Inspection on 06/07/09 for Philiphaugh

This inspection was carried out on 6th July 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Philiphaugh 29/08/07

Philiphaugh 10/10/06

Philiphaugh 09/05/06

Philiphaugh 24/11/05

Philiphaugh 11/05/05

Philiphaugh 10/11/04

Philiphaugh 06/07/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

Key inspection report Care homes for older people Name: Address: Philiphaugh Station Road St Columb Major Cornwall TR9 6BX     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: Gail Richardson     Date: 0 6 0 7 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 34 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 34 Information about the care home Name of care home: Address: Philiphaugh Station Road St Columb Major Cornwall TR9 6BX 01637880520 01637880520 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Stephen Michael Hendy care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service users to include up to 12 adults of old age (OP) Service users to include up to 19 adults aged over 65 with a mental illness (MD(E)) Service users to include up to 19 adults aged over 65 with dementia (DE(E)) Service users to include up to 6 adults aged over 65 with a learning disability (LD(E)) Total number of service users not to exceed a maximum of 32 Date of last inspection Brief description of the care home Philiphaugh provides care for up to thirty two people in need of care by reason of old age, dementia, mental disorder and a learning disability. Respite care is available at the home in addition to long stay care (when a bed is available). The home also Care Homes for Older People Page 4 of 34 0 0 0 0 Over 65 19 6 19 12 Brief description of the care home provides a day care service. The home is situated close to the town of St Columb Major enabling the more mobile people to visit the shops and facilities independently. The home is set in attractive grounds and is a listed building. Car parking is available in the grounds of the home. The building has been extended with two wings. There are several communal rooms including an activities room and a smoking lounge. Access to the first floor in the main house is by a staircase, which is provided with a stair lift. Bedrooms are available on the ground and first floor of the home. Many of the bedrooms have en suite facilities. The fee range (correct as of July 2009) is fron 315.00 pounds to 375.00 pounds and does not include chiropody, hairdressing, newspapers and some toiletries. 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: This was an unannounced inspection, which took place over 1 day (7 hours) on the 6th July 2009 by Regulation Inspector Gail Richardson. For the purpose of this report the term We will be used when refering the the Care Quality Commission. A tour of the home took place and a selection of the bedrooms and all communal areas were seen. There were 23 people currently residing at the home. One person was admitted for respite on the day of the inspection. All people were receiving personal care. The last key inspection was undertaken on the 29th August 2007. An Annual Service Review was done on 31st October 2008. No other visits to the home have been undertaken. We spoke to 7 people using the service and 9 members of staff, the Registered Care Homes for Older People Page 6 of 34 Manager was available throughout the inspection. We spent time talking to people within the home and staff and we observed care being provided. The home has provided CSCI with a completed AQAA (Annual Quality Assurance Audit) which was completed by the Manager and gives details of all aspects of the home. As part of this inspection we surveyed the opinions of a random selection of people using the service and their representatives- two were recieved back. We received one survey back from a visiting health professional and nine surveys from staff members. Records relating to care including 4 care plans, 3 staff files, finances and health and safety records were examined The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are, excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The registered manager must ensure that pre admission assessments are detailed to include all areas of identified need. This information must then be incorporated in the risk assessments and plan of care for each person. This care plan must detail what the need is and instructions for staff to meet that need. The care plan must be agreed with the person and reviewed monthly to ensure that short and long tern care needs are monitored and changes addressed. Medication practices need further development to ensure that safe practices are maintained. Activity recording needs further development to ensure that choices and preferences for each person are noted and developed. The monitoring of meals is needed to ensure that a consistent mealtime service is Care Homes for Older People Page 8 of 34 maintained. The dining experience is also recommeded to be developed to ensure it is a social event. Staff training in abuse awarness and the policies in place for this area need to be reviewed. This is needed to ensure the safety and protection of people using the service. Some areas of the home are in need of repair/ replacement and an audit of the environment is needed with a clear plan of maintenence. The areas identified are detailed in the body of this report. Staff training needs to be monitored clearly to be able to identify which staff need further training updates. Recruitment of staff needs to have further detail to ensure the safety f people using the service. Some areas of health and safety practice need to be recorded and there needs to be monitoring of hot water systems to protect people using the service from the risk of injury. The storage of substances hazardous to health need to be secure to avoid any risk of accidental ingestion. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes Service User Guide, Statement of Purpose and contract of residency have been updated to ensure that prospective people can make an informed decision about the home. Pre admission assessments and documentation do not consistently reflect all areas of identified need and so may place the person at risk. Evidence: The home has in place a Service User Guide and Statement of Purpose to enable prospective people using the service and their relatives/representatives to make an informed decision about the home. This had been updated to reflect changes in contact details. We looked at 3 pre admission assessments. Two were noted to not be signed and dated when completed and so did not give a clear indication of when people were seen prior to admission. It was also noted that in one case a person had specific needs Care Homes for Older People Page 11 of 34 Evidence: which were not noted on the pre admission assessment. The manager confirmed that she receives a copy of the Social Services Assessment when possible and talks with relatives prior to admission. People have the opportunity to visit the home to test run the service if that is appropriate. We received two surveys from people using the service who told us that they had received enough information prior to admission and one person told us at inspection, that their family had viewed the home prior to arranging the admission on their behalf. We were unable to assess if staff had sufficient training to meet the specific needs of people using the service as there was no documented training overview. Staff told us that they received training in all mandatory areas. It was observed that staff appeared to know people using the service well and supported them with tasks and through discussion. The home is registered to supply specific mental health, dementia and learning disability care. There was no evidence of staff training in these specific areas. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans did not contain sufficient information to ensure that staff are aware of the plan of care required to meet the risks identified. The knowledge of the staff group ensures that the needs are being met but insufficient recording and monitoring may place people at risk. Staff were observed to treat people with dignity and respect at all times and people feel well cared for. Medication systems are mostly well managed but require further review in some areas to ensure the safety of people using the service. Evidence: Four care plans were reviewed, these included the most recent admissions to the home. We met with some of these people and observed care being provided. The care plan statement at the beginning of each record states As the name suggests it contains a statement of the care that is to be given and goes on to say The care plan should demonstrate a logical flow of ideas from assessment, through action to evaluation and back to assessment . Care Homes for Older People Page 13 of 34 Evidence: Each person has a detailed assessment of their needs. There are currently no care plans in place to provide staff with a plan of care for each identified need. Risks are currently identified but do not state the level of risk. Each person has specific physical and mental health needs which should have appropriate risk assessments and clear plans of care with instructions for staff. By not providing a clear plan of care for staff to follow, short and long term care needs are not clearly monitored and reviewed and this may place people at risk. There are records of input from visiting health professionals and monitoring records for weight and personal care given. There is also a daily record maintained. There are monthly reviews of care in place but these were not consistently undertaken. People using the service sign the care plan to agree the content. All records are stored securely in line with the Data Protection Act 1998. Management and staff demonstrate a clear understanding of the care of the people using the service. Staff appear to understand the importance of people being supported and encouraged to enable them to exercise their rights and make their own decisions and choices.Both male and female staff are employed. One staff told us that the gender preferences for care are known by staff, however this is not recorded in the care records and may affect peoples preferences should they not be able to communicate them. It was evident from discussion with staff and people using the service, observation of care practice and surveys received that people felt their care needs were been met. Each person who spoke with us at inspection confirmed that staff were kind and supportive and that they had all their care needs met. A survey by a person using the service told us The carers respect and cater for individual needs of clients without discrimination. Staff told us The home and staff has worked very hard over the last 3 years to bring standards back up to where they should be. We all feel very proud that we deliver a high standard of care and treat every service user with up most respect. All staff are aware that the home is the service users home and that they have the right of choice. Medication systems were in place to promote good practice, however some ares are required to be addressed to ensure the safety of people using the service. All staff who dispense medication have appropriate training. There is a clear medication policy which is signed by staff. The medication records were well maintained but require a photograph for each person to ensure clear identification. It is required that all prescribed creams and nutritional supplements are signed for to ensure evidence of Care Homes for Older People Page 14 of 34 Evidence: administration. Not all creams stored in bedrooms and bathrooms were clearly labeled and non had the identified date of opening. One tube of Conotrane cream was labeled Bathroom. This clear labeling is recommended to ensure that there is no risk of cross infection and that the creams do not exceed their shelf life. It was discussed with the manager that when people leave the home for short periods of time the medication that they take with them must be clearly labeled to include the persons name, name of medication and clear directions for administration. The home must record that this medication has been supplied. Only one person self administers medication and it is required that a risk assessment be put in place for that person to be reviewed and monitored regularly to ensure safe practice is maintained. It is is also required that any stock given out is recorded to provide a clear audit of medications provided. Disposal systems are well maintained and the manager is advised to clear unusable stock from bathroom and keep the room secure when not in use to prevent the risk of accidental ingestion. The controlled Drug Cupboard is not sited correctly and is required to be moved to a fixed wall. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides activities in various setting and people have the choice of participation. Contact with the community and is maintained and the relevant contact is available to meet any religious needs. The meals provided are generally enjoyed by the people using the service and a choice is available. The comments received indicated that the quality of the food was variable. Evidence: The home does not have a designated activity staff and activities are organised by care staff and advertised on an activity board in the recreation room. The home undertakes personal histories of each person which includes activity interests and preferences.The manager told us that these records direct activities provided. People told us that they joined in if they want to and they were happy with the level of activity provided. The home has recreation room available and was seen to be in use. A summer fete had been undertaken by the home the previous weekend and people told us how much they had enjoyed this. On the day of inspection people were seen to entertain themselves during the morning, people were seen to be playing dominos and moving freely around the Care Homes for Older People Page 16 of 34 Evidence: home. In the afternoon staff were seen talking to people and being encouraged to participate in activities.One person has a small dog which lives at the home and is supported by staff to continue with this arrangement. Recording of activities is limited to recording in the daily record. It was discussed that a more detailed recording system would identify that all people had received social interaction and stimulation each day. The level of participation and enjoyment could also used to develop further activity preferences. The home has a mini bus and people told us that it was used regularly. Comments received included, The home provides good social entertainment and caters for personal interests, facilitates for many activities ie. Parties social group activities by visiting artists. Also The home provides religious meetings and visits by transport to areas of general interest. The manager told us that people are registered to vote If they are able. No assessments of capacity are undertaken to establish if people are able to participate in the electoral process. The manager told us that she can access an independent advocacy service but is not required currently. The statement of purpose states that the home celebrates the diversity of people in our community and in this home by respecting and providing for the ethnic, cultural and religious practices of the service user. The home has an equal opportunities policy that supports people of any race, gender, age and disability.This policy has not been regularly reviewed to ensure that it continues to support people at the home. People told us that their relatives visited the home whenever they wanted to and that they were supported to leave the home on visits. The people using the service confirmed that they generally enjoyed the meals and that a choice is available.The comments received from people were variable and some people felt that the food was very good and some felt that the quality of food was not always up to a good standard. Breakfast is served in the persons bedroom or the dining room, lunch is the main meal of the day and a lighter evening meal is served around 5pm.Supper is provided early evening. The menu is planned by the cook and the manager with input of choices from people using the service. People are asked on the day what their choice of main meal will be. Several people did not know what was for lunch and whilst a written daily menus is available the manager is recommended to provide a more visually accessible method of display to be considered. The home has a full time cook who demonstrated a good understanding of specialist diets needed at the home. Nutritional training is supplied in Care Homes for Older People Page 17 of 34 Evidence: house by the cook. One survey told us that the home could improve by Sometimes the food could be better. Another commented that the home could do better by Improve quality and choice of catering suppliers, cheapest is not always best value. We observed lunch and the range of choices available was seen. Puree diets were served separately to ensure that people could discern different tastes and textures of food. People were supported to eat and drink as needed. The dining room is a large area with some large tables which do not promote a social dining experience as people were too far away from each other to speak. The registered manager is recommended to review the organisation of mealtimes as a dining experience to ensure that the social aspect of dining is promoted. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that they are listened to and their requests acted upon. Staff understand of their role to ensure that people using the service are protected from abuse. Policies in place are not clear to support staff if allegations of abuse are made and staff training records are not available to ensure staff tarining has taken place. Evidence: The home has a complaints policy and includes the correct contact details. This is displayed in the home to enable access to all. It is recommeded that the registered manager include details of the timescales to be expected in response to any complaints or concerns raised. No complaints have been received by CQC or the home since the last inspection. People using the service and staff were all confident that any issues raised could be taken to the manager and they would be dealt with promptly and appropriately. People told us that the manager and staff are always approachable. Surveys said that people knew how to make a complaint and who to talk to if they were unhappy. One staff told us Alice is spot on, any problems we go straight to her and she sorts them out. The homes Statement of Purpose states The home make all possible efforts to protect service users from every sort of abuse and from the various possible abusers. Care Homes for Older People Page 19 of 34 Evidence: Training in POVA (Protection of Vulnerable Adults) is not recorded on an overview and records were not evident in the three staff files we looked at. The manager advised us that staff read and sign literature related to the subject. The manager is required to ensure that all staff have recieved updated abuse awarness training. The policies of the home are contradictory and confusing and should be adjusted to reflect the current local practice guidance. This updated information should be provided to all staff at the home to ensure that they are clear of what to do if an allegationis made. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides residents with a clean and homely place to live. Maintenance of the decor is required to ensure a safe and hygienic environment. Evidence: The home consists of an original country home with extensions on one side. Bedrooms are situated on the ground and upper floor with access in both cases by stair lift and stairs. Most rooms are single accommodation and all appear to be of a good size. The home provides ample social and recreational areas. The outdoor space is well maintained and accessible. CCTV are used to monitor the front door area, car parking and access corridor of the home. The decor of the communal areas and bedrooms was of a good standard and people told us that they could bring small personal items with them. Rooms were seen to be decorated in a personal manner reflecting the tastes and interests of people using the room. The home provides equipment were there is an assessed need. Two wheelchairs were noted to not have footplates. One person was seen to be transported to the dining room with no footplates in place. This may place people at risk of serious injury and this practice must be reviewed. The home is generally well maintained with some rooms having been upgraded. However, some areas of the home require repair/replacement. Some windows on the Care Homes for Older People Page 21 of 34 Evidence: upper floor were unrestricted and may be a risk of injury from falls. The manager arranged at the inspection for the windows to be inaccessible until risk assessment and restrictors could be fitted. Freestanding wardrobes and bookcases also require to be risk assessed and appropriate action taken to address any risk of tip hazard. Some windows identified to the manager need repair/ replacement to ensure the safety and comfort of people using the service. Some toilets and bathrooms were seen to need repairs to tiles which were, raised, cracked or missing. This may pose a risk of cross infection. Furthermore some bathrooms have floor covering which is damaged or ill fitting and again may pose a risk of cross infection. Currently only one bathroom is in use at the home. A second bathroom is no longer in use and there are several en suite showers available around the home. The manager must ensure that the in use bathroom room is kept secure when not in use as it is used to store toiletries and may place people at risk of accidental ingestion. Some doors do not have a locking facility for people using the service who may wish to lock their rooms. The deputy manager explained that each person is risk assessed and rooms provided with working locks only if the management thought this was safe. Some rooms were noted to have padlock brackets at the top of the doors. We were told by the deputy manager that this was to stop people accessing unused rooms. There are to be removed by the homes handyman. The home uses disposable gloves as a means of infection control. No paper towels and flip top bins are available in bedrooms and staff take used gloves to a downstairs kitchenette to dispose of them and wash their hands. The manager must ensure that staff are aware of the risks of cross infection involved in transporting gloves through the home before hand washing. The home has three cleaning staff on duty most days and the standard of hygiene was good. The home appeared clean with no areas of malodour. One person told us The home is also kept very clean by a brilliant team of domestic staff. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs enough staff to meet the needs of the people using the service . People benefit from having experienced staff who have a good understanding of their needs. Some areas of recruitment and training need further documentation. Evidence: For the current number of people living at the home there are four care staff plus the registered manager and deputy manager. There are also three cleaners a housekeeper and a cook on duty. In the afternoons there are 3 care staff and overnight there are two waking night staff. Staff and people using the service told us that they felt there were sufficient numbers of staff to meet the needs of people using the service. Everybody we spoke with were complementary about the staff saying that staff were kind and always helped them. One visiting health professional told us that It is a very good home, always working for the benefit of their residents. One staff member told us I enjoy my job and the great team spirit and you could not ask for better support from the manager. This is a very nice place to work as everyone gets on with each other. Staff rotas were not clear and did not enable us to see if all shifts were covered. The staff rota is required to be dated and include the full names of all staff members. The Care Homes for Older People Page 23 of 34 Evidence: manager confirmed that whilst permanent staff pick up extra shifts , some agency staff are used. All staff receive a 1 day introduction to the home and a further induction program using the Common Induction Standards. Staff told us that further training is ongoing, however the manager does not hold a staff training record overview and so we were unable to see if all staff have received training in all mandatory areas. One staff member told us that they had not undertaken any Moving and Handling training since being employed at the home ten months ago. The registered manager isrecommended to undertake an overview record of staff training in a manner which will indicate any shortfalls. These shortfalls must then be addressed. The registered manager currently undertakes monthly supervision with staff and records training at that point. The staff files we looked at did not contain any staff training records and some certificates seen were out of date. The manager confirmed that over 50 of staff have achieved a National Vocational Qualification (NVQ). Four staff recruitment files were looked at. These contained all the checks required, however the employment histories for two staff had gaps in. It is recommended that all gaps be discussed at interview and the reasons documented. This is recommended to ensure that people using the service are not placed at risk. Care Homes for Older People Page 24 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. Staff and people using the service have confidence in the management of the home. The views of people are important to the home and help change care provided. The home promotes the health and safety of people using the service, further action and record keeping is needed in this area. Evidence: The registered manager is Alice Taylor. She has run the home for several years and promotes an open and inclusive managment approach. All people using the service and staff told us that they felt able to approach Alice and had confidence in her management. The views of the people using the service are sought by both questionaire and regular discussion. The questionaire responses are not gathered and no plan of action made to address any isses raised. It was discussed with the manager that by gathering the information there was evidence of clear plan of action. Care Homes for Older People Page 25 of 34 Evidence: Personal monies can be stored by the home and a record maintained of all deposits and withdrawals. These records were noted to be correct . Records stored at the home are stored securely and in line with the Data Protection Act. Staff are aware of the need for security of confidential documentation and all records are maintained individually. Accident records are maintained for people using the service and staff. The manager is recommended to review all accidents and audit monthly to identify trends and incidences to promote accident prevention. The records relating to health and safety were seen, some records were missing and copies are to be forwarded to CQC. It was identified that the home does not monitor the delivery temperature of hot water outlets. This most be done monthly and recorded to ensure that the hot water is delivered within Health and Safety temeprature guidleines. It was observed that some rooms contained dental tablets. People using the service may be at risk of accidental ingestion and the manager advised that these would be removed on the same day as the inspection. Care Homes for Older People Page 26 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 27 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 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 3 14 The registered manager 13/08/2009 must ensure that all pre admission assessments are fully completed to identify all areas of assessed need. These assessments must should be signed and dated on completion. This is required to ensure that the home can identify and be sure it can meet all the persons needs prior to admission to the home. The documents need to be signed and dated to provide a clear audit trail of the admission process. 2 7 15 The registered manager 07/08/2009 must ensure that a care plan is in place for each person using the service. This plan must include all risks and areas of identified need. This is required to ensure that staff have a clear plan Care Homes for Older People Page 28 of 34 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 to follow and enable monitoring of short and long term care needs. 3 9 13 The registered manager is required to ensure that all precribed creams and dietary suppliments are signed for when given This wil provide a clear audit trail of all medications administered 4 9 13 The registered manager 09/08/2009 must ensure that any person who self medicates has a risk assessment in place which is reviewed regularly. This will ensure that any risks are identified and monitored to promote the safety of the person. 5 9 13 The registered manager 07/08/2009 must ensure that all medications which are given to people when they go out of the home are clearly labelled to identify the name of the person, medication and instructions. This will provide clarity for administration when outside of the home. 07/08/2009 Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 9 13 The registered manager must ensure that the Controlled Drug Cupboard is sited on a secure wall. This is required to ensure that the cupboard cannot be moved and provides secure storage of medications. 21/08/2009 7 18 18 The registered manager is 21/08/2009 required to ensure that a clear policy on abuse awarness is available for staff. This policy must reflect the best practice local policy for Safeguarding Vulnerable Adults. This will ensure that all staff are aware of the correct actions to take should an allegation of abuse be made. 8 18 18 The manager is required to ensure that all staff have reciecved updated abuse awarness training. This is required for the protection of people using the service. 28/08/2009 9 19 12 The registered manager must ensure that all upper floor windows are risk assesed and restricted. 21/08/2009 Care Homes for Older People Page 30 of 34 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 This is required to prevent the risk of falls to people using the service. 10 22 12 The registered manager 21/08/2009 must ensure that all wheelchairs have the foot plates attached when transferring people using the service. This will prevent the risk of injury to people using the service. 11 24 12 The registered manager must ensure that all rooms with locks have been risk assessed to ensure that people are not able to lock themselves in without emergency access from outside. This is required to ensure the safety and well being of people using the service. 12 38 12 The registered manager 31/07/2009 must ensure that dental tablets are risk assessed and the approriate action taken with reference to storage. This is to prevent the risk of accidental ingestion. 21/08/2009 Care Homes for Older People Page 31 of 34 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 13 38 12 The registered manager is required to ensure that the hot water temperatures are checked monthly. This must be done monthly and recorded to ensure that the hot water is within Health and Safety temeprature guidlines. 21/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The registered manager is recommended to ensure that all people using the service have a photograph available on their care plans and medication records. This will clarify identification when needed. The registered manager is recommended to ensure that all creams stored in bedrooms and bathrooms are clearly labeled to include the prescribed persons name and date when opened. The registered manager is recommended to review the storage of dressings in the downstairs bathroom . The stock must be reviewed to be sure that prescribed dressings are returned and not used as stock. The registered manager is recommended to review recording of activities to ensure that all people had received social interaction and stimulation each day and the level of participation and enjoyment. The registered manager is recommended to ensure that the capacity of each person is assessed to support any partcipation in the electoral process. The registered manager is recommended to review the content of meals and the organisation of mealtimes as a dining experience to ensure that the social aspect of dining Page 32 of 34 2 9 3 9 4 12 5 14 6 15 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations is promoted. 7 15 The registered manager is recommended to provide a more visually accessible method of display of meal choices to be considered. The registered manager is recommeded to include within the homes complaints procedure, timescales of expected responses from the home of any concerns or complaints made. The windows identified at inspection are recommended to be repaired/replaced to ensure the safety and comfort of people using the service. The registered manager is recommended to ensure the repair of the bathroom walls and floors as identifed at inspection. The registered manager is recommended to risk assess all free standing units and ensure the appropriate action is taken. The registered manager is recommended to ensure that staff have a clear protocol for the safe disposal of gloves and hand washing to ensure there is no risk of cross infection. Staff rotas were not clear and did not enable us to see if all shifts were covered. The staff rota is required to be dated and include the full names of all staff members. The registered manager is recommended to have a overview record of all staff training to ensure that updates of training are identified. It is recommended that all gaps in employment histories be discussed at interview and the reasons documented. The registered manager is recommended to gather all the information form quality assurance surveys and create a plan of action to address issues raised. The manager is recommended to review all accidents and audit monthly to identify trends and incidences to promote accident prevention. 8 16 9 19 10 19 11 23 12 26 13 27 14 28 15 16 29 33 17 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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