Inspection on 02/12/09 for Old Shenfield Place

This inspection was carried out on 2nd December 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Old Shenfield Place 03/12/08

Old Shenfield Place 31/07/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Old Shenfield Place 2 Hall Lane Shenfield Essex CM15 9AB     The quality rating for this care home is:   one star adequate 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: Michelle Love     Date: 0 2 1 2 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 31 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 31 Information about the care home Name of care home: Address: Old Shenfield Place 2 Hall Lane Shenfield Essex CM15 9AB 01277220636 01277223638 shenfield@ardtully.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Rajan Dhirjal Madlani care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Old Shenfield Place is an attractive 17th century building, which has been renovated and refurbished to provide comfortable accommodation for 31 older people. There is a choice of three lounges, a dining room and a visitors room. 21 bedrooms are single and five are double. The majority of rooms have an en-suite hand washing and WC facility. A separate hairdressing room is available. The gardens are well maintained and accessible to residents. To the front of the house there is limited space for car parking. Old Shenfield Place is situated close to local shops, bus and train services. The home has use of a mini bus for outings. The current weekly fees are from 580.00 for a twin room en suite, from 680.00 for a Care Homes for Older People Page 4 of 31 Over 65 31 0 0 3 1 2 2 0 0 8 Brief description of the care home single room en suite, from 710.00 for a bed-sit and 775.00 for a twin room en suite single occupancy. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 9 hours, with all key standards inspected. Progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the registered manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. We forwarded surveys to the home Care Homes for Older People Page 6 of 31 for residents, relatives, staff and healthcare professionals to complete and return to us. The rationale for this is so as to enable people to provide us with their views as to the quality of care and services provided at Old Shenfield Place. Where comments have been made, these have been included within the main text of the report. The number of responses received were positive and included 7 relatives surveys, 10 surveys from people who live at the home, 1 survey from a healthcare professional and 3 staff surveys. The registered manager, team leaders and other members of the staff team assisted us on the day of the site visit. Feedback on the inspection findings were given at the end of the day to the registered manager and team leaders. The opportunity for discussion and/or clarification was given and no questions were raised. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 31 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 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to choose a home that will meet their needs. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective persons needs. Since the last key inspection to the home, changes have been made to the pre admission format so as to ensure that the persons care needs are captured. Admissions are not made to the home until a full assessment has been undertaken. Records showed that in addition to the formal assessment procedure, supplementary information is provided from individuals Local Placing Authority and/or Primary Care Trust. As part of this inspection, the care files for the 2 newest people admitted to the care home were examined. Records showed that a pre admission assessment had been completed for both people, prior to their admission to Old Shenfield Place. The information recorded within both pre admission assessments was seen to be Care Homes for Older People Page 11 of 31 Evidence: informative and detailed and is used to inform the persons individualised care plan. One person spoken with confirmed that the admission process had been smooth and that they and a family representative had visited the home prior to their admission to see if it was suitable for their needs. We were advised that they are enjoying the experience of living at Old Shenfield Place and stated I love it. As part of our inspection process we also looked at records of staff meetings and comments recorded from staff surveys and the homes own quality assurance undertaken in September and October 2009. These told us that staff did not always feel they were provided with sufficient information at hand-over or given enough information prior to a prospective persons admission. A copy of the Statement of Purpose was readily available within the main reception area of the home. This document details the services and facilities provided at the home and sets out the homes aims and objectives. In addition to this document a copy of the homes previous inspection report was on display. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to have the majority of their care needs identified, however further development is required to ensure positive outcomes for people. Current medication practices and procedures do not always safeguard people in the home. Evidence: There remains a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. In addition to the care plan, formal assessments are completed in relation to manual handling and pressure area care. Records showed that all people case tracked had a plan of care. As part of this site visit the care files for 5 people were examined (3 in full and 2 in relation to peoples specific care needs). Records showed that since the last key inspection, the management team of the home have reviewed the care plan documentation so as to ensure that information recorded is personalised, person centred and fully reflective of the persons care needs. Improvements were noted whereby information recorded was observed to be more Care Homes for Older People Page 13 of 31 Evidence: person centred and included peoples strengths, abilities and areas where they require specific staff support. For example the care plan for one person in relation to their nutritional care needs recorded them as requiring special cutlery as a result of a degenerative disability, having their meals cut up for them and requiring a special cup and straw. Records also showed that actual staff support provided is kept to a minimum so as to ensure that the person maintains their potential and independence wherever possible. On the day of the site visit the resident was observed to be provided with the above specialist equipment at lunchtime. Additionally their care plan relating to their night time routine showed that their personal preferences, likes and dislikes were taken into account e.g. the times they get up in the morning and retire to bed, the number of pillows required, the preferred nightime drink, whether or not they like to have a night light on and/or the door open or closed. While we acknowledge many improvements in the general recording of peoples care needs, further development is required so as to ensure that the specific care needs of individual people are clearly documented and all elements of their care plan are regularly reviewed and updated to reflect peoples changing needs. For example the weight records for one person showed that over a 6 month period their weight had been relatively stable, however in the past month they had sustained a weight loss of over 7KG. From inspection of their care plan relating to nutrition, daily care records and healthcare records, there was no evidence to show this had been picked up by staff or the actions being taken to proactively address the persons weight loss. Daily care records for a 3 week period showed on several occasions that they had a small appetite and could refuse their meals. During feedback of the inspection findings to both the registered manager and team leaders, it was of concern that no-one had been made aware by staff as to the above issues. Additionally the Medication Administration Records (MAR) for one person showed they regularly refused some of their prescribed medication. While this was clearly recorded on the MAR record, there was no evidence of a care plan or risk assessment detailing how this was to be monitored, managed or if advice had been sought from a healthcare professional. The care file for another person made brief reference to them experiencing back pain and having pain relief medication prescribed. No care plan or risk assessment was compiled. There was little evidence in some cases to show that individuals care needs were being regularly reviewed and updated to reflect their current care needs. For example the care plan for one person showed that some elements of their plan of care had not been reviewed for 3 consecutive months yet their needs had changed in some areas. Care Homes for Older People Page 14 of 31 Evidence: Since the last key inspection to the service (December 2008), the risk assessment format has been reviewed and updated. On inspection of the format this was seen to be predominately a tick chart method but comprehensive detailing physical, psychological and environmental hazards. However care must be taken to ensure that there is specific information recorded specifying how each risk is to be minimised so as to ensure peoples safety and wellbeing. For example the care file for one person recorded them as on occasions being low in mood and/or depressed. There was no evidence to show how this was being monitored and the steps staff should take to reduce and/or deal with the persons low mood and if this should escalate. From discussions with both senior and care staff, people demonstrated a good understanding and awareness of individual peoples care needs. During the day of the site visit, staff were observed to provide care and support to people who live in the home in a timely manner and with sensitivity. Staff were observed to positively interact with individual people and for the focus of care and support to not be solely based on routines and tasks. Two people who live in the home who were spoken with told us that staff are kind and caring and confirmed that care provided is appropriate to meet their specific care needs. Comments included We can have a laugh and joke with the staff and We are well cared for during the day. Comments recorded within the quality assurance surveys forwarded to the home included I am very grateful for the genuine concern and kindness shown by all the staff, carers and others and I am very satisfied with the care provided. As a result of the above improvements in the care planning and risk assessment processes, we have taken a proportionate view and are rolling forward the repeat requirement. We looked at the practices and procedures for the safe storage, handling, recording and use of medicines. The temperatures of where medication is stored and the temperature of the fridge used to store medicines are recorded each day and were observed over a 3 month period to be within recommended guidelines. A random sample of Medication Administration Records (MAR) were inspected for a total of 10 people. In general terms records were observed to be completed relatively well, however some issues were observed which require addressing. Where some people are prescribed a variable dose, the specific dose administered was not always recorded. This means that some people are at potential risk of receiving too much medication. MAR records also showed for one person that two of their prescribed medications had not been available on some occasions as the home were awaiting for prescription. This means that some people are at risk of not receiving their prescribed medication. In addition MAR records for some people recorded O other, however on Care Homes for Older People Page 15 of 31 Evidence: the reverse of the MAR record no rationale was recorded to evidence why. Not all packets and/or bottles of medication were signed and dated when commenced. The majority of medicines are stored securely for the protection of residents but we found one persons prescribed medicine in their room which was not secure and could be accessible to other people. We watched medication being given to people during the lunchtime period by a senior member of staff and saw that the medication trolley was left open and unattended with medication on the top of it while the staff member was giving medication to people in the dining room. Evidence showed that she could not have been in a position to intervene if someone had taken medication from the trolley. As a result of these unsafe practices an Immediate Requirement Notice was issued to the registered manager detailing the shortfalls. A prompt response was forwarded to us detailing the actions taken by the management team of the home to address the deficits. In the fridge that is used to store medication that requires cold storage, we observed there was out of date medication stored (cream). From discussions with the manager we were advised that the person named on the box was no longer prescribed this medication. On inspection of a random sample of staff files for those people who administer medication, records showed that the training manager had failed to undertake regular competency assessments so as to ensure that staff who administer medication remain competent to do so. This is of concern given the issues highlighted above. The manager confirmed to us following the inspection that team leaders are now responsible for undertaking staff medication competency assessments. The AQAA confirms that shortfalls in medication needs urgent attention. On the day of inspection some members of staff were observed to receive medication training from the homes pharmacist. In addition on inspection of Regulation 26 visit reports, these showed that shortfalls relating to the completion of medication had been identified in recent months. Staff meeting records also showed that medication deficits had been highlighted and discussed by the management team of the home with staff, relating to missing and erased signatures, omissions on the MAR record and medication administered too early on some occasions. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to have their social care and dietary needs met so as to ensure their mental and physical wellbeing. Evidence: We were advised by the manager that currently all staff are responsible for undertaking and providing social activities to people in the home. The manager stated that she is looking to employ an activities co-ordinator in the future for approximately 4 hours each day, Monday to Friday and possibly on alternate weekends. Planned activity sessions are held at the home each week and there are regular external entertainers to the home. On the day of the site visit people were observed to enjoy in the afternoon a quiz and gentle exercises. Throughout the day people were seen to spend time how they wished, either participating in planned activities or to engage in their own personal choice of activity e.g. watching television, reading a newspaper, book or magazine, listening to the radio or talking with other people. An activity information sheet is completed for each person and on inspection of a random sample, these showed that people in recent weeks have enjoyed games of scrabble, quizzes, reminiscence, bingo, listening to music, ludo, snakes and ladders, films, sing-a-long, dominoes, cards, skittles and manicures. People spoken with Care Homes for Older People Page 17 of 31 Evidence: confirmed they were happy with the level of activities provided. There remains an open visiting policy at the home whereby visitors can see their member of family and/or friend at any reasonable time. Throughout the day of the site visit, several visitors were observed to come to the home and to meet with their member of family. People are able to receive visitors in the privacy of their own room or to use the conservatory or small visitors lounge. Two visitors spoken with confirmed to us that they can visit the home at any time and are always made to feel welcome by the management and staff team. The lunchtime meal was observed on the day and this was seen to be a positive experience for people living in the home. Tables were attractively laid with tablecloths, placemats, cutlery, condiments and serviettes. The quality of the meals provided was seen to be plentiful and attractively presented. Where people received a soft diet each food item was served seperately to make it look as attractive as possible. The majority of people choose to eat their meal in the dining room however people have the choice to eat their meal in the lounge or in the comfort of their own room. People were observed to be offered a choice of drinks including alcohol with the lunchtime meal. During the morning and afternoon tea round, people were given the choice of hot and cold drinks. Residents comments relating to the quality of meals provided included the meals are lovely, there is plenty of choice and you get plenty of food and choice here. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to have their concerns taken seriously and to be listened to. Evidence: There is a complaints policy and procedure in place. This identifies to who any compliments or complaints should be referred to and the timescale within which any complaints received would be responded to following investigation. We spoke with 4 people who live at the home and they were able to confirm that they felt confident that any complaints and/or concerns raised would be dealt with promptly and they knew who to raise issues with. Comments recorded within the homes own quality assurance stated If I have a problem then I just go to the office and it is sorted out. On inspection of the complaints log, records showed that in the last 12 months there have been 5 complaints. These were seen to relate to staff not accurately signing in and out in the staff book, some staff not talking to people in the home in a dignified/sensitive manner and one resident in the home speaking to staff in a rude manner. Following the last key inspection to the service the documentation to record complaints has been reviewed and updated so as to ensure the specific nature of the complaint, the actiontaken and the outcome is clearly recorded. Records were observed to be much improved. On inspection of daily care records for one person case tracked, records detailed they had been left on the commode for several hours without staff support. We discussed this with the management team of the home and Care Homes for Older People Page 19 of 31 Evidence: they advised that they were unaware of the issue. We were advised by the manager that there have been no safeguarding referrals since the last inspection. There is a safeguarding policy and procedure in place and following discussion with staff, they were able to demonstrate a good understanding of safeguarding procedures. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 safe, well maintained and comfortable environment which meets their needs. Evidence: A partial tour of the premises was undertaken with the registered manager. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home environment continues to be maintained, decorated and furnished to a good standard and is both homely and comfortable. Furnishings and fittings were domestic in nature and were of a good quality and were in keeping with the environment. There is sufficient communal space in the home in the way of a large lounge, large open plan seating area off the main reception area, large conservatory that also doubles as the main dining area and small lounge/quiet room/visitors room. There are sufficient bathing and communal toileting facilities available which enable immediate access and these are fitted with appropriate aids and adaptations. On the day of the site visit the home was well lit, clean and odour free, with no evidence of any unpleasant smells or odours. A random sample of residents bedrooms were inspected and all were seen to be personalised and individualised to suit individuals taste and personal preferences. The AQAA details in the next 12 months that it is hoped for a wet room to be newly designed and created so as to assist with people who have poor mobility needs and Care Homes for Older People Page 21 of 31 Evidence: their personal care needs. In addition the carpet in the main reception area, both lounge areas and corridors are in need of relacing as they are looking worn and tired. A maintenance person is employed at the home Monday to Friday between 08.30 a.m. and 17.00 p.m., however these hours remain flexible to cover evenings, weekends and emergencies. The home was in a good state of general repair and no health and safety issues were highlighted at this site visit. Robust maintenance checks are carried out and there is a scheduled maintenance programme in place which ensures the environment is kept safe for peoples health and wellbeing. A random sample of fire records were examined and these were seen to be in order. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service so as to ensure their safety and wellbeing. Evidence: The manager confirmed that staffing levels at the home remain at 1 senior member of staff and 4 care staff between 07.00 a.m. and 14.00 p.m., 1 senior member of staff and 3 care staff between 14.00 p.m. and 21.00 p.m. and 1 senior member of staff and 2 care staff between 21.00 p.m. and 07.30 a.m. each day. Since the last inspection the manager has employed 2 team leaders since August/September 2009, who provide day to day management support and assistance alongside the manager so as to ensure the effective and smooth running of the home. The registered managers hours remain supernumerary to the above figures and both team leaders are rostered to have a mixture of supernumerary shifts and to work as part of the care team. In addition a number of anciliary staff are employed and these include chef, housekeeper and laundry person. The manager advised at the time of the site visit that there were no staff vacancies and staff shortages are covered by existing staff or by utilising two external agencies. On inspection of 4 weeks staff rosters these evidence staffing levels as detailed above are being maintained. We checked the staff roster on the day of the site visit and this reflected accurately the staff on duty. Throughout the day of the site visit the Care Homes for Older People Page 23 of 31 Evidence: deployment of staff was observed to be appropriate and positive for the numbers and needs of people living at the home. People at the home were observed to be provided with assistance promptly and with due care. Comments from staff surveys recorded as part of the homes quality assurance recorded, I feel an extra carer on each shift at busy times is needed and not always recorded to staffing levels being appropriate. Surveys returned to us from people who live in the home recorded We need a few more staff on in the afternoon as at bedtime the staff are very busy and The staff are very kind but there could be more staff during the afternoon. The staff recruitment files for 3 people newly employed at the home since the last key inspection were examined. Records showed good recruitment procedures are in place so as to ensure peoples safety and wellbeing. The majority of records as required by regulation and the National Minimum Standards were in place. No recent photograph was available within any files examined, the employment history for one person was not fully explored as there were some gaps and for one person one of their written references were received after they commenced employment. A record of induction that complies with Skills for Care Common Induction Standards were in place for each person. On inspection of the staff training matrix, this showed that in the last 12 months the management team of the home have been procative in providing some members of staff with training in both core and specialist subject areas. These include manual handling, basic food hygiene, basic first aid, health and safety, infection control, death, dying and bereavement, dementia awareness, fire awareness, challenging behaviour, nutrition, mental capacity act and effective communication. The AQAA details that training for staff in anxiety and depression, Bi-Polar Affective Disorder, Schizophrenia, Korsakoffs and effective communication is planned throughout December 2009. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that it is run in their best interests. Evidence: From discussions with the manager, it is evident they have the necessary qualifications and experience to run the home and have been employed at Old Shenfield Place for several years. The manager has attained NVQ Level 3 and 4 and is near to completing the Registered Managers Award. During the site visit the manager demonstrated a good understanding and awareness of the main principles of person centred care and the importance and value of delivering good care to the people who live at Old Shenfield Place. The manager confirmed she holds a regular weekly surgery at the home so that she can meet with residents, relatives, staff and other stakeholders. While we recognise good areas of practice, improvements and sustainability in some areas, there are still some areas identified in this report that require further development as these potentially effect the quality care outcomes for people living at Care Homes for Older People Page 25 of 31 Evidence: Old Shenfield Place. This refers specifically to ensuring that further improvements are made to the care planning and risk assessing processes and medication practices and procedures are improved. The registered provider has a quality assurance system in place that includes obtaining the views of residents, their relatives and staff. We were advised that this was initiated in September and October 2009 and several completed surveys have been returned, however the summary of the results has yet to be finalised. Comments from people who live at the home and their relatives were generally positive and included I think our relative is cared for to a very high standard and we all feel that they are in good hands, We are all very pleased with the level of care our relative is presently receiving, We as a family would like to express our thanks to the manager and all the staff at Old Shenfield Place for the care and understanding given to [name of resident] and I am very happy here and the carers are excellent. In addition to the above a representative of the organisation undertakes monthly Regulation 26 visits and compiles a report. Records also showed that there are regular staff meetings held at the home. A system was in place for staff to have one to one supervision meetings which provides opportunity and support, for example to review, training needs and care practices. Records of supervision viewed for 4 people indicated that discussions include reference to 6 core areas of choice of home, health and personal care, daily life and social activities, complaints and protection, environment and staffing. Where there was documentary evidence to show these had taken place the information recorded was detailed and comprehensive, however records showed that these have not been undertaken as regularly as they should or in line with National Minimum Standards recommendations. Records of routine safety checks were requested to ensure a safe environment was maintained for people who live at the home and staff. Routine safety inspection certificates were examined and these were seen to be appropriate and in date. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be devised for all areas of assessed risk so that risks identified can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the person and steps taken to reduce the risk. Previous timescale of 6/1/2009 not fully met. This will ensure that risk areas are identified and staff are aware of the associated risks to residents health and wellbeing. 15/02/2010 2 7 15 Care planning at the home must identify, and be effective in meeting all residents assessed needs and ensure these are regularly updated and reviewed to reflect the most up to date information. Previous timescale of 6/1/09 not fully met. This will ensure that staff have the most up to date information and can provide appropriate care to meet their needs. 15/02/2010 3 36 18 Ensure that staff, receive 01/02/2010 Page 27 of 31 Care Homes for Older People 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 regular supervision. Previous timescale of 6/1/09 not met. So that staff feel supported and residents know that staff are appropriaetly managed. Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 Ensure that medication is not 03/12/2009 left unattended and easily accessible to people in the home or others that it is not prescribed for. So as to ensure peoples safety and wellbeing. 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 9 13 Ensure that where 22/01/2010 medication is out of date and/or no longer required this is removed and destroyed or returned to the pharmacy. So as to ensure peoples safety and wellbeing. 2 9 13 Where people are prescibed 22/01/2010 a variable dose, ensure that the specific dose administered is clearly recorded on the MAR record. So as to ensure peoples safety and wellbeing. Care Homes for Older People Page 29 of 31 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 29 Ensure that all records as required by regulation are sought and in place. Care Homes for Older People Page 30 of 31 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. 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