff complete an admission assessment, when they build upon the information already gathered about the person. All of this information is used when writing subsequent care plans about specific needs, and how staff are to support individuals to meet these needs. In most cases, all areas of assessed need had been covered, although, it was agreed that more could be written down about peoples individual social needs and choices, and what staff should do to meet these. A number of assessments are also completed to identify specific risks to people, for instance, in relation to skin problems, moving and handling, and falls. The quality of the care plans seen differed. In two care plans looked at, the information was written in a very thoughtful and individual way, which would support good, consistent care. Two were less detailed. Although the care needed by the person, and risks to their health, was known to staff, they were not written down in Care Homes for Older People Page 13 of 33 Evidence: enough detail to help staff make good decisions. In relation to this, we discussed the following with the registered manager and nurse manager: One person does not want protective bumpers fitted to their bed rails. However, this choice, and a health need which could affect risk to them, had not been written down. Doing so would remind staff to consider these points during the monthly review, when deciding whether this agreement remained safe and acceptable. Another person was having a number of falls. However, their risk assessment had not taken these into account, which meant the outcome of the assessment was wrong, and further advice had not been sought. The registered manager agreed that he would ask the doctor if this person could be referred to a falls assessor. The plan for a person to show how staff should assist them to meet their individual personal care needs was not written in sufficient detail to help staff work in a consistent way. Writing only that the person will require the assistance of one carer when bathing does not identify how the person needs help, and what they can manage to do for themselves. Such gaps in care plans make it more difficult for staff, especially those who do not know the person so well, to see the extent of support the individual may need to maintain their good health and wellbeing. Staff who returned their surveys said that the way information is shared by people usually or sometimes works well. We discussed our general findings with the registered manager and nurse manager, who agreed to take action where shortfalls were identified. The care plans are reviewed monthly by staff. It would be good practice to involve the person and, if appropriate, their relatives in this review. On speaking to relatives, it appeared that this option had not been offered to them. Doing so would help to make everyones plans very individual, and would mean that staff can then know better, and respond to, peoples personal choices, needs and wishes when providing support. Staff on the day spoke to people respectfully and kindly. People responded well to this. The vast majority of people who returned their surveys said that they always get the care and support they need, that staff always listen and act on what they say, and that they always get the medical support they need. They made comments like Everyone is well looked after, It provides all the care I need. Always with a smile, Carers look after us well. A relative commented All care is very good....everyone is really helpful and nice and kind. Care Homes for Older People Page 14 of 33 Evidence: Someone on the day said that staff were respectful, although sometimes talked to them in a way which assumed that they would have difficulty understanding them, when they do not. Another said how much they like the staff, who, they said, always respond if they ring for attention. A health professional thought the home provided personable care. They had experienced good working relationships and co-operative working. Another had connections with two people living at the home, and said in both cases they appear to have had a high level of care and consideration, and their personal dignity has been respected at all times. And another said Excellent personal care. High quality care friendly. People with nursing needs now live at the home, as well as those who need support with their personal care only. Nursing staff administer the medication for people with nursing needs. Care staff, who have completed training in the safe handling of medication, handle the medication for others. The medication was safely stored and generally well managed. The systems are audited both by staff at the home, and also by the registered manager. Shortfalls identified on the day were discussed with him and the nurse manager: Because of the ordering systems, one person had gone for a week without their medication to stop constipation. This is not satisfactory, and this administrative problem needs to be sorted out, so the supply of medication is not disrupted. The dispensing surgery does not supply medication record sheets, which are completed electronically by the registered manager. Staff do not formally check and countersign these. One medication was spelt wrongly. Although a minor error, this would have been identified sooner had the sheets been checked. All sheets should be checked and signed by a second member of staff in the future, to reduce the risk of more serious errors happening. Where the dose is variable, staff do not sign to show how much medication has been given. This should be implemented, so that the doctor can see, on review, how well the medication has been working, and whether any adjustments are needed to the persons prescription. Staff now check peoples pulse before deciding whether to administer one particular medication. The registered manager must check with the doctor that this practice is acceptable, and must then include in the relevant care plans the decision reached, so Care Homes for Older People Page 15 of 33 Evidence: that practice within the home is consistent, and meets with the doctors wishes. One person looked after their own inhaler. A risk assessment had not been completed to check that it was safe and acceptable for them to do so. The nurse manager said she would complete this straight away. This will help to monitor that it is being taken as prescribed, and that the person is happy and able to continue to manage the medication themselves. Care Homes for Older People Page 16 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. People can maintain links with families and friends who are important to them. Further development of peoples individual care plans would help to make sure that the activities offered to them meet their individual social needs and preferences. Evidence: People who returned their surveys said there were always or usually activities for them to join in. An activities co-ordinator is employed to work at the home three days a week. She advertises in advance the activities that she has planned for people. There are also additional activities provided such as exercise class, visits from the hairdresser, and occasional trips out. The activities are mainly for groups, and the registered manager knows that meeting peoples individual social needs is something which could be developed further. People have been allowed to bring their pets into the home to live with them. This was greatly appreciated by those people concerned, who said they would not have liked to move anywhere without them. The home has links with the church, who visit each month and provide people with a communion service. The registered manager said he has links with other Care Homes for Older People Page 17 of 33 Evidence: denominations, which are not required by the current occupants of the home. These links help to meet peoples spiritual needs. People can have their visitors whenever they wish. They can see them in the communal areas, or their own room, if this is their choice. We spoke to people and staff about choice, and how this was considered. People said that generally, they can choose what they want to do, and when. One person said they could have more choice about when they went to bed, and when they got up. Although another said I can go to bed and get up whenever I want. Staff said that they try hard to make sure that they accommodate peoples choices. One staff member said it is sometimes difficult to give people choices with regard to rising and retiring times, but, they said, they always strive to meet these. This attitude helps to keep care flexible, and means that one day does not have to be the same as the next for people. There are two dining areas. The tables were set attractively. This helps to make the meal experience more enjoyable. Menus were available on each dining table, which helps people to recall what they have ordered, so they can look forward to their meal. There is a four weekly menu which provides choice, and people are offered three meals a day and supper. We were told that fresh meat, vegetables and fruit are delivered to the home regularly. Fruit is offered to people each afternoon. The cook was aware of peoples specific dietary needs, and explained what she does to meet these needs. The kitchen is kept unlocked at night so that staff can make snacks and drinks if people wake up hungry or thirsty. People who returned their surveys said they always or usually liked the food. One person said the home could do better if they were to provide mint sauce with lamb, and apple sauce with pork. They said otherwise all the meals are very good. Most people on the day were satisfied with the meals. They made comments such as The food is nice - we get choice. One person thought that their requests were not always carried out when they told staff how they would like their meal served. The registered manager said they would sort this out straight away so that this persons mealtimes were more enjoyable. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples complaints are taken seriously, but delays in reporting safeguarding issues to the relevant organisation could mean they are not properly investigated in a timely way. Evidence: Of those people surveyed who live at the home, everyone said they know who to speak to informally if they are not happy, and all but one of them also know how to make a formal complaint. One person we spoke with on the day said You wont get any problems here - everything is fine. Another said If there was anything wrong I would tell you. I can always tell Bernie (the registered manager). But no problems. And another said I have no concerns. I would like to be at home, but its OK here. A relative agreed that if there has been any problem, Bernie has sorted it out. Another said that the home was generally receptive to complaints. There have been no complaints made to the commission in the last year. The home has received one complaint, which the registered manager had recorded, showing what the complaint was about, and what action he had taken to put it right. The complainant had signed to show they were happy with the outcome. There have been two safeguarding referrals made since the beginning of the year to the local authority by the home. They also let the commission know about each of the Care Homes for Older People Page 19 of 33 Evidence: allegations made. The first investigation has been completed. In the second incident, although action was taken by the home to protect people, there was a delay of two days by the home, in reporting to the local authority, who have the responsibility to investigate such matters. The incident should have been reported as soon as it happened, so any investigation into the incident could begin straight away. The majority of staff have completed training in safeguarding adults. We spoke to one staff member who had not. However, they were clear about their responsibilities to report any concerns straight away. Some staff were not immediately responsive when asked about the role of the local authority. And there were no readily available telephone numbers for staff to ring, if they had the responsibility to report an incident. The registered manager should make this sort of information easily accessible, so staff do not have to worry about where to find this information in an emergency. Care Homes for Older People Page 20 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. People live in a warm, comfortable environment. Evidence: The home is situated in a quiet location close to the main road between Harrogate and York. It is generally well maintained, and provides a number of communal areas for people to choose from. These include sitting areas, and two separate dining areas. One of the sitting areas is currently not used. People living there chose instead to use the sitting areas which are closer to the general activity of the home. The majority of people who returned their survey said that the home was always fresh and clean. The registered manager told us in the information provided before we visited that there is an ongoing plan of redecoration in place, and that some of the bedrooms need to be decorated. We looked at a sample of bedrooms. Those seen were nicely decorated, and contained some personal belongings, to make the occupant feel more at home. People can have their own telephones if they wish. This is good, because it means they can have conversations with their family and friends in the comfort and privacy of their own room. At this visit, one of the communal bathrooms was not being used, because the bath Care Homes for Older People Page 21 of 33 Evidence: hoist was not working. In another, the hoist seat was worn, and the plastic below the seat covering the metal tubing was peeling off, leaving exposed rusting areas. This will make it difficult to keep clean, and to keep the risk from cross infection to a minimum. The registered manager said that the company was aware of this, and that replacements were being organised. This planned work should be completed as soon as possible, so people continue to have a good choice of safe bathing facilities that are easy to keep clean and hygienic. The home was required at the last key inspection to make sure that window restrictors were properly fitted. The registered manager confirmed at this visit that any windows where this had been a problem have now been replaced with plastic windows which have integral restrictors which only open to a safe limit. There were no gloves and aprons in the laundry for the staff there to use. Having these readily available makes it easier for staff to practice good infection control. Although the laundress knew that they were available elsewhere in the home, they were not being used at the time we visited the laundry. The registered manager has agreed to make sure that there is a ready supply kept there. He must also make sure that laundry staff have completed training in infection control. The person running the laundry on the day had not completed this. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who are properly vetted, and trained to provide good, safe care. The current shortage of employed nurses means that those people with nursing needs may receive this care from staff who they do not know. Evidence: The home is, at the moment, using agency staff regularly. This is due to the fact that there are currently insufficient nursing staff employed to provide twenty four hour cover each day. These vacant posts have been advertised by the company. The nurse manager, when requesting agency cover, always tries hard to make sure that the same agency staff return, so that the people living at the home get some continuity of care. She personally works long hours through choice, because she wants to make sure that the care people get is consistent. However, forthcoming staff holidays and planned longer term leave means that agency staff will be used much more frequently during this period. We have asked the organisation to tell us how they are going to manage this situation, so we can be assured that people will continue to get the same level of support that they are accustomed to, from a staff team who know enough about their needs to meet these consistently. Six of the seven people who returned their survey said that there were always Care Homes for Older People Page 23 of 33 Evidence: enough staff to meet their needs. The seventh said this was usually the case. Staff who returned their surveys said there were usually or sometimes enough staff to meet peoples individual needs. Those spoken to on the day agreed that there were usually enough of them. One said this became more difficult on the days when there are no kitchen staff, laundry or cleaners. On these occasions, it is the care staffs responsibility to make sure that these tasks are completed, as well as their own. The registered manager must be mindful of this. However, on the day of the site visit, neither people nor staff seemed unduly rushed. We looked at two recent staff recruitment files. Both confirmed that the required checks are completed before staff are allowed to work at the home. One staff member had started working after the registered manager had received official confirmation that they were not barred from providing care to vulnerable people. This staff member confirmed that they worked supervised at all times until their full police check was returned. These measures help to keep people protected from unsuitable workers. New starters complete an induction. Staff who returned their surveys said this covered what they needed to know either very well or mostly. Staff also get a range of training to help them understand their role better. As well as compulsory training, staff told us they get other opportunities, such as National Vocational Training in Care at Levels 2 and 3. A large proportion of staff have completed this training which means that people are being cared for by staff who know what good care is, and how it should be provided. Some staff have also completed a course recently on the care of the dying. The trained nurse spoken with confirmed that they too get training opportunities to keep their qualification up to date, as well as regular clinical supervision and support from the area manager, who is her direct supervisor. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples best interests and views are considered when deciding how the home should be run. Evidence: The registered manager has held this position for sixteen years. He has completed management qualifications to underpin the work he does. He is well known by the people who live at the home. They said they see him regularly. He gets regular support from the company. The area manager visits on a weekly basis, to make sure that standards at the home are maintained. As part of the visit, the registered manager receives supervision, certain areas of the home are audited, and an action plan is left, to address areas where things need to be improved upon. This helps to maintain good standards. Staff made positive comments about the manager, who they said was open. One said We can approach the manager if we are not happy. They said communication was good. One said Bernie (the registered manager) is a good manager - he listens. Care Homes for Older People Page 25 of 33 Evidence: Another said The residents are Bernies world. The home has provided personal care only for a number of years. However, the home is now registered to provide nursing care as well, which has meant some changes to the way the home operates. This has posed challenges for the registered manager and staff, with regards to who is responsible for what, and how things are communicated. One staff commented that there had been ups and downs at the home when nursing care was first introduced. Another said that the change had been a big learning curve. They said that they have to report to different staff now for advice which, in the past, would not have been the case. Another said that it had been a tricky transition, although continued that there had been no major conflicts. However, the registered manager, the deputy manager and the recently appointed nurse manager are attempting to define roles, and areas of responsibility. The registered manager said that he and the nurse manager are working well together. The company sends surveys out to people, their families, health professionals and staff. These results are compiled, to identify areas of good practice, and also where the services people get, and staff practice, could be improved. We were told that these results are published, so people can see what is being done in response to their comments. The home will look after peoples personal allowance if this is their choice. Clear records are kept about what is spent on their behalf, and we were told that people have access to this money whenever they want it. People also have lockable facilities in their room where they can store their valuables if they wish to. The information provided before the site visit showed that the home is kept regularly maintained. We looked at some records kept by the registered manager, which showed that in house checks are also completed regularly to make sure that, for instance, the fire alarm remains in working order, that the water temperatures accessible to people are not too hot, and that the call bells in peoples rooms ring when activated. Staff get a range of compulsory training which is kept updated. Training has recently been provided in safe moving and handling and fire safety. Food hygiene training has been planned for the near future. The fire officer visited some time ago, when he asked for the home to complete a fire safety risk assessment. This has been done. At the time of this site visit however, one persons bedroom door was held open in such a way that it would not close Care Homes for Older People Page 26 of 33 Evidence: automatically should the fire alarm sound. This is not safe practice, because it increases risk from fire to the person who lives in the room. The registered manager said that this was not normal practice, and removed the obstruction straight away, He has given an assurance that it will not happen again. Should this door need to be held open, the registered manager must consult with the fire officer for advice as to the safest way to achieve this. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 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 13 Assessments undertaken to determine risk to people must take into account all relevant areas of concern which may affect the final outcome of the assessment. This is so the assessment is correct, the right action is taken to protect people from harm, and staff are alerted when advice from other professionals may be needed. 30/11/2009 2 8 12 The relevant doctor must be consulted to check whether or not he wishes peoples pulse to be checked before staff administer one medication which was identified at the time of the site visit. This will make sure that people get this medication following the correct instructions from the 30/11/2009 Care Homes for Older People Page 29 of 33 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 professional who has prescribed it. 3 9 13 It must be ensured that there is sufficient supply of medication in stock for people. This is so people do not run out of medication and always receive this as prescribed by their doctor. 4 9 13 People must only look after their own medication after completion of a risk assessment. This will make sure that it is safe for the person to do so, and that they are willing and able to take on this responsibility. 5 18 13 All staff must understand their responsibilities so they know who to report to, and how to report, allegations of abuse. This is so the right action is taken to protect people immediately, and incidents are passed onto the local authority straight away, so they can take swift action to assist in keeping people protected from harm. 30/11/2009 30/11/2009 30/11/2009 Care Homes for Older People Page 30 of 33 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 6 26 16 Key members of staff, such as those working in the laundry, must have up to date training in infection control. This is so that they have up to date knowledge about how to work in the safest way to minimise the risk to people from cross infection. 31/12/2009 7 27 18 There must be a proper and robust action plan in place to make sure that there are sufficient and consistent staff available to meet the needs of those admitted for nursing care. This is so people get consistent care from a team of nursing staff who understand their needs well. 30/11/2009 8 38 13 Fire doors must be kept shut 31/10/2009 unless the fire officer advises otherwise. This is so people are kept safe from the risk of the spread of fire. 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 7 Peoples care plans should say more about their social Page 31 of 33 Care Homes for Older People 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 needs, and how the staff should work with people so that these individual needs are met. Peoples care plans should always be completed in enough detail so that they explain their needs in an individual way, and assist staff in providing consistent care. People and/or their families should be asked whether they would like to be involved in the regular review of the persons care plan. This will help to make sure that the plan is designed to match the persons personal choices and preferences. 2 9 Medication charts written up at the home should be checked and countersigned by a second member of staff, to reduce the risk from errors occurring. Staff should record how much medication they have administered where the dose is variable. This will help the doctor see on review how well the medication has been working, and whether any adjustments are needed. 3 12 More about individual social needs and interests could be learnt from people, which would in turn help staff to develop individual activities to help meet these needs. Key contacts and telephone numbers for the local authority should be readily available to staff so they know who to contact should they need to report an allegation or incident of abuse. There should be a readily available supply of protective clothing in the laundry so staff are encouraged to use these in order to keep the risk from cross infection to a minimum. 4 18 5 26 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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