Inspection on 11/11/09 for Pine Lodge Retirement Home

This inspection was carried out on 11th November 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pine Lodge Retirement Home 09/06/08

Pine Lodge Retirement Home 22/06/07

Pine Lodge Retirement Home 12/09/06

Pine Lodge Retirement Home 29/11/05

Pine Lodge Retirement Home 26/07/05

Pine Lodge Retirement Home 05/12/04

Pine Lodge Retirement Home 06/07/04

Pine Lodge Retirement Home 08/03/04

Pine Lodge Retirement Home 29/12/03

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The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

Key inspection report Care homes for older people Name: Address: Pine Lodge Retirement Home 32 Key Street Sittingbourne Kent ME10 1YU     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: Elizabeth Baker     Date: 1 1 1 1 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 32 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 32 Information about the care home Name of care home: Address: Pine Lodge Retirement Home 32 Key Street Sittingbourne Kent ME10 1YU 01795423052 01795423052 pine.lodge@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Stephen Paul George Thompson,Mrs Gillian Lesley Thompson Name of registered manager (if applicable) Ms Evelyn Marion Fielding Type of registration: Number of places registered: care home 57 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 57. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Dementia (DE). Date of last inspection Brief description of the care home Pine Lodge Retirement Home occupies two connecting wings of detached premises, with accommodation for 57 residents on two floors. The home is registered for older people and for people with dementia. There are two shaft lifts accessing Care Homes for Older People Page 4 of 32 Over 65 0 57 57 0 Brief description of the care home accommodation on the first floors. There is allocated car parking to the front and rear of the building and two enclosed garden areas. The home is situated close to Sittingbourne town centre, with local shops, public transport and other community facilities nearby. The range of activities includes cultural talks and themed activities, classical music, discussion groups, arts and crafts, special interest film shows, mystery tours and cream teas and music for health. External entertainers provide additional activities. A Holy Communion service takes place weekly. Current fees range from £431.62 to £595.00 per week depending on assessed needs, funding arrangements and room occupied. Additional charges are payable for newspapers, hairdressing, chiropody and toiletries. Care Homes for Older People Page 5 of 32 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: On the 11 November 2009 we the Commission carried out a key unannounced visit to the service. The visit lasted about ten and a half hours. The link inspector was accompanied by a pharmacist inspector for part of the visit. At the time of the visit 47 people requiring personal care and or dementia care were resident at the home. We walked around the home and talked with some residents and staff. We had conversations with eight residents and three visitors. We met with three members of staff. We looked at care records, medication records, staff files, policies and procedures, complaints books, minutes of meetings and schedules. Judgements have been made with regards to each outcome area in this report based on records viewed, observations and verbal responses given on the day. These judgements have been made using the key lines of regulatory assessment (KLORA) which are guidelines that enable us to make an informed decision about each outcome area. Care Homes for Older People Page 6 of 32 Verbal feedback was provided to the registered manager and deputy manager during and at the end of the visit. The last site visit took place on 9 June 2008. An annual service review was done on the 27 May 2009. At the time of our visit three safeguarding vulnerable adult investigations were being carried out. Because of some of the issues raised including a medication administration error and injuries sustained by a resident due to a fall, we brought forward our next planned key unannounced visit. The safeguarding investigations had not been concluded at the time of our visit and are being investigated in accordance with the countys multi agency procedures. In view of the above an up to date Annual Quality Assurance Assessment was not available for our inspection purpose. And surveys have not been used either. We have received one complaint about the service since the last visit and this was anonymous. We looked at the issues raised and have made one recommendation following our visit to the home with regard to the issues. This is in respect of seeking and recording the views of all residents with regard to their preferred getting up times to make sure residents get up when they want to. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: All residents must be asked for their preferred rising and retiring times. The information must be recorded and reviewed frequently with the individual residents. For residents welfare and protection, care records should be maintained in a style which provides the reader with a coherent picture of the residents assessed needs, action taken and goals planned. For residents safety, the content of risk assessments for residents who smoke must be expanded, so that all the risks associated with this activity are identified, assessed and recorded. Care plans must contain more medicine information where required and Medication Administration Record charts must be completed appropriately. For the protection of residents, all incidents affecting residents wellbeing and safety must be investigated in accordance with the countys multi agency safeguarding vulnerable adults policies and procedures. Care Homes for Older People Page 8 of 32 For the protection of residents, staff and visitors, action taken to meet residents individual preferences must not compromise the homes overall fire safety standards. More information must be obtained and recorded of residents cultural and spiritual wishes and preferences in respect of their end of life care. For residents safety full employment histories must be obtained on new applicants, as well as recorded evidence that unexplained employment gaps have been investigated. Visits required under regulation 26 must carried out monthly and written reports of the findings made available for inspection purposes. We have made three requirements. A number of good practice recommendations have been made throughout the body of the report 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 32 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 32 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. Prospective residents move into the home knowing their needs can be met. The homes Service User Guide generally provides prospective residents with the information they need to know in order to make a decision about moving into the home Evidence: The home has updated and expanded the Service User Guide to incorporate the Statement of Purpose. The document has been produced in large print and includes some colour photos. The information generally follows our guidance for content. However the document could be further improved in that precise bedroom sizes are not stated. Our regulations require this. Some prospective residents are able to visit the home to have a look around before deciding whether to move in or not. If the prospective residents are unable visit their advocates do this on their behalf. Care Homes for Older People Page 11 of 32 Evidence: To make sure the home can meet the needs of prospective residents a pre admission assessment is carried out. This is either done during the prospective residents visit to the home or if their condition prevents this trained staff visit them in their current place of occupation. Information gathered during the pre admission process is recorded and is used to develop the residents care plan. Information is also sought from other agencies involved in the prospective residents care including local authorities. Trained staff endeavour to carry out re admission assessments of existing residents awaiting discharge from hospital stays. This is good practice. The home is not registered for intermediate care. Standard 6 is not applicable. Care Homes for Older People Page 12 of 32 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. Personal care is offered in a way to protect residents privacy and dignity and promote independence. The health needs of residents are met with evidence of good multi disciplinary working taking place on a regular basis. However it was difficult in some cases to evidence this in supporting care records because of the current system and practices. The medicine management procedures in the service protect the welfare of the people in the home. Evidence: For case tracking purposes we inspected the care records of seven residents. Records included pre admission and admission assessments, care plans and supporting risk assessments. The care plans and assessments covered various needs and problems including health, mobility, smoking, activities, spiritual, personal hygiene, communication, dementia, falls, nutrition, continence, skin integrity and dependency. Body maps are used to record injuries suffered by residents by incidents such as falls. Care plans and risk assessments are normally reviewed monthly. Some of the records contained some person centred care information such as the Care Homes for Older People Page 13 of 32 Evidence: need to make sure a residents hearing aid battery was in working in order. This is good practice. However, the residents plan for personal hygiene support in respect of their shaving needs could be expanded further as the information did not include what kind of shave the resident prefers. Indeed the plan stated to offer assistance to resident when he needs to shave. We were subsequently told that the resident requires full support now. A record of health professionals visits is kept. However where a particular record indicated the GP was to call on a specific date, we were unable to find the outcome of the visit. Nursing and medical care is provided by external health professionals. This includes district nurses, GPs and community psychiatric nurses. District nurses hold a clinic at the home every Thursday and visit specific residents on a daily basis. Care records included correspondence in respect of hospital appointments. The district nurse we spoke with during our visit commented that the homes moving and handling is one of the best she has seen in the area, residents are always well turned out and there is never a resident with a urine smell. A number of residents are smokers. Care records inspected included smoking risk assessments. However during our visit we observed one resident sitting outside alone enjoying their cigarette. The residents jacket had a number of burn marks. The corresponding risk assessment made no mention of the risk of clothes catching alight. For residents safety, risk assessments for smokers must be expanded. Day and night records are kept by carers. The records generally provided a mix of comments about the residents quality of day experiences. However the night entry for one resident had the statement checked every hour during the night. This is a meaningless statement and would not stand up to scrutiny if a care investigation needed to be carried out. We looked at the medicine management procedures in the home. We saw that policies and procedures relating to medicine were comprehensive and reflected the practice followed in the home. This means staff had clear guidance when handling medicines and there is consistency. We checked certificates for training for staff handling medicines and noted that there was a regular audit that safe practices are being followed. This is done by the manager as part of the supervision. The home has good facilities to store and handle medicines. Medicine trolleys are used when giving medicines so that medicines are kept safe at all times. Two people in the home were managing their own medicines under a risk assessment. One of the assessments was Care Homes for Older People Page 14 of 32 Evidence: reviewed recently. However the other one had not been reviewed for two years. We looked at the records kept around medicine orders, receipts and disposal which were complete and up to date. We looked at medicine administration record charts and noted some incomplete records. Out of 47 charts seen four charts had the odd gap where a reason for non administration or a signature should appear. On one chart we saw that the amount of medicine given was not recorded. This medicine was prescribed as a variable dose. For all the people who were prescribed a medicine only when needed there was no care plan to give guidance to staff on when to give the medicine for consistency. A care plan has the advantage of being person centered. One medicine that is to be given on an empty stomach was given with other medicines and at breakfast time to two people although others needing the same medicine were given it at 7:00 a.m. before breakfast. There was good input from the district nurses and complex medicines which require regular blood test were handled well. To assist providers and managers in medicine management and administration our predecessors published professional advice and guidance on various medicine topics. The professional advice is still available on our website and may assist the registered manager in expanding the homes policies and practices with particular regard to completion of medication administration record charts. Although care plans and risk assessment are available for all residents, we found if difficult to obtain a coherent and quick picture of residents assessed needs, the action taken and progress being made due to the homes care record keeping system. The practice of maintaining individual daily record sheets within one plastic wallet added to the problem in that the reader has to remove all the sheets to obtain a consecutive review of a residents condition, potentially presenting difficulties if quickly required. Indeed we are informed that the care recording system also presented difficulties to professionals during their recent safeguarding investigations at the home. Residents were dressed in accordance with the time of day with attention to detail where this is important to them. The home has a dedicated hairdressing room and a hairdresser visits the home twice a week. The district nurse we spoke with indicated residents privacy and dignity at the home is excellent. Although the home is not registered to provide nursing care, residents come into the home expecting to live there for the rest of their lives, where their assessed needs can be met. A care plan component specifically for palliative care was seen in one of the care records inspected. The plan contained some good environmental information, reflecting the warm and serene atmosphere observed in the residents bedroom. Indeed a district nurse commented that palliative care residents are beautifully cared Care Homes for Older People Page 15 of 32 Evidence: for at the home. The residents care records also made reference to the residents former and current religion. However the records did not provide specific information about how the residents spiritual and cultural preferences and wishes for end of life care were to be met. One of the records stated encourage resident to take part in spiritual needs. There was no information how this was to be achieved. Other care records we inspected contained brief information about end of life care. Whilst recognising this is a sensitive subject, it is an important aspect of care and must be addressed. Care Homes for Older People Page 16 of 32 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. Meals and activities offer both choice and variety. Residents are mostly supported in attaining their lifestyle preferences. Evidence: Prior to this visit we received information from an anonymous source informing us that some residents are got up from 0300. We arrived at the home at 0650. We observed seven residents up and dressed sitting in the Pines lounge and on going to the Firs lounge at around 0710 we saw another ten residents up and dressed and sitting in armchairs. During discussions with some of the residents we identified that although for some getting up early is their choice other residents indicated they had not been quite ready to get up, with one remarking they felt quite sleepy. And another resident commented that having worked all their life it would be nice if they could take it easy and have a late start. Some residents choose to sleep in late and this is respected. Indeed one resident commented that they pay for the care and they will get up when they are ready. Sadly not all residents may be able to express their wish so eloquently. Care records inspected did contain details of residents preferences for going to and getting up from bed. However in one case the file had contradictory information and in another file the information was not clear in that the times stated did not indicate night or day. For equality and diversity purposes, all residents should Care Homes for Older People Page 17 of 32 Evidence: be able to go to bed and get up when they wish to. Arrangements are made for residents to take part in a wide range of structured activities, socialise with others and or to be as independent as possible. Residents are supported in continuing the social links they had when living in the community. Indeed one resident still attends their day club and another resident goes out to church every week. A monthly programme of activities was seen in the reception area. Activities are arranged by two coordinators. The range currently includes cultural talks and food; classical music, discussion groups, arts and crafts, special interest film shows and supper theme nights. The home has recently arranged a Halloween party with fireworks and included children dressed up as Thriller characters; a 60s dance took place; a medieval garden fete was held in the summer; music for health sessions are arranged monthly; and guest speakers are invited to the home. Indeed some members of the armed forces visited the home to talk with residents. Although the home does not have its own transport, transport is sometimes hired to take residents out. This would include mystery trips, garden centres and cream teas. The home endeavours to arrange a Christmas lunch in an outside venue so that residents who wish to can experience the Christmas atmosphere in the community. This is in addition to the homes own in-house Christmas celebrations and meals. There is a secure garden at the back of the home. The home is also near to a local park. During our visit an advocate commented that their relative does get taken to the park. However the advocate felt that residents are not encouraged enough to go into the garden in the summer. And a resident spoken with indicated they had been active all their life and would like more outside activity. The homes August 2009 resident survey indicated that of the 18 respondents, 21 indicated the home has good activities, 63 indicated activities acceptable and 5 indicated poor. A weekly Church of England Holy Communion service takes place at the home. Religious ministers from other denominations visit residents where this is requested. There is a dining on both the Pines and Firs for residents to use if they want to. Residents spoken with indicated they enjoyed their meals. The two advocates spoken with commented on how much weight the residents had put on since admission. The residents weights had been low. Meals were not sampled during the visit but the lunchtime meal was presented in an appetising manner. Care Homes for Older People Page 18 of 32 Evidence: Residents are regularly weighed. Chair scales are used for this purpose and are calibrated to make sure the weights are accurate. This is good practice. Menus contain choices and the home seeks to regularly get feed back from residents about the meals, including the residents and relatives meetings. The homes August 2009 resident survey indicated that of the 18 respondents, 42 considered the standard of food to be good, 32 acceptable and 26 poor. So the home can improve residents satisfaction with the meals, taster days are being introduced. Care Homes for Older People Page 19 of 32 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. Residents can be confident their complaints are listened to and acted upon. The provider does not fully comply with the countys multi agency safeguarding vulnerable policies and procedures, potentially placing residents at risk. Evidence: The home has a complaints procedure. The procedure includes contact details of the provider, us and the local authority. Advocates we spoke with knew what to do if they were not happy about anything. Both indicated when they had concerns they have spoken to management and things were sorted out. A central record is kept of formal complaints, including subsequent action taken. The home also maintains another record for recording small niggles. However bringing the information together may help the home monitor trends for quality assurance purposes. Arrangements have been made for residents to vote in elections if they wish to exercise their civil rights. At the time of our visit three safeguarding vulnerable adult investigations were taking place. The local authority is leading the investigations. The home is working with the Care Homes for Older People Page 20 of 32 Evidence: investigators. A consequence of the investigations highlighted that not all incidents are reported to the appropriate authorities within the specified timescales. The registered manager has taken action to make sure that future incidents are reported, as required, to the individual authorities within the requisite timescales. During a safeguarding meeting held on 18 November 2009, it was identified that the home had carried out its own investigation into an incident whereby a resident sustained an injury resulting in hospitalisation. The incident occurred because the two carers assisting the resident at the time were not providing the level of support the residents care plan indicated was required. To reinforce senior staff knowledge of safeguarding vulnerable adults procedures, the provider has accessed external training for the registered manager and team leaders to attend. This will take place at the beginning of December 2009. In addition, the training schedule provided at the visit shows that other staff have or about to receive safeguarding vulnerable adults training. The home has safeguarding policies and procedures in place, including the multi agency procedures published by Kent and Medway, We have received one anonymous complaint about the service. Our visit indicated regulations have been met. However we have made a recommendation within our report for the home to make sure all residents are asked for their preferences for getting up in the morning. The information must be recorded and reviewed regularly. Staff spoken with described appropriately the action they would take if they suspected abuse had taken place. Care Homes for Older People Page 21 of 32 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. The homes environment is good providing residents with an attractive, homely and clean place to live. Evidence: Areas of the home were fresh, clean, warm and tidy. Residents and visitors spoken with all indicated the home is always kept very clean. Staff should be congratulated on this. An environmental health inspection of the homes kitchen was carried in January 2009. The visit found the kitchen and stores to be clean and very well presented. Indeed the home has been nominated for the Clean Food Swale award. Three recommendations were made following the visit. The registered manager said all the work had been completed. We did not inspect the kitchen on our visit. A health and safety visit was made to the home in June 2009. This resulted in two matters being identified for action. The registered manager said the matters have been dealt with. As a home providing personal care, pressure relief and preventative equipment is obtained on an assessed needs basis via district nurses. The district nurse spoken with indicated the home seeks professional advice and requests the equipment in a timely Care Homes for Older People Page 22 of 32 Evidence: manner. The home has equipment for the safe transfer of residents, including four hoists and eight moving and handling belts. New height adjustable commodes have been purchased and en suite flooring has been replaced by a soft non slip type. The home has two passenger lifts so residents can access rooms on the first floor. Corridors are fitted with handrails to help independent residents move safely around the home. The home has a laundry in which residents personal clothes and general linen is washed. The laundry is appropriately equipped with industrial type washing machines and tumble dryers, as well as facilities for staff to wash their hands. The home tries to accommodate all residents lifestyle wishes and preferences and this includes propping open bedroom doors, where this has been requested. On our arrival at the home many bedroom doors were seen wedged open. This was mainly done by the use of rubber wedges, although a Zimmer frame had been used in one case. Whilst not wishing to deny residents their choice, for the protection of all residents living at the home, as well as staff working there, it is the providers responsibility to make sure that only approved devices are in place. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are enthusiastic and work positively with residents to improve their quality of life Evidence: As well as care staff, staff are employed for cooking, activities and cleaning. A maintenance man, plumber and electrician are used on a contractual basis as and when required. During our visit care staff were seen carrying out their duties in an unhurried manner and being attentive to residents. The registered manager endeavours to review staffing levels and makes changes to reflect dependency levels. This has resulted in each wing having an additional early morning carer to assist in early morning routines. 81 of care staff are now trained to NVQ level 2 or above in care. This is good practice and should provide care assistants with the skills and knowledge required to perform their roles. Ancillary staff are also encouraged and supported in attaining qualifications relevant to their roles. New staff are required to complete an induction programme, which generally follows the Skills for Care model. When completed the staff member would be expected to undertake NVQ 2 care, if they have not already achieved this. Care Homes for Older People Page 24 of 32 Evidence: The training schedules supplied at the visit indicates that staff have received training in topics including health and safety, care planning, COSHH, food hygiene, bereavement, skin, first aid, medication, fire safety, moving and handling, infection control, Parkinsons disease, dementia and managing incontinence. The staff files of two members of staff were inspected. As part of the homes vetting practice, references are sought and obtained and Criminal Record Bureau (CRB) checks undertaken. Applicants are required to complete an application form. In one case the applicant had only stated two employments and no education details were recorded. Our regulations require that full employment histories are recorded and where there is a gap there is recorded evidence that this has been investigated and the reasons recorded. One of the safeguarding vulnerable adults investigations related to a medication administration error. The provider is now actively sourcing external advance level medication training. The registered manager and senior care staff will attend this. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has a good understanding of the areas in which the home needs to improve and is actively working towards this. This includes the maintenance of residents care records. The home reviews aspects of its performance through a programme of self review and consultations, which include the views of residents, relatives and staff. Evidence: The registered manager has worked at the home for about three years and has been registered with us since March 2009. Since the last visit the manager has completed the registered managers award course and the deputy manager has completed her NVQ level 4 care course. The home is now registered to admit residents with dementia and the registered manager is seeking to enrol on a foundation degree course in dementia care. Residents, visitors and staff spoke openly during the visit about their experiences of Care Homes for Older People Page 26 of 32 Evidence: choosing, visiting, living and working at the home and how approachable the manager and her deputy are. Indeed management promote an open door policy and this is much appreciated. The home has developed its own quality assurance systems. Separate questionnaires are sent annually to residents and relatives. The results are analysed and made available. The home is a member of a care home association. Meetings for residents, relatives and staff regularly take place and the findings recorded. The provider visits the home at least weekly and likes to walk around, talk with people and check up on different things. Because the provider does not write a report of the visits, a person has been nominated to visit the home at least monthly and make a report of the findings on the providers behalf. Since the last visit records have been kept of such visits, although they are not done monthly as our regulations require. Arrangements have now been agreed between the registered manager and provider to nominate a further representative to undertake the regulation 26 visits so formal monthly visits are carried out and recorded when the usual nominated person is unable to do so. Staff interviewed talked about staff meetings and the supervision sessions which the home facilitates. Supervision is carried out by staff trained to do so. The home maintains sundry monies on behalf of most residents. Individual statements of account and cash balances are kept. The monies are used to pay for services provided or items purchased on residents behalf. Receipts are obtained and kept. Because this visit was not scheduled an up to date AQAA was not available. However up to date servicing details of the homes equipment was available, including hoists and the passenger lifts. The home has internet access. This enables the registered manager to regularly access our internet site and obtain up to date professional advice and guidance. Records for both residents and staff are maintained with due regard to confidentiality. However as stated in outcome two, it was difficult for us to obtain a coherent picture of residents wellbeing because of the current system of recording care records. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plan components must 31/12/2009 cover all assessed needs including medication information and be regularly reviewed and updated This is because care plans and associated clinical and risk assessments must be maintained in a way which provides effective communication between staff responsible for and delivering care. This is because there were no care plan components in respect of medicines to be administered on a when required basis; rising and retiring details were not always clear and the current care record system does not always provide a coherent and consecutive picture of residents needs and how they are to be addressed. Care Homes for Older People Page 29 of 32 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 2 8 17 Risk assessments must contain all up to date details of potential risks posed to residents, be regularly reviewed and updated This is because risk assessments for activities undertaken by residents but which potentially place them at risk, including self administering medicines and smoking, need to regularly reviewed and updated; and in some cases expanding. 31/12/2009 3 18 13 As the registered provider you must make arrangements, by training staff or by other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm This is because all incidents constituting abuse must be reported to the local safeguarding team so that investigations are carried out by the appropriate people, in accordance with the countys multi agency safeguarding vulnerable adults policies and procedures 01/12/2009 Care Homes for Older People Page 30 of 32 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 Care Homes for Older People Page 31 of 32 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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