Inspection on 12/03/09 for Tandy Court

This inspection was carried out on 12th March 2009.

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

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

Other inspections for this house

Tandy Court 04/10/07

Tandy Court 26/07/06

Tandy Court 07/12/05

Tandy Court 11/05/05

Tandy Court 11/11/04

Tandy Court 15/07/04

Tandy Court 23/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tandy Court Tandy Drive Kings Heath Birmingham West Midlands B14 5DE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Brown     Date: 1 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Tandy Court Tandy Drive Kings Heath Birmingham West Midlands B14 5DE 01214308366 01214307581 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Anchor Trust Name of registered manager (if applicable) Mrs Patricia Ann Jackson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 40 Mental disorder, excluding learning disability or dementia (MD) 40 Physical disability - over 65 years of age (PD(E)) 40 Dementia over 65 years of age (DE(E)) 40 Date of last inspection Care Homes for Older People Page 4 of 31 care home 40 Over 65 40 0 40 40 0 40 0 0 Brief description of the care home Tandy Court is a well maintained two-storey purpose built Home, which opened in 1985 and is situated in a quiet cul-de-sac in the South of Birmingham. The Home is situated close to shops, a public house, post office and public transport. It provides accommodation for 40 residents over the age of 65 years for reasons of old age, dementia, physical disability or mental disorder. All flats are for single occupancy and have an en suite toilet and kitchen facility. There is a bath or shower in thirty-seven of the en suite facilities. However the baths within the flats have low-level access and may not be suitable for all residents. In addition, there are communal assisted bathing facilities situated throughout the Home, which are suitable for all residents to use and a portable bath seat that may be used in the low-level access baths. Aids and adaptations are available to assist residents with physical disabilities and handrails are provided throughout the Home. Communal areas consist of a dining room on the ground floor, which leads out onto a patio area and secure well maintained garden which is also suitable for wheelchair users. There are three comfortable lounges providing a choice of sitting area for residents. There is adequate off road parking to the front of the Home. Notice boards display any forthcoming events, CSCI reports, newsletters and other information of interest to residents and visitors. The weekly fees to live at Tandy Court are £485 10 with dementia, £473 55 without and there is a £38 top up if the local authority assists the funding. Items excluded from the fee include private chiropody, hairdressing and personal toiletries. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home without notice on a day in March 2009 and undertook a key inspection where we looked at the majority of the National Minimum Standards. Prior to this our last inspection was in October 2007. The home gave us information in an Annual Quality Assurance Assessment (AQAA) before the key inspection. The AQAA shows how the home rates their performance in the areas set out in this report and how they intend to improve. During the inspection 3 peoples care was case tracked, this involves looking at all the records about this person and how the home manages their care. We spoke to these 3 people. We also looked at another 2 peoples records in part. We looked at the homes Care Homes for Older People Page 6 of 31 medication records for these 3 people and 2 others. We looked around parts of the building and viewed the health and safety checks that had been undertaken. We spoke to 6 staff and the manager of the home and looked at staff records. We have received no complaints about the home. Information about all of the above is contained in this report. What the care home does well: Anchor Trust produces good information about the service that is available to people before they decide to come into the home. Before people are admitted they are visited and information is collected about them so that the service can decide whether they can meet the persons needs. The person is encouraged to visit the home and stay for a few hours to see if they like it. Further information is collected as the home gets to know the person. This helps them write care plans that say how the person can be cared for and plans to ensure that risks to the person are minimised. People were moved from place to place well using methods that kept people and staff safe. People on the day of the inspection seemed to have their personal hygiene needs met. People were talked to with respect and were helped in a caring way. Comments made about the service were: -I cant say anything is wrong, the care is a good both night and day. Have always treated my relative with respect, kindness and consideration. Quite comfortable here and Im satisfied with the care, food and attention I receive. The majority of comments about the activities were good. The home employs an activities coordinator and there was a good range of activities available. Comments made were they do their best to make the residents happy and contented with a lovely atmosphere it is very hands-on care home, there is lots going on with activities etc. They are particularly good at providing special events to celebrate Easter, Valentines Day, St Patricks Day and so on, which I believe the residents mostly enjoy. They should provide more stimulation for residents such as games, physiotherapy and outings. The food was good with kitchen staff being aware of any health difficulties when providing food. People are shown the plates of food with the choices of available at meal times before they choose and this helps people with memory problems. The home was clean and fresh, well decorated and maintained. All health and safety checks were completed. People could bring their own belongings to make their rooms feel more like home. Comments made about the home were he has a lovely room overlooking the garden. Keeps the fabric of the building looking cared for. Also its nice to have a quiet room with a water feature. The room is kept clean and tidy the home is well presented with a nice environment for residents dining and lounge and communal areas. Care staff in the home had completed or were expected to complete the National Vocational Qualification level 2 in care and this means they are given training in how to meet the needs of older people. Staff were also receiving training in dementia care. Care Homes for Older People Page 8 of 31 Generally staff were recruited appropriately and appropriate checks were made before people were employed at the home. Residents money was managed well. What has improved since the last inspection? What they could do better: Whilst there had been improvements in care planning and risk assessments of people there was at times gaps in these. Although staff had been given information about how to manage challenging behaviour generally the plans for individuals did not take into account information that may show what may set off their behaviour or how to manage it. Relatives of people living in the home said they were not always informed about the health and wellbeing of their person on a regular and routine basis. A number of people and professionals said that information about people was not communicated well at shift changes. Medication administration could be improved by ensuring there is a clear plan including what medication is, what it is for, any food stuffs or other treatments to be aware of, and in what circumstances as required medication is to be given. The medicines fridge should have a record of the maximum, minimum and current temperature and these temperatures should stay within the levels for medicines to remain useable. Although the home is writing to us about incidents of a safeguarding nature, to ensure that appropriate action can be taken in a timely way they should also telephone us with this information. One member of staff required a risk assessment to be undertaken following checks made to ensure their safety to work at the home. Comments were made about the staffing of the home at the weekend and at night the home should review its staffing to ensure that peoples needs can be met at these Care Homes for Older People Page 9 of 31 times. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 10 of 31 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 11 of 31 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 have enough information in order to decide whether they would like to live at the home. Detailed information is collected about people and this assists the home to deceide whether they can meet peoples needs. Evidence: At the last inspection the home had good information available for people coming into the home and this had not changed. We received nine comment cards for relatives and three from people living in the home that confirmed this. We looked at the admission of three people into the home and found that people had a preadmission assessment, which usually took place where the person was, such as hospital, at home or in another placement. People wherever possible had the opportunity to visit the home before deciding whether they wanted to come for a trial stay. Care Homes for Older People Page 12 of 31 Evidence: Information about the persons circumstances, health and abilities was collected at the preadmission assessment and this was added to with a baseline assessment some time later. This baseline assessment looked at how the person managed in all areas such as continence, washing and dressing and social activities within the care home. It was intended that the baseline assessment would be completed a week after admission that sometimes it was taking longer than that. However the information provided was detailed enough to ensure that good care plans could be written. The home collects information about peoples ethnic background and religion, and makes arrangements were necessary for specific needs to be met. One comment card said my client is Polish and the home have made an effort to have a Polish interpreter where serious issues needed addressing. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have plans in place that say how staff are to give the care and this helps to ensure people receive care in the way they want. Risk management plans and medication plans needed to be improved to ensure that they were individual to the person and risks can be managed effectively. Peoples health care needs are met but communication to relatives and professionals needed to be improved so peoples best interests are mantained. People are treated with dignity and respect. Evidence: There was a good amount of information to inform staff how to care for individual people however sometimes not all the information was in the care plan itself. The home was working to improve care plans so that they are of a consistent standard without gaps. We found there was not enough information for staff about how to manage individuals challenging behaviour. Although staff have methods of diverting people from Care Homes for Older People Page 14 of 31 Evidence: challenging behaviour they do not have information about what works with the specific individual. Personalised plans to manage the risks of challenging behaviour need to be set up and these need to be reviewed following any incident to ensure that any learning from the incident is put into the plan. This is especially important in a home that manages the care of people with dementia. Staff interviewed have the understanding of how dementia affects people. They showed that they knew of the other health needs of individual people. A social care worker said, The service providers are willing to try a number of options to resolve service user issues. People received a healthcare attention when needed. The home had a system of alerts that showed if there was a concern about a person. For example there were alert forms where it was noticed that a persons skin was red and where there was a new prescription for food supplements. This is good because it highlights any changes to the plan of care or any concerns to all staff. One of these alerts resulted in a care plan to ensure that the skin health was improved. The home looks at the care provided routinely on a monthly basis. However they do not summarise the events that have occurred in the intervening time. This can mean that some information is lost. The need for communication to improve was mentioned in the number of comment cards received. A health professional said, Communication between staff members is not always good at shift changes. Relatives said, the care home always notify me if my father needs to be admitted to hospital. But do not always tell me if he has had a fall. I do not feel that I am informed of changes to my mothers care sometimes there is a lack of communication between care workers and shift changes and this leads to my mother being even more confused. We sometimes get enough information via newsletter and reviews. Some staff could be more welcoming, they never ask who you are visiting and offer no feedback on how your relative is keeping. We observed how people were moved from place to place and found that this was done well. Good moving and handling techniques were used, staff gave people good instructions about how they could assist themselves and time was given to ensure that people were safe during the move. People were observed to have their personal care needs met. People were having their hair attended to on the day the inspection. People were observed to have clean fingernails, and women appear to be assisted to wear jewellery and makeup if they wish. Some improvements were needed in the storage and records of the administration of medication. Although there was a care plan for the administration of an individuals Care Homes for Older People Page 15 of 31 Evidence: medication this did not include what the medication is, what it is for, and any information that staff need to be aware of. This may mean for some medications for the person should not drink grapefruit or cranberry juice, or information that would suggest that the person is having a poor reaction to the medication. The person administering medication had received appropriate training but was not aware of all medications they were administering and information was not readily available. The records of medicinal creams and supplementary foods administration were not always completed and this may mean that on occasions these were not administered. Copies of the prescription were not kept next to the relevant medication administration record (MAR) and this is another check to ensure that the medication prescribed is recorded on the MAR. there was not a large amount of medication errors, for one person the amount the amount of medication had not been recorded in the MAR. Two medications looked at had not been signed for but had been given. Medication that needed to be given as required did not have copies of a protocol that said in what circumstances and how often it should be given with the medication administration record and this means it could be given incorrectly. We looked at the medication fridge and the record of temperature did not include the maximum and minimum. When this was checked by staff, whilst we were there, the maximum temperature was outside the recommended temperature for medication to be within its product licence and this could mean the medication is ineffective. People thought that they were treated well. People said, I cant say anything is wrong, the care is a good both night and day. Have always treated my relative with respect, kindness and consideration. Quite comfortable here and Im satisfied with the care, food and attention I receive. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are offered activities that a meaningful to them. People are assisted to make choices about activities and food and this enhances their life. Evidence: An activities coordinator is employed to assist people to become involved with activities. People have an activities care plan, which outlines the activities the person enjoyed prior to being admitted. Activities are recorded in an activities book and this shows the range of activities available to people. These include: -monopoly games, questionnaires, reading, dominoes, exercise, hand massage, wishing tree, going out to Kings Heath, bingo, reminiscence, visitors from a local school, painting making biscuits and sandwiches, dancing and songs. On the day of the inspection some people were involved in a game of Monopoly, some people were baking cakes and some people were watching TV. Work has been undertaken on the garden to provide raised beds and troughs to enable some people to do gardening in the coming months. Relatives said about activities they do their best to make the residents happy and contented with a lovely atmosphere it is very hands-on care home, there is lots going on with the days activities etc. They are particularly good at providing special events Care Homes for Older People Page 17 of 31 Evidence: to celebrate Easter, Valentines Day, St Patricks Day and so on, which I believe the residents mostly enjoy. They should provide more stimulation for residents such as games, physiotherapy and outings. One person said that they missed their friend who used to live in the home as they sometimes went out together. Relatives appear to be able to visit at all reasonable times. They said the home is secure friendly and always hospitable with lovely attitudes by staff. We feel the carers are doing a very good job. I am happy with the home as it is. Information is available for people to look at in the reception areas. The home has recently hosted a social evening for both people living in the home adn their relatives and friends. There appeared to be no undue restrictions on peoples movement around the home on the day the inspection. People are assisted to make choices about how they wish their care to be given. People are helped to get from place to place and find their rooms if needed. People seem to enjoy the food provided. One person said the food is wonderful it is very well presented. As we arrived at the home people were coming into the dining area for breakfast the tables were set with tablecloths, flowers, napkins cups and saucers spoons and knives. People were served as they arrived into the dining area and did not have to wait until everybody was present. The menu was on display in the main corridor of the home. We sat with people at lunchtime and sampled a meal. People were shown an example of each meal this assists them to make a choice of what they wish to eat. We saw that if a person was having difficulty eating a meal they were encouraged to eat and if necessary provided with an alternative. The food was well cooked and tasty. There was a record kept of the amount of food people eat and the choices they have made. The cook was aware of special diets and allergies people have and was involved in finding out peoples views on the food provided. The home keeps a record of peoples grumbles and compliments about food there appeared to be only isolated incidents where food was not enjoyed. Care Homes for Older People Page 18 of 31 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. Policies and procedures are in place to ensure that complaints are listened to and people are safeguarded. This ensures peoples health and well-being. Evidence: The home records minor concerns as well as complaints and this assists the home in determining how they can improve it. The homes annual quality assurance assessment says that there is a comprehensive complaints procedure on display and this was seen. Two comment cards from relatives stated that they were unsure about the way to make complaints however said there had no problem asking if they should have a complaint to make. We have received no formal complaints about the home. The complaints the home has recorded have mostly been about minor issues such as isolated problems of food quality, staff attitude and on one occasion the temperature of the water. The home also documents its compliments of which there have been a large number covering food, staff attitudes, activities and contact with health professionals. The home has copies of the multiagency guidelines to ensure that all staff are aware of the procedures to follow to keep people safe. There is an easy read document on display for people to look at if they are concerned about how they have treated. There have been a couple of incidents where people living in the home have not maintained relationships with each other and this has resulted in physical contact. The home has Care Homes for Older People Page 19 of 31 Evidence: written to us about the incidents however it is important that they contact us by telephone so that any action needed is not delayed. We talked to staff about safeguarding and they understood what their responsibilities were. Staff are only recruited after appropriate checks are made and this safeguards people living in the home. Staff files looked at and staff spoken to showed that nearly all staff had training in safeguarding people. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have the benefit of a secure, warm, comfortable and homely environment. They have the ability to decorate and furnish the flats as they would wish. Evidence: The home is purpose-built and is on two floors, there is a passenger lift as well as stairs to access the upper floor. People living in the home have the benefit of having a small flat that includes a bed sitting room with kitchenette facilities and separate bathroom. The home has assisted bathing and showering facilities available for people that cannot access the facilities in their flat independently. There is a wheelchair accessible garden and work was being done to create some raised troughs and beds that people living in the home can use in the coming months. There is lots of communal space including a large dining area, lounges on the ground and first floors and some areas with seating such as the reception area. Some of these areas are quiet and are used when people come to visit. The home was clean and fresh on the day of inspection. Care Homes for Older People Page 21 of 31 Evidence: Peoples bedrooms that were looked at appropriate levels of furniture and facilities. There was evidence that people could bring in furniture if they wished and most preferred to do so. The home provides furniture if the person does not wish to bring theres to the home. Some flats had equipment such as raised toilet seats, pressure relieving mattresses and cushions to assist people living in them. The home is well maintained and plans are in place to continue refurbishments. The home expects to refurbish the walls and floor in the kitchen as its next project. Relatives said about the environment he has a lovely room overlooking the garden. Keeps the fabric of the building looking cared for. Also its nice to have a quiet room with a water feature. The room is kept clean and tidy the home is well presented with a nice environment for residents dining and lounge and communal areas. Staff spoken to had a good understanding of how they could minimise the spread of infections within the home. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home receive care from staff that are recruited well and have regularly training. Staffing levels in the home should be reviewed to ensure that staff are deployed to meet the emerging needs of the people living there. Evidence: We took with us 4 week rotas to analyse and found the manager primarily works Monday to Friday 9-5 as does the deputy manager and there is administrative support on these days too. During the week on most occasions there is a team leader available throughout the day until night staff come on duty. On the weekend a senior member of staff was available although there appear to be less care staff available than through the week. We were told that staffing was sometimes low at weekends this made it very busy. We were told in a comment card and by the manager that they have improved the numbers of staff on duty. The home has housekeeping and kitchen staff as well as care staff. One social care professional that there should be more staff to residents at night. Comment cards said about the staff: - The carers are brilliant and always willing to help with any problems we have regarding my father. Their people management skills are excellent. We feel that the carers in the home are doing a very good job. Care Homes for Older People Page 23 of 31 Evidence: The homes annual quality assurance assessment (AQAA) states that 70 per cent of staff have achieved a National Vocational Qualification level 2 in care. This means staff have received training in how to care for older people. We looked at the recruitment records of three staff and found that people were generally recruited appropriately. The organisation expects people to complete an application form, be interviewed, have checks with the Criminal Records Bureau (CRB), the Protection of Vulnerable Adults list and have 2 references received before being employed. There is a record of the questions asked at interview and the responses and this ensures a fair recruitment process. We found that one check showed that a person needed to have a risk assessment completed before a determination about employment but a record of this could not be found. We looked at the training records of the new staff whose files we had looked at and at some more long standing staff and found that staff were given routine training. Staff told us about how they were given information about people when they first came to work at the home and the training they have had since. People had in addition to mandatory training such as first aid, moving and handling or back care, training in dementia awareness. We received a comment that some staff were less experienced especially with mental health problems that can be very involved. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally run in the best interests of the people living there. Peoples health and safety is protected by regular maintenance checks of equipment used. Peoples personal money is safely managed where this is needed. Evidence: The Registered Manager and the Deputy Manager have had many years experience working within a managerial role in a care environment and they hold appropriate qualifications in both management and care. Comment cards from staff show that they have a good view of the management of the home. Staff say that they have meetings with manager on regular basis to ensure that the home runs smoothly. Quality monitoring visits are undertaken by external Senior Managers on a regular basis and reports of these visits were available. Residents and staff are involved in these visits in order to discuss their experiences of living and working at the home. The homes Annual Quality Assurance Assessment was completed well. Audits were Care Homes for Older People Page 25 of 31 Evidence: completed in some key areas but these were not necessarily drawn up into an action plan. The home surveys residents, relatives and key people on a yearly basis to find out how the service can improve however communication and some key paperwork is a recurrent theme that needs action. We looked at the management of peoples money and found that the system was safe. Peoples money is paid into a residents bank account and an electronic record is kept. A small float of money is kept at the home if people want some cash and this is then taken off their electronic account. Services such hairdressing and chiropody are paid for and then the amount is taken off the individuals record. We were able to see receipts for any money that the home spent and people that bring in money were also given a receipt. Most people living in the home do not hold any money themselves. We looked at one account where the person had money brought in by a relative and then they signed for smaller amounts of money when they needed it and this was managed well. We looked at a number health and safety documents such as certificates and records for fire, gas, water and lifting equipment safety and found that this were in order. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 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 8 13 (4)(c)People with challenging behaviour must have individualised strategies to manage their behaviour and these strategies must be reviewed after every incident. This is to ensure that any triggers for behaviour can be managed and the risk to the person or others is minimised. 15/05/2009 2 9 13 (2)The home must ensure that medication is kept at a temperature within its product licence. This is to ensure medication is safe and effective. 15/05/2009 3 9 13 (2) 12(1)(a) The system for recording and administering food supplements and applying medicinal creams must be improved. This is to ensure that people have the nutrition and 15/05/2009 Care Homes for Older People Page 28 of 31 cream applications they need and to monitor their effectiveness. 4 9 13 (2) 12(1)(a)Protocols for the 15/05/2009 administration of as required medication must be kept with the MAR charts to show in what circumstances this medication can be administered. This is to ensure that people only received medication in the right circumstances. 5 9 13 (2) 12(1)(a) A plan needs to 15/05/2009 be in place for medication that describes what the medication is for and any information that staff need to be aware of. This is to ensure that medication is administered in a way that is safe for people. 6 29 19 You must undertake a risk assessment on a named member of staff and you must ensure where checks identify an issue a risk assessment is completed. This is to ensure that all staff are safe to work with vulnerable people. 08/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 31 1 8 The home must develop systems to ensure that relatives are kept informed on the well being of the person they are responsible for in the home and to improve communications with professionals. This is to ensure good relationships with people involved with the home. Where incidents have occurred that have a safeguarding nature the home should contact us by telephone as soon as possible so as not to delay any action that may be needed. The numbers of staff and their roles and responsibilities should be reviewed to ensure there are appropriate numbers of staff to meet the needs of people at all times in the home. 2 18 3 27 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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