Inspection on 28/01/10 for Ranvilles Nursing & Residential Care Home

This inspection was carried out on 28th January 2010.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ranvilles Nursing & Residential... 23/02/10

Ranvilles Nursing & Residential... 03/11/09

Ranvilles Nursing & Residential... 14/01/09

Ranvilles Nursing & Residential... 26/02/07

Ranvilles Nursing & Residential... 07/10/05

Ranvilles Nursing & Residential... 23/06/05

Ranvilles Nursing & Residential... 01/10/04

Ranvilles Nursing & Residential... 18/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: Ranvilles Nursing & Residential Care Home 5/7 Ranvilles Lane Fareham Hants PO14 3DS     The quality rating for this care home is:   two star good 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: Sue Kinch     Date: 2 8 0 6 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Ranvilles Nursing & Residential Care Home 5/7 Ranvilles Lane Fareham Hants PO14 3DS 01329842627 01329847743 ranvilles@brookvalehealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Visram Limited Name of registered manager (if applicable) Mrs Debra Mills Type of registration: Number of places registered: care home 53 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 53 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home The home offers nursing care to older people with mental health difficulties. It is a large converted house in a quiet rural area near Titchfield. The home offers accommodation in both single and double rooms. The house is set in its own gardens with car parking for visitors at the front of the house. The fees for the home currently Care Homes for Older People Page 4 of 30 Over 65 0 0 53 53 2 3 0 2 2 0 1 0 Brief description of the care home range from 695 to 800 pounds per week. Care Homes for Older People Page 5 of 30 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: two star good 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: For this Key Unannounced inspection we reviewed the information we have received since the previous key inspection and read the Annual Quality Assurance Assessment (AQAA) submitted to us by the service. We received eight surveys from relatives of people living in the home and recent information from two health and social care professionals. We visited the service, observed care practises and talked with people living in the home, relatives and staff. We viewed shared and some private areas of the home and sampled records such as assessments, care plans, medication records, staff recruitment and training record and those for maintenance and quality assurance. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? The home had a key inspection in November 2009 and in the report we made requirements about, care plans and risk assessments, meeting health care needs, medication, dignity and privacy, nutritional assessments and action plans, referrals through safeguarding procedures , staff being clear of their responsibilities regarding safeguarding, staff awareness of infection control, the skills mix of staff, staff training, quality assurance and health and safety. Further requirements were made following a random visit in February 2010, and these were in respect of care plans for people newly admitted medication and moving and handling practises and training. In April we carried out a random inspection regarding one aspect of medication, dispensing, as the home had been served a Statutory Requirement Notice about failing to comply with Care Home Regulations. At this visit the pharmacy inspector found that this specific requirement had been met. We found at this visit that work had taken place to make improvements against all of the requirements that we had made and sufficient progress had been made not to make further requirements except in the health and personal care section as described below. Care Homes for Older People Page 7 of 30 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 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. A process for assessing peoples needs before admission including consulting professionals and relatives involved is in place and this leads to a comprehensive plan of care ensuring that their needs are recorded. Evidence: In the AQAA the management told us that they carry out person centred preadmission assessments thoroughly, that they offer tours, trials and information in varying formats if needed including the complaints procedure and contract. They said that these things are kept under review. Following the random inspection in February 2010 we required that care plans to be in place for all people including those newly admitted to the home. In the AQAA the manager said they have an initial care plan on admission and their policy is to have full care plan within three days. At this inspection we looked at records for four of the people recently admitted to the home and found that assessments prior to admission Care Homes for Older People Page 10 of 30 Evidence: had been made including obtaining information from other health professionals and/or discharge summaries. We found that the home is following their admission procedures and care plans are now developed within the timescales. In the sample of records viewed we noted that individual diverse needs are assessed including a range of health, care and social needs. The manager told us that part of her weekly check on a Monday is to check that any care plans that need to be written for new people have been completed and during the inspection in the sample the manager checked this had been done. A health professional spoke positively about the homes admissions process and told us that the manager works to ensure that admissions and re admissions from hospital are done well. The manager told us about information available to people about the service and that this is available in the home and in varying formats. The information is available on the website including information about how the home undertakes assessments before admissions and its person centred approach. Visitors to the home can obtain information about the home and a notice to this effect is prominent as you entre the home. Care Homes for Older People Page 11 of 30 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. The increase in implementation of consistent care planning and monitoring systems since February 2010 has meant that peoples individual medication, health and social care needs are monitored more closely and are being met more consistently. The home now needs to continue to review and follow action plans to demonstrate that good nursing and care practises are firmly embedded to ensure that peoples needs are always met. Evidence: At the last key inspection we required that the Registered Person must ensure that care plans are sufficiently detailed and supported by adequate risk assessments for needs to be met. At this inspection we found that the management had fully implemented the new system of care planning and has completely revised the way that peoples needs and risks are documented. These documents fully used provide details of care and supported needed including social, emotional, health, medication, risks and dignity and privacy. At this inspection we sampled records for four people and looked to see if their care Care Homes for Older People Page 12 of 30 Evidence: plans had been developed and were in use. We also viewed aspects of a sample of other care plans when following up specific issues. Information we looked for was in place and up to date, and there was evidence of regular monitoring and we consider this requirement to have been met. The manager carried out a routine Monday check and care plans had been updated by staff, as required, over the weekend prior to the inspection. We noted that care plans include details of how able the individuals are to make decisions and we saw evidence of the involvement of next of kin where people are not able to make all decisions. Although some sections of the care plans used are prepopulated forms, staff complete the information in each care plan drawing out the individual needs of people. We have received positive verbal and written feedback about the service from relatives regarding care meeting needs, caring approaches in the home and being informed. One relative told us that there was a good care plan for their relative and it was discussed and agreed by the family. Others also said that they were aware of care plans and had been consulted. One said that on the whole they were happy with the care but would like to see more involvement of their relative in activities and more use of the outdoor space. They were slightly concerned by the staff turnover but felt their relative had settled and is well looked after. Another also said that their relative was well looked after. Another was concerned that their relatives needs were not always met but that the home responded well when they raised issues. In the last key inspection report we required that the Registered Person ensured that health needs are met through effective care planning processes which are monitored for their effectiveness. This was to ensure that health needs are routinely met. The AQAA outlined the steps taken to ensure that health is monitored and support delivered with the involvement of other professionals. Our sampling of the monitoring systems in place in the home showed that issues are checked regularly and effective working takes place with the health workers providing support to the home. The following paragraphs provide more examples of this. We checked to see if the requirement about the registered persons having a system in place to ensure that all staff use the moving and handling techniques identified for each person. At this inspection we noted that individual moving and handling guidance was in place in the sample of records checked. We observed moving and handling practises and staff were using the equipment provided for this purpose. We noted that the staff are receiving moving and handling training, that spot checks of moving and handling have been introduced and extra support provided where identified as needed. Care Homes for Older People Page 13 of 30 Evidence: We also saw that staff training records of moving and handling have been developed as required in our random inspection report. Following our key inspection in November 2009 we made a requirement about ensuring that peoples nutritional needs have been assessed and met. At this inspection we found, through viewing a sample of the records relating to these issues, speaking with staff and observing, that systems in the home mean that individual nutritional needs are assessed and met. A health professional involved in the home was positive about how the home addresses food and monitoring in relation to meeting health needs. We also discussed wound management and use of creams in the home and sampled records with staff. These showed that there are clear assessments of needs and planned interventions that are being followed and good records of this are in place. The requirement we made about providing and keeping good records of prescribed creams and nutritional supplements has been met. Training records showed that staff are having training in tissue viability and referrals are often made to the community nurse for consultation. The specialist equipment provided such as high/low beds and pressure mattresses, referred to in the AQAA were noted to be in use. We noted that a nurse during this inspection carried out a routine daily check of the pressure equipment and showed us how this was done. Recordings made were sampled and in place. We made requirements about medication in November 2009 and February 2010. One referring to the dispensing of medication was the subject of a Statutory Requirement Notice. A further random inspection to monitor compliance with the notice was made in April 2010 when we found that the systems for dispensing had been corrected. At this inspection we observed medication administration which was carried out without the use of pre-dispensing as required. At this inspection we also looked at the homes system for monitoring medication administration to see if this is being routinely carried out and to ensure that all requirements previously made were met. We found that procedures were being followed and recorded. We had also previously made a requirement about the storage of controlled drugs. Action had been taken to meet the requirement and correct storage facilities were in use. We had also required the home to have all prescribed medication available in the Care Homes for Older People Page 14 of 30 Evidence: home. The nurse, carrying out drug administration during our visit, explained the changes to the ordering system so that the home has more time to ensure that the right medication is available for administration. Medication was available where checked during the inspection. We made a requirement about dignity and privacy following our key inspection on November 2009. At this inspection we noted that staff as, at previous inspection were caring and friendly towards the people living in the home. Staff spoken with were respectful about the people they support. Care practises were observed and staff were noted to be attentive and intervening where support was needed. They were noted to be talking to people when using mobile hoists and dealing with issues as they arise so that peoples dignity was maintained. Care Homes for Older People Page 15 of 30 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. The home has increased the assessment of social needs and routines of those living in the home and have more plans to meet those needs by recruiting an activities coordinator. The home offers a variety of food and support is given to those who need it during mealtimes. The work carried out by the home to assess, meet and monitor individual nutritional needs has developed further over the last few months and it can now be demonstrated that these needs are catered for. The home now needs to demonstrate that this can be sustained and that the good practises now established are maintained. Evidence: The management tell us that they are actively involving families in social events such as fund raising and the the new garden project. They say that they are involving families more and are working on improving relationships with relatives. We saw evidence of a relatives meeting having been held which the management had said they would encourage. Relatives in our survey and spoken with during our visit to the home, told us that they Care Homes for Older People Page 16 of 30 Evidence: usually or always get enough information about the care service to help the make decisions. They were positive about the staff and management approaches. One person said they did not get the feeling information was always passed between staff. However the majority of responses were positive with people feeling consulted and involved and made welcome. Some comments were received from relatives that more activities could be provided. We noted that there were some activities taking place mostly based on individual needs: one person showed us their garden project, some people were attended by the hairdresser, some one to one conversations were noted between staff and residents, and some people were watching television or enjoying music. In the afternoon a small group were positively supported by a staff member to recall lyrics to songs and it created a lot of amusement for those taking part or looking on. In discussion with the manager she said that they are in the process of recruiting an activities coordinator and hoped that person would commence soon for twenty hours a week and increase stimulation. In the AQAA we were told that the home is installing a new form of pictorial signage to make it easier for residents to find their way around following feedback about the service. These are in place as are the new pictorial menu boards in the dining room installed to make it easier for residents to recognise what is on the menu. The menu for the day did reflect the written menu. A book with pictures of different types of food has also been made available for service users to use to make choices. We were also told that residents nutritional requirements are assessed using a nutritional risk tool, we have commented regarding this being in place and fully monitored in the last section. Kitchen staff are also aware of those with high needs and are regularly updated so that they know how to address individual needs. Choices are available at mealtimes.Staff are given clear responsibilities to ensure that all people living in the home are supported to have their individual needs met where ever it is best for that to happen. A trolley with a range of additional foods is available between meals and people are encouraged to consider the options or assisted based on needs or choice. Comments about the food from people living in the home,were positive. One relative in a survey said that the home was aware of their relatives nutritional needs,that food was of a good quality, and freshly made and that records are kept of what is eaten. Another said Food appears to be adequate and of good quality Another said that food is plentiful and fresh. Care Homes for Older People Page 17 of 30 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. The home encourages feedback through regular consultation and people and relatives are able to air their views and these are addressed. People living in the home are having their needs met more consistently and are supported by staff aware of their safeguarding responsibilities through discussion and training. Evidence: The management say that the complaints procedure is clear and available, responded to within the time frame, and when comments are made action is taken immediately and feedback given. They have had two complaints in the last twelve months and one was upheld. Since then a log has been made available in the home. A relative said that staff are very friendly and truly care, they never had complaints. Clean , friendly ,well run. All but one of the people completing our survey said that they knew how to make a complaint and usually or always got an appropriate response from the service. People spoke with during our visit said that the home was responsive to issues raised and had confidence in matters being addressed. Since safeguarding concerns were raised last year the home has produce improvement plans and worked with health and care professionals to improve the service provided. We have obtained positive feedback from health professionals and this was reported on in our random inspection report in February 2010. We have had further feedback about the home continuing to obtain support when needed and when Care Homes for Older People Page 18 of 30 Evidence: we have checked that issues have been brought to the attention of health and care professionals, this has been carried out. The home was required to make a further referral to safeguarding following the previous key unannounced inspection and this was followed through. Since then we have made two further safeguarding referrals to social services and we had confirmation that matters have been checked out and the home had taken appropriate action. We also made a requirement in November 2009 for the service to ensure that there is a system in place for the staff to be made aware of their safeguarding responsibilities through supervision and training. The service told us of action that they were taking and of systems in place in the home. In the AQAA the manager told us that training is provided in induction and in an ongoing training program, and are aware of how to respond should such a situation arise. In the AQAA the management said The home is very open and transparent in its discussion with external bodies with respect to issues surrounding Safeguarding Adults. Staff are also aware of their responsibility to report any improper behaviour to management.... At this inspection we found that staff were aware of their responsibilities and and accountability and have been receiving training which is ongoing. Training is also to take place in the Mental Capacity Act and Deprivation of Liberty. Care Homes for Older People Page 19 of 30 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. A rolling programme of upgrading and cleaning and maintenance is in place in the home and over the last year the range of specialist equipment to meet individual needs has increased. The home has now appointed a staff member to lead infection prevention and have been reviewing procedures in the home to minimise the risk to people living there and to effectively manage occurrences. Evidence: We viewed various shared areas of the home including bathrooms and toilets on the ground and first floor. These were all clean and equipped with facilities for meeting various personal care needs. There was a good supply of bins with lids, toilet rolls, paper towels, soap dispensers and these were all in use to promote infection control. Positive comments were received from respondents to our survey and during our visit from relatives about cleanliness. We were told that new equipment has been purchased on an ongoing basis and noted these in our visits such as high/low profile beds, reclining chairs and grab rails and a specialised bath. In the AQAA the management reported a rolling programme of maintenance with a part time and full time handyman. Records of work to be done and done were observed and no major maintenance problem was brought to our attention during the Care Homes for Older People Page 20 of 30 Evidence: inspection except for a tumble dryer which a contractor was attending to. We were told that there are plans to redecorate the the dining room and the small lounge and some furniture would be replaced. A discussion was held about the stained carpets in some of the corridors and the small lounge and the Responsible Individual agreed to use industrial cleaners prior to their replacement. The home has an Infection Control policy, and the manager was reported in the AQAA to regularly seek advice from specialists to ensure that infections are kept to a minimum. The Laundry was viewed and has recently had an updated clothes dryer. The laundress confirmed that all equipment was working and that there was a specific system in place for minimising cross infection in the washing process.They were aware of the importance of disinfection and system in place for minimising infection control. The home has appointed an Infection Prevention lead and she as well as other staff receive training in infection control and the importance of prevention. We were told she will take the lead in assessing the risk of infection, attempting to prevent, detect and control any spread of health care associated infections. Residents are encouraged to spend their day in whichever area of the home and with whom they wish. They have the choice of their room, the garden, newly refurbished TV lounge and dining area and the new sensory garden, and they are actively encouraged to interact with one another. Care Homes for Older People Page 21 of 30 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. The home has a monitoring and reviewing system in place to ensure that the staff levels needed to meet the needs of people living in the home have their needs met by staff suitably trained to carry out the tasks needed and meet peoples needs . The home has a system to, identify and provide staff training and evaluate its effectiveness to ensure care is carried out correctly. Staff recruitment procedures are monitored to ensure that those employed in the home to meet peoples needs have been fully vetted. Evidence: Following our last key inspection we required that The registered manager must ensure that a system is in place to monitor the overall skill mix of the care and nursing staff and ensure that sufficient regular training is provided. This is to ensure that staff are provide with the skills to meet needs. In the AQAA provided by the home before this inspection we were told that there is a good training budget. We were told that the home uses a range of external and internal cascade training and that staff meetings and supervision were in place in the home. During our inspection visit we talked to the manager and some staff on duty about Care Homes for Older People Page 22 of 30 Evidence: training and viewed some of the training records and the current training plan. We were consistently told that training is regular. We noted from records and discussion that it now more consistently covers more fully a variety of core and more specialist areas of training including such areas as moving and handling and tissue viability which was a cause for concern at the last key inspection. Training for staff is monitored by the manager who had evidence to demonstrate this. For example records showed that the training for nurses has included fire, moving and handling challenging behaviour, health and safety, infection control, safeguarding, first aid, tissue viability syringe driver, end of life care, Mental capacity and deprivation of liberty. In the AQAA the manager told us Ranvilles has developed a structured training program in partnership with an external provider. The initial training plan we viewed was not in enough detail to show that there is currently a clear plan to address all staff needs. However, the manager had identified needs and obtained details of other organisations that provide training and said that she had been given agreement to book further training for staff. A health professional told us that in their opinion the home was keen to educate staff and that this had had a positive effect in meeting needs.They were also aware of some of the training planned for staff and this supported information from the home. In our last report we required that a system is in place to monitor staff levels and ensure that sufficiently trained care and nursing staff are in place to meet needs. This was to ensure that sufficient staff with the appropriate skills, meet needs. We were concerned about the number of general nurses in the home to ensure that nursing needs were met. The number has increased although the home has continually been recruiting following some staff changes. The manager said that she had an agreement to appoint an additional nurse as the home had experienced difficulty in obtaining agency nurses for the night shift on occasion when needed and the home preferred to operate with permanent staff. In the AQAA the home reported we have made sure that the agency nurses are only present in the capacity of second or third nurse with the permanent nurses working as the lead nurses. Also we have endeavoured to use the same agencies and the same agency nurses so that there is continuity. At the time of our visit rotas showed that two nurses were on duty and the manager said that this increases, when numbers of residents increase. A third nurse was on duty but was supernumerary as she was on induction. Staff told us that there were usually 7-8 carers on each shift and this was matched with the rota we sampled. Care Homes for Older People Page 23 of 30 Evidence: We had discussion with care and nursing staff about how the service is organised to meet needs. They were able to explain systems and procedures when asked and they were well organised with clear instructions about what was expected of them. For example one carer had a list of people to support at various points in the day and were clear about what they had to do. They said this was flexible depending on what people wanted and to help each other out. They had positive attitudes and demonstrated friendly caring attitudes to people living in the home. Two staff members commented on when working with agency staff and said that agency staff are paired with permanent staff for some tasks such as moving and handling to ensure continuity of care. In our last key inspection report we required that The registered person must ensure that pre -employment checks include references from most recent employers and recent previous care employers. At this inspection we checked a staff recruitment records for four recently recruited staff and found the records that we sampled had been correctly completed to show that checks were made before employment. The quality assurance system in the home also now includes routine checks of the recruitment process. Care Homes for Older People Page 24 of 30 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. Management and staff accountabilities and responsibilities have been strengthened since February 2010 and auditing of the service is more robust ensuring that the needs of people living in the home are met. This must now continue to demonstrate that good practise in the home is firmly embedded and consistent over a period of time in meeting peoples needs. Evidence: The home is managed by an RMN and there is an RGN identified as the clinical lead for nursing needs. They have a good working relationship with the community nurse and work is monitored by the Responsible Individual. Working together as a team has recently increased further and regular meetings have been established for the management of the home with the clinical lead. All have responsibilities and are involved in monitoring practises in the home. Records viewed showing that the manager is involved in training and her own skill development. The Lead clinical nurse has recently successfully completed the Registered Managers Award training course. Care Homes for Older People Page 25 of 30 Evidence: In our last random inspection report of an inspection on 23 February 2010 we made a number of requirements and raised concerns that the quality assurance system in the home was not sufficient to ensure that needs were met and risks minimised. The management of the home provided us with a fully comprehensive AQAA prior to this inspection. In each section of the AQAA, which relates to the sections above in this report, they gave information about how they monitor and review the service. They have referred to matters raised in recent CQC inspection reports and given full details of how they have addressed matters and of the auditing and monitoring systems put in place. They said they have used a consultant to assist them with the process. From our observations of records of monitoring and audits in the home we have found evidence of much increased monitoring of all aspects of the service, weekly, monthly and six monthly. These include general spot checks, and more recent checks about specific issues such as medication, wound management care plans and nutrition. All of the samples considered included action plans where needed to ensure that needs are met. Our findings in other sections of this report has indicated that the homes systems of quality assurance have been more effective in raising standards in the home since our visit in February 2010. The manager said they consult people about their services routinely. At this inspection visit this was supported in our observation of records and feedback from staff, people relatives. In the AQAA the management also told us they are planning to send out a new form of Quality Assessment questionnaires every six months. Throughout the AQAA they made references to consultation and feedback from professionals, staff, relatives and people in the home and the need to take it into account. In relation to residents monies the management said they are safeguarded,that and a safe system is in place which only a very limited number of staff have access to. They said that records are audited monthly by the administrator. We sampled this and found that it is recorded accurately. In November we required that all aspects of health and safety were to be implemented and monitored. We found that attention is given to health and safety in the home and these matters are included in the homes audits. We sampled some aspects on our visit. There is evidence of staff training in health and safety matters in the home and samples of fire records required to be in place were viewed and completed. The home has been addressing infection control matters by reviewing equipment and identifying a key member of staff to monitor how it is maintained. Staff have been trained in Care Homes for Older People Page 26 of 30 Evidence: moving and handling and this is ongoing and monitored. Care Homes for Older People Page 27 of 30 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 30 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 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 29 of 30 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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