Inspection on 24/02/09 for The Albany Nursing Home

This inspection was carried out on 24th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Albany Nursing Home 21/02/08

The Albany Nursing Home 20/04/06

The Albany Nursing Home 15/02/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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: The Albany Nursing Home 7 London Road Headington Oxford OX3 7SN     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: Ruth Lough     Date: 2 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: The Albany Nursing Home 7 London Road Headington Oxford OX3 7SN 01865744444 01865744485 thealbany@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Trinity Care (Crown) Limited care home 48 Number of places (if applicable): Under 65 Over 65 48 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category/ies of service only: 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 categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home The Albany Nursing Home is a purpose built home that is registered to care for 48 older people. It is situated in the Headington area of Oxford, close to shops and amenities. The Albany is part of Trinity Care (Crown) Limited (part of the Southern Cross Healthcare Group), which has a number of similar homes in Oxfordshire. Accommodation is on two floors, accessed by a lift or stairs, and all the bedrooms overlook the attractive gardens. There is a spacious conservatory that opens onto the gardens and a safe walkway through the garden for service users. The home provides a six-bedded intermediate care unit with four single rooms and two large shared rooms, all with en-suite facilities. Care Homes for Older People Page 4 of 33 Brief description of the care home There is a sitting room with a kitchen area that is designed to enable the service users to build up confidence in being independent and safe before being discharged home. A further communal sitting room has been provided on the ground floor, which provides an opportunity for socialisation. The range of fees for this home is £528.36 to £1028.73 per week. There are additional charges for hairdressing, chiropody (none diabetic service users), newspapers and toiletries. Care Homes for Older People Page 5 of 33 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: This was an unannounced key inspection process generated from the Adequate findings identified at the last assessment of the quality of the service by the commission in February 2008. This inspection process included reviewing information provided by the service before a one-day visit to the home. During the day the records for care planning, recruitment, and administration of the service were assessed. The people who use the service and the staff who provide the support were consulted about their opinion of what is provided, through surveys. Of the fifteen people who are in receipt of support that we contacted, we received eleven Care Homes for Older People Page 6 of 33 responses at the time of writing this report. Eight staff were also contacted through surveys, of which five responded. Two healthcare professionals who have been involved with working with and visiting the service, were also contacted. From this visit it was found that the requirement and some of the recommendations that were made to improve the service during the last inspection process have been met. There were a few areas that will need to continue to improve as to protect the people they support and one requirement were made to reflect this. A number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. The home is currently without a registered manager. The organisation informed the commission at the time of the inspection that action was being taken to employ a specific person for this role and that interim measures have been put in place. 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 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 8 of 33 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 33 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. The individuals needs are assessed thoroughly before they are offered a place in the home. Evidence: Comments from service users and their representatives indicated that they were given enough information as to make an informed choice to use the home. One resident noted in a survey in regard to a contract of stay, The Manager explained the contract and discussed it with me. The records of four people living in the home were reviewed to see what information is obtained in regard to their needs before they are admitted to the home. From these records it could be seen that detailed information is obtained including that Care Homes for Older People Page 10 of 33 Evidence: provided by a referring social services department, other health or social care professionals, and relatives of the person concerned. Where possible the person requiring support is consulted about their choices and wishes throughout the process. The information available supports that key details of individuals needs are obtained including their physical and mental health, and any social interests they may have. There is a dedicated area to providing intermediate care, that provides a separate living area that is shared with the people in this unit. A team of nursing and care staff provide support with additional input from Occupational Therapists to enable the people staying for a short period to return to their own home. A sample of the combined records for care planning and support for an individual was briefly viewed on this inspection visit. Care Homes for Older People Page 11 of 33 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. The detail in the care planning records to assist staff to meet the identified needs of individuals has improved, but the gaps in some do not support that they obtain the care that they need or that their personal wishes are met. Evidence: To the question Do you receive the care and support that you need? that was included in the survey sent to residents, there was a mixed response. Of the ten respondents, four identified that they thought that they always obtained the support and care they needed. Comments included, My mother is very happy at The Albany. On one visit to her, her comment was, that she did not have a care in the world. Another resident we spoke to during the day expressed that she felt very supported and that the staff team ensured that she obtained the medical support that she needed for her complex health needs. Other people indicated in the surveys, that they usually obtained the care and support Care Homes for Older People Page 12 of 33 Evidence: they needed, and added comments: My impression is that there is not enough staff for the patients, so when I press the bell I am aware that I am depriving someone elses need. Often have to wait longer than my carer says. I was never offered a bath even though when we were shown around the home we told a bath could be available. I also did not receive an application of sudocrem to prevent sore spots. Sometimes a bit of a delay in answering the nurse call bell. My relative is contented and usually appears well cared for. When I visit I always find that my mother is clean, her hair done, also her nails painted. The selected care planning records that were reviewed supported that the format of information is a holistic approach, to providing individuals care. The sampled care plans were variable in quality; some of the more latterly developed care plans have greater detail of how staff are to provide the care and support and any changes that have occurred in their health and wellbeing is reflected. For the others who had been living in the home for a longer period, there were a few gaps in the information that could be improved to reflect the current needs of the people concerned, as changes in health and social needs had not been reflected fully. One resident had been unwell and had to remain in bed for a few days, the family expressed it was very uncomfortable time for him to remain in the room with his companion who wished to have the lights off, curtains closed, and the dividing screen across between the beds. These preferences and staffs actions to eliviate the impact on the person concerned were not noted in detail. The registered nurses should also not use abbreviations when recording medical conditions or other needs as to be sure that they give precise and clear information. These recommendations for improvements were passed back during the day of the inspection. The records did support that the nursing staff had reviewed the care planning and had been involved in the those carried out by the individuals social services, if funded by them, annual re-assessments. The care plans showed that a number of assessment and monitoring tools are used to identify and modify any changes in the care that is planned. The individuals dependency, weight, skin integrity, and nutritional needs are reviewed regularly. Care Homes for Older People Page 13 of 33 Evidence: All but one person stated that they felt that the staff listened and acted upon what they requested. With additional comments put forward: To the best of their ability, sometimes they have to be asked several times. As a service users representative, I find staff to be polite, friendly, willing to listen and very helpful. I would not hesitate to approach a member of staff in this home. Prompt action by staff, nurses and carers, follows every comment by me (Husband of resident) One person indicated that they had a negative experience with the responses from the nursing and care staff. They added, There is a lot of difficulty with understanding due to poor English, and a lack of understanding on behalf of the staff, combined with my poor hearing. I need people to speak clearly and directly to me. To the question of availability of staff the majority felt that there were usually staff when they needed them. Although some added, There were times they were too busy to provide care to my mother. I have put always to this question, although obviously you might have to wait a few minutes. There will always be the occasion when all 48 residents want help at the same time! Jolly good service. There have been occasions when I have had to wait up to an hour after pressing the bell. At weekends, Saturday and Sunday, there appears to be fewer staff readily available for assistance and discussion. All respondents thought that they always and usually obtained the medical support the needed. A relative noted that their relatives new GP visited and introduce himself to them even though they did not need medical support at the time. Comments included, Staff need reminding and prompting in that area. A relative put on a residents behalf, This is an area where I have struggled to have Care Homes for Older People Page 14 of 33 Evidence: confidence in my painkillers and other medication being delivered at my required time, often late. It has been difficult to establish a satisfactory pattern. Other comments were: A doctor was called when necessary and admission to hospital was initiated when appropriate. As I have several long term serious physical problems, I have constant medical help with follow ups with my hospital appointments, GP, dentist, dietitian, and speciality nurses. All the medications are followed thoroughly. My medical support is excellent. The information that was seen in the care records examined supported that any consultation or health treatment is sought on residents behalf. From what could be seen they are attended regularly by their own GPs and have consultations and treatment from chiropody, opticians, and specialist nurses. The medication needs of individuals is recorded on admission, although changes are not necessarily noted apart from in the records from GP visits and the outcomes from the daily records. They could implement a method of doing this, parallel to noting the significant health changes in an ongoing history as to observe for trends, adverse changes, and assist with carrying out a review of the planned care. This would be particularly relevant to the people they support who remain living in the home for longer periods. The medication records support that they are managed safely and that individuals obtain their medication when prescribed. However, according to comments made, this may not be the experience of some of the people living in the home. There are suitable safe storage facilities and the records for Controlled medications show that these are accurately managed and administered. Better care could be taken to note on the MAR(Medication Administration Record) charts as to identify that individuals receive their prescribed creams or treatments they may need as there were gaps in some of the records reviewed. The home has started providing support for, End of Life care programmes and has developed noting in greater details some of the personal choices of the person concerned for when their health deteriorates. They should continue to further developing the detail in these records as to provide staff with a clearer picture of personal choices and wishes. Care Homes for Older People Page 15 of 33 Care Homes for Older People Page 16 of 33 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 staff have obtained good information about the interests and personal history of the people they support, although the care planning and delivery may not match what they may need or wish for. The meals, mealtimes, and menu planning meet the needs and wishes for some of the residents. Evidence: To the question if there are activities arranged in the home that they could join in with, there was a mixed response. Some people in the surveys stated that there were never any activities that they could join in with, but this included those who indicated that their health was poor. The majority of the others put, usually. Additional comments were: There is a full time activities organiser, with plenty of activities for residents. Excellent! Gradually gaining confidence to join in. Due to language barrier and cultural differences it would be helpful if staff could Care Homes for Older People Page 17 of 33 Evidence: understand residents cultural needs sensitively. I am surprised that no-one offered to take me out into the fresh air, not even once in four weeks. The individuals interests and personal history were recorded in reasonably good detail in the care plans that were reviewed. There was little to note that each person had an individualised activity programme. However, their presence whilst an event was taking place, was noted. The level of participation and enjoyment of the event was not recorded in depth. From the information provided in the returned surveys and from discussion with some of the people living in the home it was evident that there is a continual programme of events provided by staff. The employment of an activities organizer had ensured that improvements have occurred during the recent months. Feedback during the day from staff was positive about the development of the activities. One member of staff expressed in a survey that the new activities organiser was brilliant and organised the programmes of activities very well with staff getting involved. Much of the present activities centre around games and music that most of the more physically and mentally active residents can join in with, should they wish. It was unclear that all residents had the opportunity to have one-to-one support with pursuing their interests, although one resident stated that she was periodically given time and support for what she needed. It was also unclear from the records that consideration had been given to the cultural, ethnicity and religious needs of some individuals within the scope of providing support. Choices for daily routines were not recorded in great depth, for those less able to speak out, staff should be given greater information about how they wish to live their daily lives. From what was identified from discussion with some relatives, on behalf of a resident, that the choices about daily routines for one person, are strongly influenced by the companion they share a room with. However, when reviewed their care plans did indicate that although some thought had been implemented by the staff to reduce the impact of this on one resident, further action had not been taken. In the ten surveys returned from residents or their representatives at least five noted that they or their relative did not partake in meals in the home because of their medical needs. Of the six others there was a very varied response. Three stated that they always enjoyed the meals on offer, one usually, one sometimes, and one never. Care Homes for Older People Page 18 of 33 Evidence: An additional comment made was, Little variety, very similar in taste, meals not hot. Tea and coffee service in cups and not hot. Tea not served in a pot. The home provides its menus through using an assessment tool, called Nutmeg, as to ensure that the chosen meal plans are balanced. Personal choices are noted about meal preferences and dietary needs on admission. Residents are asked on a daily basis in regard to their choices of meals provided on the day. From observation of the midday mealtime during the inspection, staff are divided up into providing support in the main dining room area and to those who need assistance in their rooms. What was seen was that there were a high number of residents who do not partake of the meals as they obtain their nutritional support through a PEG (Percutaneous Endoscopic Gastronomy) tube. However, a number of these residents were unfairly placed in near proximity of others who were eating normally. Perhaps a more sensitive approach to providing an alternative occupation whilst mealtimes are occurring could be implemented. The dining room is spacious and provides residents the opportunity to sit in small groups to have their meals. From information given, residents are encouraged to attend the midday meal in the central dining room, but supported to have their breakfasts and evening meals where they wish. Care Homes for Older People Page 19 of 33 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 has the processes in place to listen, respond and take action to any complaints made about the service. They have also provided staff with the information and training to ensure that they have the necessary knowledge to recognise and respond to any concerns of possible abuse or harm that may arise. Evidence: To the question if the resident knew who to speak to if they were unhappy, the majority of the respondents stated that they did. One person did add, I do not feel that I have a relationship with anyone. My key worker cannot understand me. This was the same person who indicated that they felt that their cultural and ethnicity needs were not being met. Another put, I have a key worker, you can always talk with her, also any of the staff. One relative put, My mother-in-law is improving so much in the care of this home that she has no difficulty in expressing her opinion, which are nearly always positive, small niggles are soon remedied. All, but one person indicated in the surveys that they felt that they knew who to make a complaint to. Care Homes for Older People Page 20 of 33 Evidence: The records for the management of complaints were reviewed. From information given in the Annual Quality Assurance Assessment, the service has been in receipt of ten complaints since the last inspection process. A further complaint, was found to have been received, during the interim period since the completion of this and the inspection visit. The majority of these complaints had been dealt with effectively within the organisations own complaints policy and procedures. The commission and local authority had been made aware of a small number of these concerns, as complainants were dissatisfied with the homes management or staffs responses to concerns. The commission has been made aware that there have been two safeguarding referrals made to the local authority during the last twelve months. From information given the home has responded appropriately and managed and enabled any investigations to be carried out, and have instigated actions when required. No referrals of staff to the Protection of Vulnerable Adults List have been made. The home has the necessary policies and procedures in place for safeguarding the residents from abuse and whistle-blowing. The Area Manager provided information about the training that staff are provided with in regard to protection of vulnerable adults. Of the thirty-one staff employed, twenty-one had attended training for this during the last twelve months. Of the ten others who had not received training at the time of the inspection, at least two had not completed their induction programme. Care Homes for Older People Page 21 of 33 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. The health, privacy and dignity of those who share bedroom accommodation is compromised by some of the facilities and sizes of the rooms used for this purpose. There are areas of practices for control of infection that could put residents at risk. Evidence: The home was purpose built and from a general review is kept to a reasonably good standard in both the communal and private spaces. However, a small number of concerns have been raised during the last twelve months about some parts of the home, mainly in regard to some of the personal bathroom facilities and shared accommodation. Concerns have also been expressed to the commission during this period about some of the control of infection practices in regard to managing the cleaning and sterilization of bed and commode pans and urinals used in the home. All these comments have been expressed by visiting health and social care professionals. Residents and relatives expressed that they thought the home was kept clean and fresh. Comments made were: I am impressed with the cleanliness. Care Homes for Older People Page 22 of 33 Evidence: There are unpleasant smells in the environment for example in the bedroom and lounge area. During my four week stay the main drain in the shower room did not function, floor flooded each time and the water did not drain away. Would like to see a high level of hygiene generally. Sometimes the bed catheter bag can be observed full or overflowing in the en suite. Carpeted floor seems to attract pieces of debris from medication packs. Swiftly remedied on drawing this situation to the attention of the staff. One health care professional commented, in information returned to the commission, that the shared rooms lacked privacy and compromised the dignity of the people living there. From what could be seen there is a general programme of renewal, refurbishment, and redecoration carried out. Residents are provided with four main areas of communal spaces to use. Included in these are two smaller quieter areas that can be used, one off the conservatory to the rear of the dining room, and a private lounge off the main lounge. Both give the opportunity for residents to sit comfortably in a more homely atmosphere. Of the thirty-eight bedrooms, ten are used for shared accommodation, two of which are in the Intermediate Unit. We looked at the shared accommodation specifically for one individual, whose relatives expressed their concerns about the space and facilities of the room to accommodate this. They were also concerned as previously identified, about the compatibility of the two residents as they had diverse personal preferences of how they like to live. We also reviewed some of the other shared accommodation as to see the quality of the facilities provided and that the individuals living there, privacy is protected. From what we could see and information given in the Statement of Purpose, only two double rooms provided larger spaces to accommodate two residents and gave sufficient spaces for a little privacy between beds. The majority of the others were equal if not less in size than some of the single bedroom accommodation. The layout of the beds in some of the rooms did not provide a comfortable atmosphere for the residents living in the rooms, as to do so was restricted by access and the use of equipment. The concerns about the facilities of the shared accommodation in the home and how Care Homes for Older People Page 23 of 33 Evidence: they impact upon the residents living there was discussed with the Area Manager who was present during part of the inspection process. A recommendation was made for a reassessment of the shared facilities to be carried out, with specific reference to ensuring that they meet the individuals needs, choices, and preferences. Of the sampled records for one individual, there did not appear to be an agreement by the individual or their representative to share. Again in the shared accommodation that was reviewed, insufficient care had been taken to provide separate facilities for keeping toiletries, toothbrushes, and towels separate. There is a process of monitoring and audit of the facilities of the home that should be carried out on a regular basis both internally and through the monthly visits by the provider. However, during this visit it was identified that these processes are not as effective as they should be as a number of deficits were found. These were generally about the storage of furniture in the bathrooms, facilities in the en suites, including some of the toilet seats being fit for purpose and the aids and equipment available for residents to use. The poor facilities and cleanliness seen at the last inspection process for one en suite in the Intermediate Unit, was rectified shortly afterwards. However, during this visit, the deputy manager confirmed that the problem had re-occurred and the facility was being completely refurbished and the room not utilised until this had been carried out. Some of the cleaning should be a little more robust as some of the flooring in en suites and the room designated for use by the hairdresser had not been cleaned after use. An area of concern was identified about the practices for safe management of the cleansing and sterilization of bed and commode pans in the home. The home has two sluice rooms, one on each floor, for the disposal of the contents of the items used and for a facility to clean them. Current good control of infection practices identify that the use of a mechanical disinfector can reduce the potential of cross infection in the home. A requirement was made for the home to seek appropriate professional advice as to ensure that they measures they currently have in place maximise the protection against infection spreading around the home. Care Homes for Older People Page 24 of 33 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 levels of staffing and their qualifications generally meet the current needs of the people living in the home. There are safe recruitment and employment practices carried out. Evidence: Information provided in the Annual Quality Assurance Assessment, showed that there had been some changes in the staff team since the last inspection process. This is in particular, most recently, with the registered manager leaving and the deputy manager appointed temporarily to take the lead in the management of the home. The Annual Quality Assurance Assessment, also identified that there was a very multicultural team of staff. This being so may have an effect on the communication in the home although none have been found during this inspection process. Copies of the last four weeks of rota were reviewed as to see if there are a sufficient number of qualified and skilled staff on duty at all times of the day to meet the needs of the people living in the home. From the rotas it could be seen that the numbers of staff on duty were variable. The home currently has a six registered nurses employed, including the deputy manager to cover the required needs of the service. During this period the rota identified that Care Homes for Older People Page 25 of 33 Evidence: between seven and eleven shifts were covered per week, by registered nurses provided by agencies and another home belonging to the organisation in the local vicinity. What could be seen was that there were regular agency staff employed, supporting that they had some knowledge of the people they cared for and the ethos of the home. A comment in a returned survey from at staff member stated that they thought what the home could do better, The service could do better if they hire enough carers or nurses so there will be a continuity of care from their key worker and the staff could give quality care to service users. The numbers of staff with an NVQ level 2 or above did show that there was over half of the care staff employed had attained this and seven had further extended their training to achieve a level 3. There was evidence that there is a planned programme of training given to staff, not only for the key topics of safe working practices but for additional areas for nutrition, pressure area care, medication and customer care. The recruitment and personnel records for three staff were reviewed to identify if the home continues to practice robust employment procedures as to protect residents from inappropriate staff supporting them. The records reviewed showed that generally safe practices are carried out and the required information is obtained. Better care could be taken to evidence the reason for not obtaining, for one member of staffs, a reference from their last employer. This omission would have been clearly noted and followed through if the recruitment checklist is used effectively. However, action was taken during the inspection, once identified, to seek the necessary information. Of the information seen, one referee pointed out that they had not been provided with a copy of the prospective staff members job description, which made it difficult to answer some of the questions given. The records supported that Criminal Records Bureau and Protection of Vulnerable Adults list checks are carried out before staff commence working in the home. There was evidence of induction programmes and some supervision meetings carried out. The sampled registered nurses employment records did show that the required checks with the Nursing and Midwifery Council had been carried out. Care Homes for Older People Page 26 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being managed well under the temporary management arrangements and generally in the best interests of the majority of the residents. Evidence: The registered manager left the service several weeks previous to the inspection visit and the deputy manager, a registered nurse, has stepped up to the role to provide the management of the home. She is supported by a senior team of management from the organisation who will continue to do so until a new manager is appointed to the role. General comments given in the surveys about the home and the management were: After four weeks at The Albany the family have always been made welcome, and the staff are very friendly and helpful. While my mother-in- law has only been in the home for less than one month, her Care Homes for Older People Page 27 of 33 Evidence: impressions are entirely positive and has declared herself happy and I have noticed a marked improvement in her mental state because of her relaxed comfortable surroundings. As the service users representative I am happy with the level of care given over the last three months she has been in the home. There is a recently appointed manager here who was very helpful, particularly at the beginning of my four week stay. Our impression is that she is struggling hard to achieve much better care and standards throughout. I am very well looked after and now I feel settled and happy. A comment given to the commission from a relative in a survey was, If you could address the smell issue in the environment and ensure more activities are in place. Another relative put, Overall one remains comfortable with the TLC given by the nursing and care staff involved, who invariably welcome visitors with cheerful greetings, and willingness to explain progress with the patient. One member of staff wrote about the temporary manager, Spends plenty of time with the residents and also with staff. The information in regard to the quality assurance practices, were reviewed. As previously noted some of the audits of the environment both within the home and the organisations own monthly visits had not identified the deficits in parts of the environment that do effect the outcomes for the people living there. They do though ensure that there are regular formal consultations carried out, through surveys, with residents, relatives, and others who come into contact with the home. Residents, relatives, and staff meetings are undertaken and reviews of care are carried out. The processes for handling any residents money were found to be in order during the last inspection process, therefore they were not looked at in detail during this inspection visit. The staff are provided with the necessary policies, procedures, and training for safe working practices. They are given an overview during their induction process, followed through with further training as and when required. Staff are also provided with a comprehensive staff handbook with summaries of the key policies, their responsibilities and employment information. Care Homes for Older People Page 28 of 33 Evidence: A recent incident identified that some staff were not abiding by the homes policy for safe moving and handling, even though trained, and strategies have now been put in place to improve practices. The routine checks for fire safety(Fire drills and equipment), the equipment( hoists and lift) and general running ( PAT and water safety) of the home are carried out as planned. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 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 26 13 The registered person 31/05/2009 should make suitable arrangements to prevent the spread of infection around the home. You should ensure that you seek professional advice and take the required action to ensure that there are the necessary facilities and practices in place for the control of infection around the home. You should ensure that the management and disinfection of the bed and commode pans and urinals meets the expected standards outlined in the Department of Health, Infection Control Guidance for Care Homes, best practice. Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 31 of 33 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 32 of 33 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. 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