Inspection on 10/08/09 for Rebecca Court

This inspection was carried out on 10th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rebecca Court 20/09/07

Rebecca Court 02/10/06

Rebecca Court 06/12/05

Rebecca Court 19/07/05

Rebecca Court 06/01/05

Rebecca Court 12/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Rebecca Court Rebecca Court 9 Staithe Road Heacham King`s Lynn Norfolk PE31 7EF     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: Judith Last     Date: 1 0 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Rebecca Court Rebecca Court 9 Staithe Road Heacham King`s Lynn Norfolk PE31 7EF 01485570421 01485572910 rebeccacourt@norfolk.gov.uk www.norfolk.gov.uk Norfolk County CouncilCommunity Care care home 36 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: That Norfolk County Council undertakes a review of the windows with a view to replacement of those which are causing discomfort to the Service Users. The review to be carried out by the end of March 2004. Wheelchair users may be admitted only to rooms of at least 12 sq m, rooms numbered 10, 11, 24, 32, 33, 35, 36, 49, 50, 61, 62, 65, 66 & 67 as at 31 March 2003. Date of last inspection Brief description of the care home Rebecca Court is a care home providing personal care and accommodation for thirtysix (36) older people. The Home does not provide nursing care. The Home is owned by Norfolk County Council-Community Care. Care Homes for Older People Page 4 of 34 Over 65 8 36 0 0 Brief description of the care home Rebecca Court is a large detached building set in its own grounds located in the village of Heacham, which is between Kings Lynn and Hunstanton. This is a non-smoking home for residents. Accommodation is in thirty-six single rooms on the ground and first floors. A small passenger lift is available. People have a financial assessment to determine how much it will cost them to live in the home. Information about the full current fee level is available in the guide to the home . Additional costs include chiropody, hairdressing, newspapers, magazines, toiletries, clothing and the payphone at varying costs. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: Before we visited the home we reviewed all the information we had about it. This included the information that the manager had sent us, the history of the home and what the manager had told us about things that happened in the home. We also had written comments from health professionals, staff, relatives and people living in the home, telling us what they think about the service. We visited the home unannounced and spent almost eight and a half hours there. While we are at services, the main method of inspection we use is called case tracking. This means we look at records to see what they say about peoples needs and then find out from observation and discussion how well they are being met. We used all the information we gathered and the rules we have, to see what outcomes there were for people in their daily lives. Care Homes for Older People Page 6 of 34 Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 34 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will have their needs assessed so they could be sure the home is able to meet them if they decide to move in. Evidence: The manager says there is a new system of gathering information before people come to the home, which will more formally record the actions taken by the service. The form we saw is intended to go with the senior staff member who visits the person to gather information and provide better recording of peoples own views about the care they need. In addition, information is taken from the social workers assessments and the home has access to the County Councils CareFirst system to collect this. Dates show information about peoples needs is gathered before they move to the home (except in an emergency), so that the manager could be sure the home could offer the services and support people need. Care Homes for Older People Page 11 of 34 Evidence: Two visiting professionals say that the services assessment arrangements always ensure accurate information is gathered and the right service is planned for people. The manager says there is a trial period and that people are encouraged to visit so they can decide if they would like to move in. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people get is based on their individual needs. Their privacy is respected. Evidence: Everyone has an individual plan setting out how their support needs are to be met. There is separate guidance for night staff about what they need to do to support people effectively and safely during the night. This means that staff can be clear what support they are expected to give each person. The management team say they intend to implement a new system for individual care plans, and while we were there work was started on this, for someone receiving respite care. The manager says that the system has been trialled at other homes operated by the County Council and seems to be working well. The majority of people in the home do not have their support needs set out in this way. However, existing care plans do show what staff need to do to support people, although they are not consistently reviewed and updated to make sure they properly Care Homes for Older People Page 13 of 34 Evidence: reflect peoples current needs in all areas of their daily lives. For example, one person is now said to have gone off her feet having previously been mobile, but the care plan has not been updated to reflect this and the increased risk of pressure sores that the changes would present. However, we were informed that the district nurse had been contacted about changes and supply of a suitable mattress had been arranged. This arrived during our visit and we heard that staff were also told about changes at the hand over between shifts so they would know about the persons current needs. Although the paperwork does not wholly reflect what has happened, the discussion and liaison with nursing staff shows staff do follow up changes and issues of concern. Individual plans include risk assessments for the activities people may join in with, and the home is liaising with other health professionals with regard to falls, auditing these and looking at risk reduction measures. This helps contribute to proper management of problems and ensure professional advice is secured as appropriate, to promote peoples welfare and safety. Peoples nutrition is assessed and the home has also signed up to the Good Hydration charter. We saw that drinks were provided regularly during the day we were there. This helps reduce the risk of falls, urinary tract infections and contributes to continence management. One person has a moving and handling assessment showing their weight is 63.3 kilogrammes (kgs). The person has gained over 11 kgs since it was completed, and although they do not currently have need of a hoist to transfer or move around the building, should they fall and require hoisting the assessment may present problems. This is because the assessment does not take into account weight changes and safe working loads of the hoist to be used. Staff have had some training in caring for people with dementia. The manager and two staff are qualified mappers who have looked at the way people are supported to make sure interactions are positive and that people are engaged appropriately. Care plans reflect where the behaviour of those with dementia might present difficulties, and strategies that staff can use to manage this. Records also show where the behaviour may present a risk and decisions need to be made about whether the placement remains appropriate. Ten people wrote to us. Half feel they always get the care and support they need and half say this usually the case. Eighty percent feel the home always makes sure Care Homes for Older People Page 14 of 34 Evidence: they get the medical care they need and the remainder feel this happens usually. Two social and health care professionals wrote to us and say peoples social and health care needs are always properly monitored, reviewed and met. One person sitting at the dining table in their wheelchair. The manager says that the wheelchair does not fit properly under the table if the foot rests are in place to support the persons feet, which were dangling several inches about the floor. The person is said to have a pressure relieving cushion in the wheelchair but their position means that there would be additional pressure on the backs of thighs and knees which may restrict blood flow and thus contribute to pressure area problems. We looked at medication in current use and at medication administration records for the previous month. The management team have systems in place to check the accuracy of medication records and follow up any anomalies or problems quickly. Records show when this has happened and what follow up action has been taken to make sure staff remain competent and safe to administer medicines. We saw that an audit of the previous month had been carried out and that the management team had identified where they needed to follow things up with individual staff. Medication was stored appropriately and locked away. However, when the trolley was in use in the dining room, we observed that it was left unlocked and open when a staff member was administering medication to someone at a nearby table. they had their back to the trolley. This is contrary to good practice and the homes procedures and presents a potential risk to confused or agitated service users. At present, no formal, recognised assessment process is in place for pain relief, for people who may not be aware of or able to request this for themselves. However, there are risk assessments which outline triggers to identify for staff when this may be needed. We discussed with the manager what she might like to consider doing to address this more systematically. We looked at records for controlled drugs and these matched the supplies of medication available. They were witnessed and signed by two members of staff to help ensure these are stored and managed safely and risk is minimised. Information from the manager shows that she intends to carry out a dignity audit in the home to see how people feel this is upheld for them. One person living in the home has taken on a role in this area and has recently represented people at a Care Homes for Older People Page 15 of 34 Evidence: conference. Hand over between the morning and afternoon shift took place away from people living in the home to avoid possible breaches of confidentiality or privacy. During our visit we also noted that staff knocked on doors before entering peoples rooms. However, on one occasion the staff member did not wait until the person concerned gave them permission to enter. The person said this is not what staff normally do and that they feel staff do respect their privacy. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social and recreational activities meet peoples expectations and preferences. Evidence: After tea while we were still at the home, a group took part in playing skittles. The manager says that the introduction of activities at this time has reduced demands upon staff for attention and from people wanting to go to bed early. Records from night staff meetings with the manager show that they feel people have also been sleeping better as a result. We also saw evidence in separate records of the cookery group that takes place in a small kitchen area on the first floor and one person uses this area to prepare their own tea as they prefer to do this than join with the planned menus in the main dining room. People who are able to, can go out in the local community or travel further afield. Records we saw showed one person had been to Kings Lynn and Hunstanton and also went out locally to the shops and to church. Carers supported the person to get to the church and collected them after the service. The manager says that staff do make efforts to take one or two people out for a walk locally, weather permitting. Two Care Homes for Older People Page 17 of 34 Evidence: people told us they would like the opportunity for more outings although we concluded staffing levels may make this difficult. Staff are allocated to providing activities during the course of the day and we heard arrangements being discussed for some people to attend a quiz in the local community centre. There is a small courtyard garden where people have started growing sunflowers for a competition, and tomatoes. One person also had tomatoes growing outside their room and were looking forward to them ripening. Another told us, I like my gardening and shopping trips. One visiting health professional feels that good activities are provided for people. Ninety percent of the people who wrote to us say there are always or usually activities they can take part in. Only one says this is sometimes the case but when we spoke to them say said they prefer to spend time in their own room as they find some other parts of the home too noisy. One person told us that they were able to manage their own money because they felt able to do so. One person is supported with this by an advocate. We could see from peoples rooms we visited or passed, that they were able to bring in small items or mementos from home to make their rooms feel more homely. Menus we saw show that a choice of main meals is on offer. Eight percent of people commenting to us say they always or usually do enjoy the meals on offer. Two people say this is sometimes the case. One relative commented that the food is good, while another felt the menu is not very varied and there is little if no selection of food. They added there could be more alternatives at tea time other than sandwiches and crisps. However, we saw three different meals provided to people sitting at the same table for their tea. We also heard that someone who did not feel able to eat the main meal on offer at lunch time, was offered and provided with soup, and also requested a glass of milk. This shows people are able to exercise some choice about what they eat. We saw that people requiring assistance were given this, with staff sitting alongside them in a dignified manner. However, it was clear that staff were stretched at mealtimes with 7 people needing prompts, supervision or physical assistance to eat their meals. One staff member expressed concern that they needed to get meals out while they were still hot, to people who were in their rooms but also that one person Care Homes for Older People Page 18 of 34 Evidence: needed to be fed and they cant do both. Additionally, a survey from a staff member says that the service could do better in less rushing of residents to meet mealtimes. One person prefers to make their own arrangements at tea time and has a small fridge in their room. They say they do not like the noise in the dining room. However, they buy the food that they eat for breakfast and tea from their own finances when provision of meals is part of the terms and conditions of residence and is covered by the fees people pay. We spoke to the manager about this and what was clearly the persons wish to do their shopping and eat small meals in this way but also about the contractual obligations of the provider. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns would be taken seriously and there are systems in place to help protect them from abuse. Evidence: The majority of people who wrote to us (eighty percent) say that they know how to make a complaint if they need to. Relatives say they know how to make a complaint, and those who have needed to say the home has always responded appropriately. One person told us they would go to the manager because shes the top one who can sort things out. In addition to taking complaints up within the home, people have access to the local authoritys complaints procedure and everyone living in the home who completed surveys for us, says there is someone they can speak to informally if they are not happy. Staff have training in safeguarding vulnerable adults and the provider has a long established procedure for managing any concerns about potential abuse. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely and comfortable environment, and are benefiting from improvements. However, environmental constraints (locations of toilets, lengths of corridors and sizes of rooms) do impact on peoples daily lives. Evidence: Redecoration has continued and windows have now been replaced to provide something more suitable and better insulating than previously. Although there are rooms (bedrooms, toilets and communal facilities) on the ground floor, the ability of the home to provide accommodation to people who require hoists and wheelchairs is limited because of the sizes of rooms, which do not allow safe manoeuvring of equipment. A health and social care professional has commented on this. Some toilet and bathing facilities have been redecorated and doors have been painted the same colour so that people who are confused will be able to orientate themselves better. New fire doors have been fitted to some locations which are linked to the fire alarm and so allow people to pass freely through them while closing automatically if the fire alarm is triggered. This helps promote peoples safety. Care Homes for Older People Page 21 of 34 Evidence: Historically we have had concerns that the internal gates on the lift are heavy and need to be closed manually. This is difficult for people who are physically frail and may wish to use it independently. While we were there one person needed to call for assistance as they could not summon the lift because the internal gate had not been properly closed when the last person had got out. People are not able to control the temperature of their own rooms because heating is not adjustable individually. The courtyard garden has been refurbished and railings fitted. There are automatic doors to this area and so people can access it safely. The arrangements for people living in the home who wish to smoke, have been reviewed and one person smokes in the porch way (which is directly ventilated to the open air, but is under cover). Last time we visited, people who wished to smoke had to travel a considerable distance around the home and could not smoke under cover in bad weather. Accessibility to one bathroom and toilet was restricted because a laundry trolley had been left in front of the W.C, presenting a risk of falls. The grab rail was in an upright position and left with coat hangers on it which could catch someone who tried to use it. For some people, toilets are located a long way from their bedrooms, meaning that for convenience - they have commodes in their rooms at night. There are appropriate laundry machines in the home to cater for personal laundry. Bedding and towels are sent out to a contract laundry. We had concerns about infection control which had been compromised when we visited by the absence of any cleaning staff. There was brown coloured matter on the grab rail in one toilet, that appeared to be faeces, and in the same toilet, a used continence pad was laying on the floor. Staff were busy attending to peoples care needs and so had not been able to check and address this promptly. One staff member has had more involved training in infection control and been involved in auditing the premises to see what further improvements can be made. Nine out of 10 people who wrote to us, say they feel their home is always fresh and Care Homes for Older People Page 22 of 34 Evidence: clean. One says this is usually the case. However, one relative specifically comments about cleanliness and says the persons room could be a bit cleaner - such as dusting and hoovering - it is not too bad, may be cleaners do not have enough time. A staff member also commented to us that they felt the home could be cleaner. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a competent staff team who work hard to meet peoples needs. However, staff are not always available to people when they need to be. Evidence: When we visited, there were four carers and one senior carer in charge during the afternoon. (Staff say that there are generally four people on duty for up to 36 people.) Two of the four carers were agency staff although one was said to have worked regularly in the home and had been able to get to know people. Our observation was that staff were particularly stretched at mealtimes. One staff member said they had to feed someone as well as go round with meals and cant do both. Information from the manager and staff is also that up to 7 people require assistance, prompts or supervision to eat their meals. It also shows that half of the people living in the home are singly incontinent and approximately half have dementia or other mental health needs. Additionally there are no laundry staff and carers are expected to do peoples personal laundry and any ironing so taking them away from directly supporting people. Only two out of the seven staff who wrote to us are able to confirm that they felt there are always enough staff on duty to meet peoples needs. Over half of them feel that Care Homes for Older People Page 24 of 34 Evidence: there are only sometimes enough staff to meet peoples needs. One specifically commented that the home could do better if they did not take cleaners off their duties to do care work. The manager says that where these staff are asked to do particular tasks, they are always part of their job description. However, this supports further that there are occasions when care staffing levels do not meet peoples needs. Service users surveys show that only thirty percent (3 out of 10) feel staff are always available when they need them. Staffing levels are further reduced when breaks are taken. For example, staff are entitled to two breaks during the course of the late shifts, and each carer has a total of 45 minutes (one 30 minute meal break, and one 15 minute break) which are staggered and allocated during the shift. This means that for a total of three hours during each afternoon shift, there are effectively only three carers on duty. One person living in the home specifically commented that staff sometimes cannot support them when they need it and say they will be back in ten minutes. However, they do not always come back. On the day we visited there were no cleaning staff on duty in the home. Care staff did not have time to check and audit what needed doing, although one carer out of the four afternoon staff, was allocated to vacuum the dining area - so taking them away from providing direct care for service users at that time. The manager says she has no recourse to agency cleaning staff when the homes own staff or relief staff are not available. The condition of one of the WCs that we looked at placed people living in the home at risk of infection because it needed cleaning and staff had been too busy to notice the problem or attend to it. The manager acknowledges that staffing levels have been difficult because of a number of people who were on long term sick leave but have now returned to work. However, during the three months up to submission of her written information to us, 163 shifts had been covered by agency staff. On the day of our visit, two of the four carers were agency staff although both were said to have worked at the home before and one had done so regularly. This shows that the management team try hard to make sure people are supported by staff who have got to know them and understand their needs. Staff say they have access to good training opportunities and we could see that induction training is given to staff promptly. All staff surveyed say that they are given training that is relevant to their work, helps them understand peoples needs and gives them enough knowledge about peoples health. Care Homes for Older People Page 25 of 34 Evidence: Three out of five relatives feel that staff always have the skills and experience they need to look after people properly. Two feel this is usually the case. Two visiting professionals also feel that the staff and managers have the right skills and experience to support people with their health and social care needs. One goes on to say that the carers learn how best to look after each service user. The organisation has a history of making appropriate checks about the suitability of staff before they are taken on to work in their homes. However, one of the files we checked did not contain appropriate confirmation from the personnel department that an enhanced Criminal Records Bureau check had been carried out, and of its findings. In two other files seen, the necessary information was present so it is likely this was an oversight. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from effective management where their views, and welfare are taken into account but where improvements could be made to demonstrate their safety is wholly promoted. Evidence: The manager has worked at the home for a number of years providing stable and consistent management. She continues to update her skills and training, including in how to support people who have dementia effectively. This means that she is able to provide guidance to other staff and has the underpinning kinowledge she requires to run the service effectively. She is supported by a management team including care coordinators and senior carers who take responsiblity for overseeing shifts on a day to day basis. There are centralised systems to support the running of the home in relation to staff management and monitoring as well as developing, updating and reviewing policy and Care Homes for Older People Page 27 of 34 Evidence: procedural guidance for staff to make sure this complies with recent legislation and good practice. Records show that, where money is held for safekeeping on behalf of service users, it is checked regularly and appropriate receipts are obtained where purchases are made on their behalf. Staff have access to training to help them work safely. This includes training in infection control, , fire safety, moving and handling and first aid. We could see from service information that equipment used for moving and handling is maintained and tested regularly. However, the records of audits that the manager is supposed to complete show these are not carried out as regularly as intended. The last recorded monthly safety inspection was in March. There are other checks carried out on a day to day basis to make sure for example, that fire exits are free from obstruction so that people could get out of the home quickly and safely if there was a fire. Staircases in the home are freely accessible to all service users. The manager says that this has not presented a problem so far. However, individuals are not assessed for possible risks when they are allocated rooms near a staircase, taking into account their abilities, mobility and any issues arising from confusion or dementia. Likewise, antibacterial handwashes are located through the home to aid in infection control. The manager says that there have been no problems with accidental ingestion or misuse of these arising from people with dementia having access to them. However, associated risks for individuals have not been assessed and documented to see if they are acceptable. We could see that people living in the home have opportunities to express their views about the quality of the service, through regular meetings and through discussions at monitoring visits carried out by the line manager for the service. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Assessments, including about moving and handling people, must be kept up to date when things change. This is so people are not at risk of staff using equipment that is not of sufficient calibre to move them safely. This is so people are not placed at unnecessary or avoidable risk. 11/09/2009 2 9 13 Staff must follow proper 11/09/2009 procedures for the safekeeping of medicines when they are administering them. If this does not happen, medicines are accessible to vulnerable service users so placing them at risk of harm. If medicines are not secured when unsupervised they Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action may be accessible to staff or visitors not authorised to handle them. 3 26 13 There must be arrangements to ensure the shifts of ancillary workers are covered. This is so care staff are not taken away from supporting service users in order to carry out cleaning tasks. This is so people are not exposed to increased risk of infections spreading. 4 27 18 The management team must 30/10/2009 re-assess peoples dependency and support needs at peak times of day and review staffing levels accordingly. This is so people can have support from staff when need it and in a reasonable time. This is so the manager can show there are always sufficient staff on duty to meet changing needs. 5 38 13 The hazards and risks 16/10/2009 presented by open and accessible stairways must be assessed and recorded. 09/10/2009 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to see if any action is needed to promote peoples safety and reduce risks. This is so the home makes sure people who may be confused, disorientated or over-estimate their abilities, are not placed at avoidable risk. 6 38 13 The hazards and risks presented by freely accessible antibacterial handwashes must be assessed. This is to see if any action is needed to promote peoples safety and reduce risks. This is to make sure they do not present a risk to confused people who may ingest or use them inappropriately. 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 16/10/2009 1 8 Where there are difficulties arising from the use of wheelchairs, the person and the equipment they are using should be reassessed. This is to make sure the persons position is comfortable and does not compromise tissue viability. Care Homes for Older People Page 32 of 34 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 2 9 A system for assessing pain in people who have declining health or dementia, should be used. This would help staff identify when someone may need pain relief even if they are not able to request it for themselves. Where people choose to purchase their own food and prepare small meals for themselves (and so exercise increased choice and independence), the service should consider its terms and conditions of residence and how best to meet its contractual obligations. 3 15 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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