Inspection on 09/02/09 for Prospect Mount Road (101) - North Yorkshire County Council

This inspection was carried out on 9th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Prospect Mount Road (101) -... 05/02/07

Prospect Mount Road (101) -... 08/02/06

Prospect Mount Road (101) -... 16/08/05

Prospect Mount Road (101) -... 10/11/04

Prospect Mount Road (101) -... 02/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Prospect Mount Road (101) - North Yorkshire County Council 101 Prospect Mount Road Scarborough North Yorkshire YO12 6EW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Charlton     Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Prospect Mount Road (101) - North Yorkshire County Council 101 Prospect Mount Road Scarborough North Yorkshire YO12 6EW 01723366716 01723383429 ProspectMount.Road@northyorks.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : North Yorkshire County Council care home 39 Number of places (if applicable): Under 65 Over 65 0 27 dementia old age, not falling within any other category Additional conditions: 12 0 The maximum number of service users who can be accommodated is: 39 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, Dementia - Code DE. Date of last inspection Brief description of the care home This residential care home, 101 Prospect Mount Road, provides personal care and accommodation for up to 39 people. There is also a day unit for 12 people that opens for five days each week, Tuesday to Saturday. The home is divided into four units; the Homeward Bound unit that provides intermediate care, a dementia care unit, a unit that takes respite care and an EMI day unit. There are currently three long stay service users within the respite care unit. No further long stay admissions are planned. North Yorkshire County Council owns the home. The home is located on the outskirts of Scarborough. There is a bus service from outside the home into the town centre. All Care Homes for Older People Page 4 of 35 Brief description of the care home the bedrooms are used as single accommodation. The home has accessible grounds, the EMI unit also has its own secure garden area. Fees for the home are dependant on the unit a person is staying in. There is a six week free stay in the Homeward Bound unit, and weekly fees are set between £350 and £375 per week. Residents are subject to a financial assessment to determine their contribution to the fees. Care Homes for Older People Page 5 of 35 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: An unannounced visit was made on the 9 Febraury 2009. A total of eight hours were spent in the service. The manager was present throughout the inspection. Before the visit we looked at Information we have received since the last visit on the 5 February 2007. The Annual Quality Assurance Assessment (AQAA) that gives CSCI evidence to support what the service says it does well, and gives them an opportunity to say what they feel they could do better and what their future plans are. How the service has dealt with any complaints and concerns since our last visit. The providers view of how well they care for people. The views of people who use the service, their relatives, staff and other Care Homes for Older People Page 6 of 35 professionals who visit the service. We have also reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the visit we Talked with people who use the service, staff and the manager. Looked at information about the people who use the service and how well their needs are met. Other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around the building/parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since our last visit. We told the manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: Make sure that all pre and post assessment documentation is fully completed, dated and signed, this includes health information, promotion of independence and risk assessment forms. Provide a full range of care plans to support the needs of people living or staying in the home so that staff know exactly what care and support they should be giving and how. Care Homes for Older People Page 8 of 35 Make sure that when healthcare or eating issues are identified they are followed up and that if a person has expressed new preferences about who they like to sit with or where to make them more comfortable that they support these choices. Ensure that staff always follow proper policies, procedures, and guidance when dealing with the ordering, receipt, recording dispensing and disposing of medication. This helps to keep people who live in the home safe and well. Follow up the environmental issues identified in the Homeward Bound and dementia units for the comfort and pleasure of the residents. Review the role of the registered manager and consider an increase in the number of hours when she is not expected to be available on the staff rota to carry out care and support duties. This will promote the management and organisation of the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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. People are only admitted to the home after an assessment of their care and support needs has been carried out but areas of the assessments are not always completed and extra information is not always added following admission which could place people who move into the home at risk. Evidence: The home is divided into four units one of which, the day unit, is not inspected by CSCI. The other three units provide permanent accommodation for people who are elderly mentally infirm, are receiving respite care or intermediate care in the Homeward Bound unit. There are still three permanent residents living in the respite unit. We looked at the records for four people who were using services across each of the units in the home. Pre-admission assessments are complete by a social care coCare Homes for Older People Page 11 of 35 Evidence: ordinator or social care assessor (qualified) from the local authority assessment team that carries out this process of anyone wanting to use the home. Each file we saw contained a copy of the original social care assessment/care plan. We were told that staff use this to provide the care and support that people need, that they are encouraged to read the files and that information about a persons needs is shared at handover time. A consent form is in place to record a persons agreement about who their personal information may be shared with. No further assessments are carried out by the home either pre or post-admission. We saw a form DORI - Procedure 8 in one persons file that was to be used to gather information when a person was admitted to the home but this had not been completed. Short term rehabilitation in the Homeward Bound unit is provided in conjunction with the community assessment rehabilitation team who are managed by the Primary Care Trust. We saw the file for a person admitted to this unit from hospital in February. The initial referral was dated 20 February 2009, and gave an outline of why the person was admitted to hospital, how they were mobilising, what they needed support or supervision with to improve their strength and stamina before returning home. The health information and promotion of independence forms had not been completed and neither was the health admission and management plan. No risk assessment or moving and handling plan had been completed despite information that the person mobilised with a frame with the assistance of a member of staff. North Yorkshire County Council assesses the dependency level for each home from information submitted by the homes manager. A scoring system is used and when the home achieves a score of 42 points they are unable to admit anyone else to the home even if there is a vacant bed. This is a way of ensuring that staff on duty are sufficient to meet the needs of people living in the home. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live or stay in the home have their care and support needs met in a way they choose but records are not always up to date and dont give staff all the information they might need to keep people safe and well. Evidence: Healthcare professionals such as the district nurse, physio and occupational therapists attend the Homeward Bound unit every day. Every Tuesday the Multi-disciplinary team meets to review each person progress. A Team manager or level 3 worker from the home attends these meetings and the home manager also attends occasionally to observe. People we talked to as we walked around the home told us that the staff were very good and they got the care they needed. One lady said I have lived here for 15 years and I wouldnt stay if it wasnt good. Care Homes for Older People Page 13 of 35 Evidence: The home uses the pre-admission assessment and care plan from the assessment team to provide the care and support that people need, this is the local authoritys practice. On one assessment form we saw that someone had made additions to the information recorded such as no strawberries to be eaten and takes food supplements also now, but these were not dated and signed by the person making the entry. We looked at the file for a person recently admitted, on a permanent basis, to the dementia unit. There was information about the person needing to be given time to communicate, help with continence, short term memory, and skin integrity. There was a nice recording about short term memory loss that said please approach these situations in a sensitive manner as she does not recognise that she has any particular memory problems. Little other advice or guidance was included and there was nothing about possible night terrors and hallucinations. The admission information checklist for this resident had not been completed, neither had the Promotion of Independence for for getting out of bed and getting washed in the bedroom. The general risk assessment and manual handling risk assessments had also not been completed. The service plan review sheet had been completed on the 2 February but contained little information other than the review being carried out dut to change in living environment. We saw evidence of people having access to a range of healthcare professionals to support them. For one person staff had noted on the contact sheet not eating well. There was no additional recording about what staff should be looking out for or whether a referral needed to be made to the dietician or speach and language therapist. We later saw a note in the same persons file that said seems to eat better when sat with other ladies and not the men. There was no care plan to support meal times and where the person should sit to promote a better intake of food. For a person admitted to the Homeward Bound unit the health information, promotion of independence and health admission/management plan were not completed. The person was mobilising with a zimmer frame and one member of staff but there was no risk assessment or guidance to support his. It was also recorded that the person was Care Homes for Older People Page 14 of 35 Evidence: suffering low mood, which appeared to be linked to returning home. We asked the staff what was being done about this and they replied that it would be dealt with when the person returned home. We were told that when people are admitted to the home for the first time their ability to self-medicate is assessed by staff watching them for 2-3 days, checking that they know what they are taking, why they are taking it and how often it should be taken. Each person has a locked facility in their own bedroom where they can keep medication and other items secure. A record is kept of the amount of medication a person who is able to self-medicate brings into the home. We carried out a random check of medication held in the treatment room on the first floor. The medication trolley is kept locked and secured to the wall. There are also locked cabinets and an additional secure cupboard for controlled medication. There are wash hand facilities available in the treatment room together with supplies of paper towels and soap dispensors. The home insists on people bringing their medication with them in the original containers that are clearly labelled. There is an identified person on each shift who holds the keys to the medication trolley and cupboards. Most of the entries on the Medication Administration Records (MAR) are handwritten. These should be signed by the person making the entry and a second person to say that the information has been properly transcribed onto the MAR. We saw gaps in the MAR records that had not been completed when a person had refused medication or it had not been administered for another reason. During the check of medications held in the home we saw two occasions when the medication recorded as being brought into the home, dispensed and remaind did not agree. Twenty five simvastatin tablets had been signed in, 24 signed as administered but four were still left. Twenty seven digoxin tablets had been signed in, 25 signed as administered but three were left. Care Homes for Older People Page 15 of 35 Evidence: In the controlled drugs cabinet we found a bag of 132, 10mg, morphine sulphate tablets that had not been recorded in the controlled drugs register. There was a note attached to them saying that another home had said they were no longer used. The manager confirmed by email the day after the inspection that all medication records were not up to date. We saw residents privacy and dignity being respected throughout the inspection. Staff knocked on bedroom doors before entering and engaged in conversations with people in a warm, friendly and sensitive way. People who live in the home get the chance to mix with those people who come in for short periods of time. We spoke to two ladies who told us that they meet up every time one of them goes in for a period of respite care or comes to the day centre. They were really happy with this arrangement. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in or visit the home for short stays are able to join in a variety of activities and social events and enjoy a varied, nutritious food at meal times. Evidence: We were told that staff promote a flexible approach to life at 101 Prospect Mount Road. This was apparent throughout the day of the inspection with people spending time where they wanted, with whom they wanted, doing things they liked. A programme of Jackies Craft Sessions was advertised. From November to April this included/includes card making, things to do with pine cones, quizzes, crafts, and Easter crafts. There was a diary sheet for January this year telling people about bank holidays, birthdays and interesting events that have taken place in this month in other years. For example, in 1863 the London Underground opened, the Homeward Bound unit opened in 1999. This is a nice idea. Volunteers run a bingo session in the home every Monday afternoon. This was very Care Homes for Older People Page 17 of 35 Evidence: well attended. North Yorkshire County Council has produced a guide for staff entitled Equality and Diversity in Social Care. This covers disability, race, gender, sexual orientation, age and fatih. It also introduces staff to legislation that supports equality, diversity and equal opportunities for people and identifies good practice areas. The guide includes useful information about celebrations, food and religion, festivals that different people celebrate and dress codes. We were told that during the summer months there is a weekly outing that people can join if they wish. Sometimes a picnic is taken or people have fish and chips or visit an ice cream parlour as part of the outing. Leaflets about how to make contact with an advocate to support a person are displayed in the home and the manager told us that they had also made use of an Independent Mental Capacity Advocate (IMCA) under the Mental Health Capacity Act, to support a person. People are encouraged to bring personal items into the home with them to make their bedroom and other areas more familiar to them. We spoke to the chef on duty and tasted one of the lunch options. Everyone said they enjoyed the food in the home. Drinks and snacks are available at all times. In one persons records we saw that over a period of ten hours, from late one evening to the next morning, they had requested and received snacks of cereal or toast on three occassions, followed by two breakfasts and hour and a half apart. Meals are ususally served in the dining room on each unit but people can eat in their own bedroom if they wish. Lunch on the day of the inspection was seen to be a very social and relaxed event, with staff supporting people where necessary or eating their lunch with a group of residents. Their was lots of animated conversation going on. The lunch choice was sausage and mash or cold meat and chips, followed by home made sultana sponge and custard, or yogurt/fruit. People get two hot options at both lunch time and tea time. The kitchen is very spacious and commercial in style, with areas clearly defined for food preparation and washing up. All cupboards, refrigerators and freezers were well stocked and there was a good choice of things like soup in small tins if people wanted Care Homes for Older People Page 18 of 35 Evidence: a snack or something different at lunch time. Cook told us that people could make a choice to have something different and they were usually able to meet this choice. Lots of home baking takes place. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are protected by policies, procedures and staff training in complaints and safeguarding adults. Evidence: The local authority has comprehensive policies and procedures in place to promote the receipt, recording and investigation of complaints and safeguarding allegations. There is also a whistle blowing policy. We were told that the home operates an open and honest approach to complaints and concerns and that staff are encouraged to be critical friends for each other to promote god practice and effective information sharing. The local authority has introduced a Consent form for people taking part in raffles and competitions, we saw copies of these in residents files but they had not been signed. Staff are employed in accordance with the General Social Care Council (GSCC) Code of Conduct, and have to have a Criminal Records Bureau (CRB) check carried out at an enhanced level to make sure they are able to work with vulnerable people. The home recently received a commendation, flowers and chocolates from a Locum GP who was moving away from the area. This was to thank them for all their hard work Care Homes for Older People Page 20 of 35 Evidence: and commitment. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is warm and comfortable and that gives them access to space where they can spend time privately or with others. Good hygiene routines were observed promoting the health and wellbeing of residents. Evidence: We looked around the home. This included some bedrooms, all communal areas, the kitchen, laundry and treatment room. The majority of the ground floor is used by the day centre that is not inspected by CSCI and office accommodation. The dementia unit is also on the ground floor but has its own entrance at the opposite end of the home. Everyone who lives or stays in the home has their own bedroom and there are two bedrooms that could be used for a couple. These were previously double rooms that are no longer used in this way. Each bedroom has its own wash hand basin but there is only one that also has a toilet. Communal bathing, toilet and shower facilities are located close to bedrooms on each floor. Care Homes for Older People Page 22 of 35 Evidence: The dementia unit is secure and people can move around freely, they also have access to an enclosed garden. There is a kitchen, dining room and lounge on this unit although the latter is quite small. We were told that the kitchen on this unit is due to be replaced. The top floor provides a nine bedded rehabilitation unit known as the Homeward Bound unit. There are practice areas for kitchen skills and stairs in this area. Two bedrooms on this unit have been re-decorated but seven still need attention. We were told that the home encounters problems with the cost of meeting refurbishment costs of bedrooms on this unit as the Primary Care Trust do not contribute towards this cost and the turnover of people using the rooms means they need refreshing quite frequently. The first floor is used for the respite service but three people still live on this floor on a permanent basis. There is lots of communal space where people can spend time. The main kitchen is also on this floor. We saw an exceptionally well organised laundry where staff have access to washing machines that can be used on different programmes including sluice, three dryers and a large railed area where delicate or woollen items can be hung to dry. All areas of the home were seen to be clean and tidy and no odours were apparent at any time. Swing bins throughout the home need to be replaced with foot operated bins to promote good hygiene routines and infection control. The manager confirmed by email the day after the inspection that new foot operated bins had been ordered. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who are properly recruited and trained to help them do their job, promoting the health and wellbeing of residents. Evidence: The local authority has rigerous policies and procedures for the recruitment and selection of staff. This includes an application form, interview, references, checking evidence of a persons identity and CRB records. We were shown a list of CRB checks, these are renewed every three years. This is good practice. The records for five members of the staff were seen, these included two for people recently recruited to the staff team. Basic records are held in the home but the remainder are at Headquarters. We told the manager about the agreement an organisation can sign with CSCI about records they wish to hold centrally, this also includes a format for information that should be available in the service. Staff induction takes place over a period of five months. This includes mandatory Care Homes for Older People Page 24 of 35 Evidence: training, issuing of the GSCC Code of Conduct and the local authority equalities book. This training can be used by staff to evidence National Vocational Training (NVQ). We spoke to a kitchen assistant, who is still working well past the usual retirement age, she said she enjoyed her work. Each unit has its own staffing team. A new post has been created in the dementia unit which will provide 20 hours a week of dedicated activities time. We were told that the registered manager and team managers all have office days built into their rota. The registered manager would benefit from additional supernumary hours. Twenty nine out of 45 staff have achieved a qualification at a minimum of NVQ level 2, six staff have an NVQ at level 3 and two have a level 4 qualification. Four more staff are registered for their NVQ at level 4. This is an excellent achievement. Staff working in the dementia unit are able to meet twice a year, away from the unit, to look at training and support needs. This is also very good practice. Some training can be done through Distance Learning with Selby College. This includes Safe handling of medication, palliative care, dementia awareness and equality and diversity. Care Homes for Older People Page 25 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run in their best interests, in an open and inclusive way but some records and risk assessments do not always promote their health, safety and wellbeing. Evidence: The home sent us their Annual Quality Assurance Assessment (AQAA) when we asked for it. It was detailed and gave us information about what the service feels it does well, how they would like to improve and what changes they have made since the last inspection. The registered manager is qualified and experienced to carry out her role although she only has limited hours when she is not also included in the care rota. As a new initiative the manager had prepared a file of evidence so that staff and the inspector could access all the information they needed even if she was not on duty. Care Homes for Older People Page 26 of 35 Evidence: This was extremely helpful. Staff meetings are held monthly and everyone is expected to attend at least six in 12 months. Minutes of the meetings are signed to say that people have read them and an attendance sheet is kept for monitoring purposes. The manager said that people usually attend more that the required six meetings. In addition there is a programme of one to one supervision giving people access support to do there job and the opportunity to discuss any issues they may be affecting their work. Resident and family meetings are also held on a monthly basis. There is a questionnaire for people who have short stays in the home that covers the quality of their bedroom, cleanliness, food, menu choices, the standard of care, attitude of staff and whether they knew who to speak to during their stay if they had a concern. We saw a copy of the minutes of the residents meeting held in December 2008. Cook had attended to talk about food issues and a decision had been made to remove one choice from the menu. The manager told us that this can sometimes be a problem as each month there are different people staying in the home and they may have a different idea about what should be on the menu. This is seen as a bit of a challenge for staff. We also saw the schedule of planned dates for meetings. This helps to give people time organise themselves to attend. There are also quality checks carried out in-house and by staff visiting from another home. The internal quality audit is aimed at meeting National Minimum Standards. The annual visit by staff from another home is an opportunity to get feedback on areas of good practice and improvement. For two people we saw that staff had not used the proper inventory forms to record what personal items they had brought into the home with them, instead there was a list on torn scrap of paper which could easily get mislaid. All monies kept on behalf of people staying in the home are checked twice a day at staff handover. We saw that receipts and individual payment sheets are kept. Financial records are also audited bi-monthly by staff from outside the service. Residents all have a locked draw in their bedroom where they can keep any valuables Care Homes for Older People Page 27 of 35 Evidence: or personal items safe and secure. We looked at the records and contracts for the servicing and maintenace of equipment and systems in the home as well as those for checks that must be regularly carried out. These were all in order with the exception of the weekly alarm checks. Staff had got out of the routine whilst the new fire system was installed but the manager dealt with this immediately. Risk assessment forms are not always completed. We saw one where ticks had been put against the areas of distrubed sleep, short term memory loss, disability, fraility and wandering. There was no other recording to show the level of the problem or what interventions by staff might need to take place. One lady in the dementia unit has been assessed as being able to go out independently. Recently she has got on the wrong bus on two occasions finding her way to a sister home several miles way who then returned her safely, and more recently was returned to the home by a stranger assisted by an old neighbour but was then found to be missing her handbag. A care plan review had been held on the 7 January 2009 when it was noted the person can go out alone - will need letter for the public, identification and possibly a tracker watch, a capacity assessment had also been carried out at the same time. No new care plans had been drawn up, there was no risk assessment for the person going out alone, no written action plan (including at what time staff should take action in the event of a non-return to an outing), no letter had been provided/written, no identification had been provided and there was limited follow up to the incident involving the lost handbag. A new and extensive fire risk assessment has been carried out and recorded to meet the requirements of the latest Fire Authority legislation. Evidence of regular visits by the provider under Regulation 26 was also seen in the home. There is also a Service Improvement and Development Plan for the home covering 2009/2010. Throughout the inspection staff were helpful and able to provide all the information we Care Homes for Older People Page 28 of 35 Evidence: requested, they spoke about the people they care for with warmth and sensitive and had a good knowledge of there needs and wishes. Care Homes for Older People Page 29 of 35 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 30 of 35 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 Pre and post-assessment information must be fully completed. This will mean that staff have access to all the information to provide care and support to a person moving into the home, helping to keep them safe and well. 09/05/2009 2 6 14 Health information and promotion of independence records must be completed for people moving into the Homeward Bound unit. This will mean that staff have access to the right information and people using the unit will get the right care and support to promote their return home. 09/05/2009 3 7 15 A full range of detailed care 09/05/2009 plans must be in place to meet the individual assessed needs of people living in the home. Page 31 of 35 Care Homes for Older People This will mean that staff have access to all the information they need to provide the right care and support to people living in the home. 4 8 12 Records must include details 09/04/2009 of actions taken to follow up health care and residents preferences when these are identified. This will mean that people living in the home get the right care and support, or are able to sit and eat with residents of a preferred gender. 5 9 13 Staff must follow proper procedures for the safe receipt, recording, adminstering and disposing of medication. This will mean that people who live and stay in the home are kept safe and well. 6 38 13 When areas of risk are identified and decisions are taken about what a person living in the home needs to be provided with to enable them to go out independently this must be followed up. This will help to protect vulnerable people when they go out alone, helping to keep them safe and well. 30/03/2009 09/03/2009 Care Homes for Older People Page 32 of 35 7 38 13 Risk assessments must be carried out, properly completed, dated and signed, giving staff clear advice and guidance about what they should be doing and how. This will help keep people who live in the home safe and well. 09/04/2009 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 7 Handwritten additions to assessments and/or care plans should be signed and dated by the person adding the information. This will mean that everyone is sure when information has been updated or a persons needs or wishes have changed. MAR sheets should be fully completed to indicate when medication has been administered, refused or not administered for another reason. This will help to keep people who live and stay in the home safe. Handwritten entries on the MAR should be double signed to show that the information about the medication and dispensing arrangements have been properly transcribed. This will help to keep people who live and stay in the home safe. The consent form for people taking part in raffles and competitions should be regularly completed, particularly for people with a mental frailty, so that staff know it is alright for them to take part in these events. This will help to keep people who live in the home safe. The local authority should consider discussing with the Primary Care Trust the on-going cost of re-furbishing bedrooms in the Homeward bound unit. This will make the bedrooms more confortable for people that need to use them on a short term basis. Consideration should be given to increasing the size of the shared lounge in the dementia unit. This would mean that 2 9 3 9 4 18 5 19 6 19 Care Homes for Older People Page 33 of 35 people had more room to move around and be comfortable. 7 19 Ensure the planned refrubishment of the kitchen area in the dementia unit is carried out for the comfort of staff and residents and to promote good hygiene routines. Swing bins throughout the home should be replaced with foot operated ones to promote infection control and good hygiene routines. THE MANAGER CONFIRMED BY EMAIL THAT THESE REPLACEMENT BINS HAD BEEN ORDERED. The local authority should consider entering into an agreement with CSCI to hold staff records centrally and adopt the recognised, acceptable format for keeping records in services. This will mean that everyone is clear about what information is to be kept and where. Consideration should be given to how to support the person in the dementia unit who likes to go out independently until all the recommendations from the last case review have been put in place. This will help to keep the person safe. 8 26 9 29 10 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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