Inspection on 10/06/09 for Orme House Residential Home

This inspection was carried out on 10th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orme House Residential Home 07/04/10

Orme House Residential Home 17/06/08

Orme House Residential Home 04/07/07

Orme House Residential Home 06/07/06

Orme House Residential Home 04/10/05

Orme House Residential Home 24/05/05

Orme House Residential Home 04/08/04

Orme House Residential Home 30/04/04

Orme House Residential Home 11/03/04

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 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Orme House Residential Home 59 Kirkley Cliff Lowestoft Suffolk NR33 0DF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Small     Date: 1 0 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Orme House Residential Home 59 Kirkley Cliff Lowestoft Suffolk NR33 0DF 01502574068 01502574068 sandy@sahadew.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Anglia Care Homes Ltd care home 19 Number of places (if applicable): Under 65 Over 65 1 19 dementia old age, not falling within any other category Additional conditions: 0 0 1 The home may accommodate one person, whose name was made known to the commission in June 2005, who is over 65 years and requires care by reason of dementia. Date of last inspection Brief description of the care home Orme House is registered as a care home providing personal care for 19 older people aged over 65 years. One of whom has dementia. Care assistants staff Orme House on a 24-hour basis. One of the registered proprietors, Mr Sahadew is also the registered manager. The layout of the home is on 3 floors with level access provided in most areas by means of a shaft lift. Rooms 5, 6 and 11 are not accessible by the shaft lift. A stair lift can be used to access rooms 5 and 6, but to access room 11 the occupant needs to use stairs. Single bedrooms and shared accommodation are available. The home looks out to Kirkley Cliff, a busy one-way thoroughfare. Kensington Gardens, Care Homes for Older People Page 4 of 34 Brief description of the care home with its many attractions and sea front. Parking is on the road. The manager told us that the fees for the home were £365 per week. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced inspection took place Wednesday 10th June 2009 from 10:05 to 17:20 and Tuesday 16th June 2009 from 10:15 to 10:45. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The registered manager was present for the majority of the first day of the inspection. During the inspection health and safety records, staff training records and the Care Homes for Older People Page 6 of 34 recruitment records for three staff were viewed. The care records of three people that live at the home were tracked, which included care plans and medication records. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and eight people that lived at the home, one visitor to the home and six staff members were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and it was returned to us. Staff, service user and health professional surveys were sent to the home. Seven service user and two staff surveys were returned to us before the inspection. Four health professional surveys were returned to us, three of which had been completed by relatives of people that lived at the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 34 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 who use the service can expect to be provided with information about the home to help them to decide if they want to move in and to have their needs assessed prior to moving into the home. The home does not provide an intermediate care service. Evidence: People were provided with the information about the service that was provided at Orme House in the Statement of Purpose and the Service Users Guide. The Statement of Purpose was viewed and it included information such the accommodation provided including the sizes of the rooms, the homes mission statement, aims and objectives, philosophy of care, the arrangements for referral, assessment and admission, terms and conditions, the arrangements for safeguarding peoples possessions and finances, the services and facilities that were provided to meet peoples needs, the managers and staff training and qualifications and the Care Homes for Older People Page 10 of 34 Evidence: complaints procedure. Since the last inspection the Statement of Purpose had been updated to show the contact details of CSCI (Commission for Social Care Inspection), it needed to be updated further to include the details of CQC (Care Quality Commission). The Service Users Guide was viewed and included details of the services and support that was provided at the home and information such as the arrangements for medication administration, care planning, meals and quality assurance. The complaints procedure was included in the Service Users Guide and this also needed to be updated to show the contact details of CQC. Six service user surveys said that they were provided with enough information about the home before they moved in so that they could decide if it was the right place for them and one did not answer. Comments included (relative) did help me to make a decision and was shown around and met other service users and I liked it when I first saw it. The care records of three people that lived at the home were viewed and each held a detailed needs assessment, which had been completed by a member of the homes management. The assessments identified the support that each person required and preferred, such as with their personal care, mobility, communication and continence. The assessments had been reviewed since the last key inspection and the manager told us that they had used the assessment templates which were provided to them by Suffolk social care quality and monitoring team. Peoples records also included a needs assessment which had been provided by the placing authority. The AQAA stated we ensure that all residents are assessed prior to admission and they are given the right to choose and make the final decision. Each of the peoples records that were viewed held a care plan which identified how their assessed needs and preferences were met. Care Homes for Older People Page 11 of 34 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 who use the service can expect to have their health and social care needs met which are set out in an individual care plan, to be treated with respect and to be protected by the homes medication procedures. Evidence: The care records of three people that lived at the home were viewed and each held a care plan which identified how their social and health care assessed needs and preferences were met and the areas of their care that they could attend to independently. The records identified the support that people required and preferred with areas such as personal care, mobility, continence, health and diet. There were manual handling risk assessments and skin tissue viability assessments in place, which identified risks and methods of minimising the risks. The records were updated regularly with peoples changing needs and preferences. One of the care plans that was viewed was of a person who had recently moved into the home, the care plan included the details of how the persons needs were to be met, however, there were some areas that had not yet been completed, which included the persons wishes at Care Homes for Older People Page 12 of 34 Evidence: the time of death. The manager told us that they were working on the care plan and in the process of speaking with the person and their relatives to gain their preferences. The AQAA stated a comprehensive care plan is drawn prior to giving care. Daily records were viewed and they identified the support that people had been provided on a daily basis and the observations of the staff regarding their well being. There were records in place which showed the medical treatment that people had been provided with and the outcomes of the treatment. Records of key worker meetings were viewed and they showed that people were consulted with about the care that they were provided with. The manager told us that all the care plans had been updated onto the care plan template that was provided by social care quality and monitoring team. Staff that were spoken with told us that the care plans provided them with the information that they needed to meet peoples needs. During the inspection staff were observed to complete peoples daily records. Two staff surveys said that they were always provided with up to date information about the needs of people that lived at the home. People that lived at the home that were spoken with told us that their needs were met in the ways that they preferred and needed. They told us that they were provided with medical appointments, such as with the doctor, when needed. The service user survey asked if they were provided with the care and support that they needed. Six answered always, one answered usually and comments made were hairdresser calls every two weeks, chiropodist calls once per month and I get all the care I need and everyone is nice. The survey asked if they were provided with the medical support that they needed. Six answered always and one answered usually. The health professional survey asked if the service sought advice and acted upon it to manage and improve peoples health and care needs. Three answered always and one answered usually. The survey asked if peoples individual health care needs were met. Two answered always and two answered usually. The AQAA stated all residents have their own GP, dentist, chiropodist and optician and are easily accessible when needed. The homes medication procedures were viewed and they identified how people were safeguarded. There were medication audits, which had been completed by a local pharmacist. The audits identified the areas for improvement and when they had been addressed. Care Homes for Older People Page 13 of 34 Evidence: Each persons care plan that was viewed included a medication profile, which identified their prescribed medication and the reasons why the medication had been prescribed. One persons records held guidance for when PRN (as required) medication was to be administered. The MAR (medication administration records) charts were viewed for three people and it was noted that the medication was accounted for. There were two gaps identified in one persons MAR charts, one was for PRN (as required) cream and the other had been marked with a highlighter pen. The manager explained that they had identified the gap in the MAR chart during a medication audit and that they had investigated and addressed the discrepancy. The manager told us that they had recently reviewed the MAR charts that they had used because the previous records did not identify the codes that were used for when people had not been administered with their medication, such as if they had refused pain relief PRN medication. It was noted that the current MAR charts showed the codes and they had been used appropriately. Part of the lunchtime medication round was viewed and it was noted that medication was stored in MDS blister packs in a secure medication trolley. The staff member that administered the medication was observed to wear clean gloves and an apron, they used clean medication pots, fresh water and clean cups and they secured the trolley when they left it. The staff member was spoken with and they told us that the senior staff were responsible for administering medication and that they had been provided with medication training. Another staff member was spoken with and they said that they were confident in the medication procedures and that they had been provided with training to administer medication safely, their training records were viewed, which confirmed that they had been provided with medication training. The controlled medication was stored in a secured metal cabinet inside a metal cabinet, which did not meet the current requirements for the storage of medication. A staff member was spoken with and they told us that the local pharmacy had ordered an appropriate controlled medication storage cupboard about a month ago. We observed the staff member telephone the pharmacist immediately and checked when they could expect the delivery. They told us that they had been told that it had been ordered and that it should be delivered within twenty eight days, which would be the week following the inspection, which showed that they had taken action to meet with current requirements to ensure that people were safeguarded by the homes medication processes. During the inspection we observed that peoples privacy was respected. Staff were observed to knock on bedroom and bathroom doors before entering them and each shared bedroom was provided with a portable screen. People that were spoken with Care Homes for Older People Page 14 of 34 Evidence: said that their privacy was respected. The health professional survey asked if peoples privacy and dignity was respected. Three answered always and one answered usually. People who lived at the home that were spoken with told us that the staff at the home treated them with respect. We observed that the interaction between staff and people that lived at the home was friendly, respectful and professional. It was noted that people were clean and well groomed, which showed that their dignity was respected. Three care plans that were viewed identified how people preferred to be supported with their appearance and personal care. The AQAA stated all residents privacy and dignity is maintained at all times. Care Homes for Older People Page 15 of 34 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 use the service can expect to be provided with opportunities to participate in activities which are of interest to them, to be supported to maintain their chosen contacts and to be provided with a balanced diet. Evidence: People were provided with the opportunity to participate in activities which were of interest to them. A staff member told us that they were responsible for organising group activities and that a staff member was placed on the rota each day to facilitate the planned activity, which was confirmed by the rota that was viewed. The staff member told us that there were some people who preferred not to participate in group activities and these were provided with one to one time with staff if they wished. They said that they would be arranging more trips out of the home as the weather had improved. The activity programme was viewed and activities that were provided included board games, sing along, quiz, bingo, skittles, knitting, old time talk, art and crafts, movement to music, DVD and popcorn and outings. Peoples care plans that were viewed detailed when they had participated in the activities that were provided. During Care Homes for Older People Page 16 of 34 Evidence: the inspection it was noted that there were several games and jigsaws that people could use. We observed people participating in activities during the inspection. During the morning a person was observed reading a book in their bedroom, they told us that they preferred their own company, a staff member painted peoples nails, people chatted with each other and staff and people watched television. During the afternoon of the inspection a staff member played board games with people in the lounge. People that were spoken with told us that there was plenty to keep them occupied in the home and one person showed us their collection of colouring books, reading books and wordsearch books, which they said that they enjoyed doing. A person told us that they regularly attended a day centre and social clubs, which they attended by using a local taxi company. The service user survey asked if there were activities were provided that they could participate in. Three answered always, four answered sometimes and comments made were I mostly enjoy smoking outside and I like the singing and am looking forward to the Broads trip. When my (relative) phones up to take me out, the staff always have me ready. The AQAA stated that they did well by providing social activities as per ability and preferences and that they had improved in the last twelve months by motivated a large number of residents to participate in group activities. Peoples care plans that were viewed identified the contacts with family and friends that people chose to maintain and when they had received visits or telephone calls from their chosen contacts. People that were spoken with told us that their visitors were always made welcome at the home. A visitor to the home was spoken with and they told us that they visited the home regularly and that they were made welcome. During the inspection four people were observed to enjoy visits with their relatives. The AQAA stated encourage relatives to visit regularly and all residents are encouraged to practice their beliefs and culture. However, we had noted that one persons needs assessment had stated that they had no cultural needs, yet the assessment had stated that the person had previously lived in another county to Suffolk and that their religion was Church of England. We asked the manager what the statement had been based on because all people have cultural needs. The manager told us that the persons relative had said that they had no specific cultural needs and so this was recorded. The manager amended the needs assessment at the time of the inspection to show where the information had been gained from and that they had not chosen to practice their religion. People that were spoken with told us that they chose what they wanted to do in their lives and that the staff listened to them. Six service user surveys said that the staff Care Homes for Older People Page 17 of 34 Evidence: listened and acted upon what they said and comments made were very attentive and do not act sometimes straight away. A person was spoken with and told us that they had asked for a flannel to be bought to their room in the morning and that they were still waiting, the time was approximately 11:00am. The manager acted immediately and ensured that the person was provided with the flannel. People were observed to make choices throughout the inspection such as what they wanted to eat and drink and if they chose to participate in activities. The health professional survey asked if people were supported to live the lives that they chose to. Two answered always, two answered usually and one commented yes I think to let elderly people to keep as much independence as possible is very important. Peoples care plans that were viewed showed how peoples preferences were taken into account in their care provision, such as their likes and dislikes and their preferred times for getting up in the morning and going to bed in the evening. The records held keyworker meeting minutes, which showed how each persons key worker regularly discussed peoples preferences with them. There were two monthly residents meetings and the minutes for the last two meetings were viewed and they identified how people had been consulted with about the meals and activities that were provided in the home. The cook was spoken with and they told us that they attended residents meetings and spoke with individual people about their dietary requirements and preferences. The menu was viewed and it was noted that people were provided with choices of each meal and the menu was balanced and varied. During the inspection lunch was a choice of chips and fishcake or pasta bolognese and jam rolly polly or cheese and biscuits. People told us that they enjoyed their meal and it was noted that there was little left on the plates. The meal looked appetising and there was music playing from the 1940s when people were enjoying their meal. The dining room was clean and there were sufficient seating for the people that lived in the home. People were observed to enjoy an evening meal of bubble and squeak and bread and butter. The evening meal had been prepared by the cook and the care staff served the meal. One person showed us their meal of smoked haddock, which they had been given as a gift and they told us that the staff had prepared it for them. People were provided with choices of hot and cold drinks with their meals and during the day of the inspection. There were no cold drinks seen in the communal areas that people could help themselves to during the inspection. However, a staff member told us that there Care Homes for Older People Page 18 of 34 Evidence: were usually jugs of squash that people could help themselves to but they thought that they had been cleared away in readiness for their meal. The service user survey asked if they liked the meals that were provided at the home. Six answered always, one answered usually and comments made were excellent food, good home, good food, the choice varies and the meals of the best quality, we are given choices for all meals and meals are very good. People that were spoken with told us that the food at the home was good and that they were provided with enough to eat. The AQAA stated that they did well by providing menu as per residents choice and dietary requirements. Care Homes for Older People Page 19 of 34 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 use the service can expect to have their complaints listened to and acted upon and to be protected from abuse. Evidence: The complaints procedure was viewed and detailed how people could raise issues if they were unhappy about the service that they were provided with and the actions that would be taken as a result of complaints. People that lived at the home were provided with the complaints procedure which was included in the Statement of Purpose and the Service Users Guide. The AQAA stated complaints procedure is in place an all residents and relatives are made aware of this and one complaint received and dealt within successfully. The records of the complaint and the actions that had been taken as a result of the complaint was viewed and stored in the persons file. Informal complaints and the actions that had been taken to address the issues were recorded in peoples daily records, for example a recent meeting that had been held with a relative of a person and the placing authority regarding concerns that had been raised to social care about the standard of care provided was documented and a concern that had been raised that a person had been wearing clothing that did not belong to them. People that lived at the home who were spoken with told us that they were aware of Care Homes for Older People Page 20 of 34 Evidence: how to raise formal and informal complaints. One person told us that when they had raised concerns they were always acted upon. The service user survey asked if they knew who to speak to if they were not happy. Four answered always and three answered usually. Seven surveys said that they knew how to make a complaint. The health care professional survey asked if the service had responded appropriately if concerns about the care provided at the home had been raised. Three answered always and one answered usually. Two staff surveys and staff that were spoken with said that they knew what to do if a person wanted to make a complaint. Training records that were viewed showed that the staff team had been provided with safeguarding training March 2009. Staff that were spoken with confirmed that they had attended the training and were aware of actions to take if they had concerns about a persons well being. We had been made aware by Suffolk social care that a safeguarding alert had been made following a concern raised by a relative about the support that was provided. We had not yet been provided with the outcomes to the investigation. However, the meeting that was held was detailed in the persons records, which is identified in the second paragraph of this section. The AQAA stated POVA (protection of vulnerable adults) training is provided to all staff to ensure that all residents are protected from abuse. Care Homes for Older People Page 21 of 34 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 who use the service can expect to be provided with a clean and comfortable environment to live in. They cannot be assured that the stand aid is in working order should it be required for use. Evidence: A requirement was made at the last key inspection which stated that repairs should be undertaken in a timely manner, such as a broken light fitting and toilet seat in a ground floor toilet. The repairs had been undertaken. The maintenance book was viewed and it identified when repairs had been identified and when they had been addressed. The manager told us that there was a maintenance person employed at the home who undertook repairs as required. A tour of the building was undertaken and it was noted that the home was clean and homely. The communal areas included an open plan style lounge, dinning room and sun room. There was sufficient seating and people were observed to relax in the area throughout the day of the inspection. There was a small garden, which was paved and provided a bench which people could use if they chose to. The manager pointed out an area in the entrance to the ground floor toilets, where the tiles were missing. They said that the repair was due to be undertaken and that the tiles had been damaged by people entering the area in wheel chairs. The manager told us that they were in the Care Homes for Older People Page 22 of 34 Evidence: process of ordering a new carpet for the lounge, dinning room and sun room area. They said that the current carpet had been laid for two years, however, it had been faded by the sun. The AQAA stated we maintain a homely, safe and odour free environment to our residents and redecorated all the rooms and convert first floor bath room into a walking shower room. The service user survey asked if the home was fresh and clean. Five answered always and two answered usually. A requirement made at the last inspection was that the there should be no offensive odours in the home. Upon our arrival to the home on the two days of the inspection it was noted that the home smelled fresh and there were no unpleasant odours. On the first day of the inspection it was noted that there was a smell of urine present near to the ground floor communal toilets, during the late afternoon of the inspection. A staff member was spoken with and agreed that they would consider methods of ensuring that the toilets were cleaned later in the day as well as during the morning, which was the usual routines of the homes domestic staff. Peoples bedrooms that were viewed were clean and comfortable and each was personalised with items such as peoples personal memorabilia and photographs, which reflected their choice. People that were spoken with told us that they were happy with their bedrooms and that they were cleaned daily. One person told us that they had recently moved into the home and that their bedroom had been redecorated before they moved in. There were two hoists and a stand aid in the home for manual handling purposes. The stand aid held a notice which stated that it must not be used. The manager told us that they thought that it had been out of order for approximately two weeks and that they were waiting for the stand aid to be repaired, a date was not provided. The manager told us that the people that lived at the home at the time of the inspection did not require the use of the stand aid and that it would be repaired to ensure that if needed it would be available. Certificates were viewed which showed that the hoists were regularly serviced. There was a lift, which provided access to all floors of the home. There had been issues noted prior to the previous inspection when the lift had broken. Service certificates that were viewed showed that parts had been replaced in the lift and that it was in good working order. During a tour of the building it was noted that there was a notice on the lift which stated that the door should not be slammed. The manager told us that there had been no lift breakdowns, however, if the door was slammed then it caused the sensor to trip. They said that there had been no instances of people being trapped in the lift and that it was safe to use. People were observed to use the lift Care Homes for Older People Page 23 of 34 Evidence: during the inspection. The large laundry was viewed and it was noted that it was clean and tidy. The previous washing machine was out of order and there was a replacement top loader style washing machine and there was one drying machine. There were baskets in the laundry and each held the name of a person that lived at the home in which their clean laundry was placed, which ensured that they were provided with their own clothing. The external wall to the laundry included a garage door, at the previous inspection we were told that there were plans to replace the garage door with a solid wall, door and window. This had not yet been actioned, the manager told us that they were planning to ensure that the work was completed and that there was no date planned as yet. The laundry provided hand wash facilities, which included hand wash liquid and disposable paper towels which minimised the risks of cross infection. During the inspection staff were observed to use disposable gloves and aprons when they were supporting people with personal care, administering medication, serving food and undertaking domestic duties. It was noted that the staff changed their aprons and gloves regularly with each task, which minimised the risk of cross infection. A staff member that was spoken with told us that they had been provided with infection control training and they explained the homes procedures. Care Homes for Older People Page 24 of 34 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. People who use the service can expect to be supported by staff who are trained and competent to do their jobs and to be protected by the homes recruitment procedures. Evidence: The manager told us that the home was fully staffed and that there were three carers, the cook and a domestic each morning shift (there was a second domestic provided Monday morning), two carers for the afternoon/evening shift and two waking night carers each night. They told us that they had decreased the staffing of the afternoon/evening shift because there were fifteen people living at the home and the staffing would be increased when more people moved into the home. The rota was viewed and showed that there were three staff on both the morning and afternoon/evening shifts, which was confirmed by the staff members that were working at the time of the inspection. It was noted that staff were attentive to peoples needs and that call bells were answered promptly. The minutes from a recent staff meeting were viewed and they stated that the staff team had been advised that they must answer call bells promptly. Staff that were spoken with told us that there was sufficient staff working at the home, however, they were sometimes very busy in the evening when there was only two staff members on duty, which they told us had recently been the case. The staff Care Homes for Older People Page 25 of 34 Evidence: survey asked if there were sufficient staff to meet peoples individual needs. One answered always and one answered usually. The service user survey asked if the staff were available when they needed them. Five answered always, two answered usually and one commented even during the night. People that were spoken with told us that the staff were attentive to their needs and that they answered call bells promptly. However, one person told us that they sometimes had to wait for staff to act on their requests, such as when they asked for a flannel, which is discussed in the personal care and support section of this report. The recruitment records of three of the newest staff members were viewed and it was noted that the appropriate checks had been undertaken to ensure that people were safeguarded by the homes recruitment procedures. Each of the records held the staff members work history, identification, two written references and POVAfirst (protection of vulnerable adults) checks. Two of the records held a CRB (Criminal Records Bureau) check and one did not, a copy of their CRB application was present. The manager was spoken with and told us that the person had recently started working at the home following a satisfactory POVAfirst check and that they were supervised when at work until the time that their CRB was received. The manager told us that the majority of the staff team had worked at the home for several years. This was confirmed by staff members who were spoken with. The manager told us that two newly recruited staff members had started their Skills for Care induction on the day of the inspection which was provided by the local authority and incorporated the Common Induction Standards. The National Minimum Data Set, which was viewed at the home stated that 75 of staff had completed an induction course. Two staff surveys said that they had been provided with an induction which had covered everything that they needed to know to do the job when they started. The training records of three staff members were viewed, which were training certificates that were stored in their individual records. The certificates showed that they had been provided with training such as safeguarding, manual handling, infection control, health and safety and fire safety. A staff member told us that they were waiting for the dates of dementia training and that the manager had told them that if they wished to attend further training that it would be provided. Another staff member told us that the training provision at the home was good and that they had been provided with all the mandatory training. All staff that were spoken with told us that they were provided with the training that they needed to support the people that lived at the home. Two staff surveys said that they had been provided with training which Care Homes for Older People Page 26 of 34 Evidence: was relevant to their role, kept them up to date with new ways of working and helped them to understand the individual needs of people. The AQAA stated all staff has received statutory training. The health professional survey asked if the care staff had the right skills and experience to support individuals social and health care needs. Two answered always, one answered usually, one answered sometimes and one commented carers need more training and education in care of the elderly before working in residential homes. The home had met the target of 50 of staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 as identified in the National Minimum Standards relating to older people. The qualification had provided assessments on the staff members competence to perform their job role, which included areas of health and safety, safeguarding and meeting peoples needs. The AQAA stated the home has 80 NVQ level 2 and above trained staff. The National Minimum Data Set which was viewed at the home stated that 92 staff had achieved an NVQ qualification. Two staff members that were spoken with told us that they had achieved an NVQ level 2, one said that they had achieved an NVQ level 3 and one was a qualified nurse. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect that the home is run in their best interests and to have their financial interests safeguarded. They cannot be assured that the fire safety processes are sufficient to safeguard them in case of a fire and that their personal records are securely stored to ensure their confidentiality. Evidence: The home was managed by a person who was fit to be in charge. They had achieved a nursing qualification and the RMA (registered managers award). They had been successful in the CSCI (Commission for Social Care Inspection) registered manager application process. The manager told us that they had updated their knowledge with attendance to training such as safeguarding and health and safety. They said that in the near future the deputy manager of the home would be making an application to become the registered manager. The deputy manager had achieved the RMA award and had attended training such as safeguarding, Mental Capacity Act and Deprivation of Liberty. The manager also told us that they were in the process of considering Care Homes for Older People Page 28 of 34 Evidence: making an application to CQC (Care Quality Commission) to make a variation on their registration which included the provision of support to people with dementia. The homes management routinely notified us of notifiable incidents, which was a requirement made at the last key inspection. It was noted that Regulation 26 visit reports were not in place, the manager told us that they were the both the responsible individual and registered manager of the home and that the visits were not undertaken on behalf of the organisation due to their daily presence in the home. They were aware of their responsibilities of Regulation 26 visits in the future should the management of the home be changed. People were provided with the opportunity to express their views about the service that they were provided with in regular satisfaction questionnaires, key worker meetings and residents meetings. The AQAA stated quality assurance is carried out on a yearly basis to ensure that the residents are satisfied with the care and service provided. The Service Users Guide clearly identified the arrangements for safeguarding peoples finances. Peoples spending monies were stored in the safe where required and clear records of their spending and receipts were maintained. A person that lived at the home was spoken with and they told us that the staff helped them to budget their money and that they signed their finance records when they had requested money. They said that they were happy with the arrangement and were confident that their finances were safe. The AQAA stated managing two residents finance (weekly allowance only). We viewed service certificates for the lift, call bell, gas appliances and hoists. There were issues identified during the inspection regarding the lift and stand aid which are further discussed in the environment section of this report. Risk assessments were viewed which identified risks and methods of minimising the risks in the home. The risk assessments included new and expectant mothers, domestic duties, manual handling, the use of portable electrical equipment, water outlets and radiators, both of which was identified were provided with temperature control valves. The AQAA stated a risk assessment is carried out to promote health and safety of both residents and staff. There was a fire risk assessment in place, which the manager told us had been undertaken by a professional organisation. The fire safety records were viewed and it was noted that they had not been undertaken on a weekly basis to ensure that the fire Care Homes for Older People Page 29 of 34 Evidence: safety equipment was working appropriately in the case of a fire. An immediate requirement was made to ensure that regular fire safety checks were regularly undertaken to ensure that people were safeguarded in case of a fire. During the second day of the inspection we viewed the homes diary/communication book and it was noted that weekly checks had been entered and they were included in the shift plans which ensured that the checks would be made. A fire safety check was scheduled for the second day of the inspection, this had not yet been undertaken at the time of our visit. During the first day of the inspection the fire bells had sounded, the manager and the staff reported to the area where the fire alarm was situated and they checked the building for the source of the fire alarm activation. However, it was noted that one person was observed to go into the toilet and they were not advised of the actions that may be taken to ensure their safety should there be a fire in the home. During the second day of the inspection it was noted that the fire alarm system showed a fault. A staff member told us that this had been faulty since the first day of the inspection and that the engineer had been called out and was due to return to the home during the afternoon of the second day of the inspection. Two staff members were spoken with and they clearly explained the actions that they should take in case of a fire. A staff member agreed that they would ensure that personal evacuation plans for each person in the home would be provided to ensure that people were safeguarded in case of a fire. Peoples records that were viewed included the appropriate documentation regarding the support that they needed and preferred to meet their assessed needs. However, it was noted that they were not securely stored to ensure that their confidentiality was maintained. The records were stored in a cupboard in the staff room, there was a padlock attached to the door but the padlock mechanism had been removed from the cupboard. Care Homes for Older People Page 30 of 34 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 31 of 34 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 38 13 Fire safety checks must be regularly undertaken and recorded and people should be made aware of the evacuation procedures. To ensure that people are safeguarded in the event of a fire. 16/06/2009 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 22 23 The stand aid must be repaired. To ensure that it is available in the event that people may need to use it, for example, due to deteriorating mobility. 30/07/2009 2 37 17 Peoples personal records must be stored securely in the home. To ensure that their confidentiality is maintained and respected. 15/07/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 32 of 34 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 26 It is recommended that consideration be made to cleaning the communal toilets more often than during the morning, to ensure that offensive smells do not occur from their constant use. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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