Inspection on 21/05/09 for The Grove

This inspection was carried out on 21st May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grove 28/05/08

The Grove 19/06/07

The Grove 17/10/06

The Grove 14/02/06

The Grove 19/07/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Grove 181 Charlestown Road St. Austell Cornwall PL25 3NP     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: Diana Penrose     Date: 2 2 0 5 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: The Grove 181 Charlestown Road St. Austell Cornwall PL25 3NP 0172676481 0172667457 thegrove@fastmail.com 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) : Venetian Healthcare Ltd care home 38 Number of places (if applicable): Under 65 Over 65 38 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 38. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Grove is a care home registered to provide care and accommodation for up to thirty-eight people who have care needs within the categories of Old Age, not falling within any other category (38), and either gender. The Grove is not registered to provide intermediate care or nursing care. It does not have the specialist categories to provide care for people with significant dementia or mental frailty needs. The Grove also offers respite care for older people to have a short break, and day care for local older people The Grove is situated within its own grounds, on the main road into Charlestown. It is a large home that has been successfully modified over the years to provide residential care. It has recently undergone a major refurbishment to extend and improvement the facilities, offering an increase in the number of people who can Care Homes for Older People Page 4 of 32 Brief description of the care home be accommodated at the home. Some of the bedrooms have a sea view, a balcony or a patio. The majority of the bedrooms have an en-suite toilet and wash hand basin. Some have an en-suite bathroom. There is a shaft lift and stairs to access the bedrooms on the first floor. The home has a large garden that the people using this service can use. Car parking is available in the grounds of the home. The current scale of residential fees is #350.00 to #640.00 depending on assessment of care needs, room size, facilities and location within the home. These fees do not include hairdressing, chiropodist, telephone, newspapers and magazines, toiletries and personal sundries. Information about additional charges is available in the Service User?s Guide (brochure) provided by the home. This information was given to the Commission for Social Care Inspection (CSCI) in May 2008. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An Inspector visited The Grove Care Home on 21 and 22 May 2009 and spent twelve hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that peoples needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that placements in the home result in good outcomes for people. All of the key standards were inspected. On the day of inspection thirty four people were living in the home, five of these were receiving respite care and one was attending for day care. The methods used to undertake the inspection were to meet with people using the service, staff, visitors and management to gain their views on the services offered by the home. Records, policies Care Homes for Older People Page 6 of 32 and procedures were examined and the inspector toured the building. The manager has returned a completed Annual Quality Assurance Assessment, which has informed this inspection. Also CQC surveys have been returned in respect of 1 member of staff and 1 health professional, these have also informed this inspection. This report summarises the findings of this key inspection. The people using this service expressed satisfaction with the care and services provided at the home and said they were treated with kindness and respect by the staff, manager and owners of the home. Feedback was given to the management team throughout this inspection and issues were discussed. What the care home does well: What has improved since the last inspection? This was the Inspectors first visit to the home so has only been able to compare her findings with the last report. Everyone spoken with said there have been a great deal of changes since the new manager has been at the home and they were complimntary about this. The manager Care Homes for Older People Page 8 of 32 said she has been reviewing the systems in place and has recruited a good team of staff. The requirements issued at the last inspection have been met although two references have not always been received prior to employment and this has been discussed during this inspection. Life histories are being compiled for each resident which gives further information for staff to relate to the people they care for. The manager has reviewed and updated the care plans although further work is required. She has also changed the format for the pre assessment recording. All of the homes policies are being reviewed and updated. Staff information has been collated and is now held in one place. NVQ training is taking place for all staff not just the care assistants. The managers now have a separate office to the administrator that allows for privacy and confidentiality. A variety of meetings now take place with minutes maintained. Further re-decoration and refurbishment has taken place. What they could do better: Care plans could be written in more detail to clearly inform and direct staff. They should specify what the person is able to do for themselves and the actions to be taken by staff. Any risk assessments undertaken should be included in the care planning as well as specific information regarding medicines, for example those administered as required and any that the resident administers themselves. The daily records could contain more detail as well to inform staff of the day and night events. The storage of controlled medicines does not comply with current legislation. The purchase and fixture of a cupboard that complies with legislation is required and the detail was discussed with the manager who began to address this straight away. The medicines policy requires updating to include reference to the Handling of Medicines in Social Care document which the manager said staff adhere to. The document was not available to staff on the day of inspection. There needs to be evidence that people administering their own medicines have been risk assessed with the level of support required from care staff documented and that reviews are undertaken regularly. Formal medicines training needs to be introduced for care staff during their induction period and the manager said she would do this. Care Homes for Older People Page 9 of 32 There has been a very high turnover of staff in the past year which the manager said has been for various reasons. She was reminded that the Commission should be informed if staff are disciplined or dismissed as there maybe issues that are detrimental to the welfare and safety of people using the service. The manager should ensure equal opportunities in the recruitment, vetting and selection of staff. Two appropriate references should be received prior to employment and any convictions recorded on CRB disclosures should be investigated with a record maintained to evidence this. The manager must ensure that people responsible for training staff in the home are suitably qualified to do so and are up to date with their own training. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 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 32 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. Appropriate information is given to prospective residents enabling them to make an informed choice as to where to live. People are only admitted to the home following an assessment of their needs to ensure the home can provide suitable care. Evidence: We were shown a combined statement of purpose and service user guide which provides good information about the home. It needs some minor updating and this was discussed with the manager. The manager said she is hoping to provide a version in large print and in future on audiotape. She also stated that a copy is given to all prospective service users to help them decide if the home is suitable for them. The Grove also has a website that provides information and photographs of the home and grounds www.grove-charlestown.co.uk The manager said that two members of the care team visit prospective residents to Care Homes for Older People Page 12 of 32 Evidence: undertake a full assessment of needs. If the person is out of the county the assessment may be undertaken by telephone. Recent assessments were seen for two people using the service and were written on specific forms; they were dated and signed by the person completing them and the resident or their representative. The information was detailed and used to inform the initial care plan, along with information from the department of adult social care and hospital staff if applicable. Care Homes for Older People Page 13 of 32 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. Each person using the service has a written care plan but more detailed information is required to fully direct staff and ensure that healthcare needs are met. There is an appropriate system for the use of medicines, more attention to records and specific care planning would provide further safeguards for people using the service. Evidence: We were told that each person using the service has a written care plan compiled within four weeks of admission. The assessment documentation is used along with the daily records, to inform staff, until such times as the full care plan is complete. Some people spoken with were aware of their care plans others knew that staff had a lot of paperwork but did not know about care plans. Life histories are being compiled for residents and the activities coordinator said she is assisting with this. Four care files were inspected during this visit. The care plans cover health, personal care, social and religious needs and some risk assessments are included. Some have been signed by the resident or their representative and they are reviewed on a monthly basis. The Care Homes for Older People Page 14 of 32 Evidence: plans need to contain more detail to fully inform staff on the specific care to be provided and this was discussed with the management team who agreed to address it. The daily care records are written by the care staff and are variable in content. People using the service said the care they receive is very good and their needs are met. One person said she has the best of everything. People spoken with said their health needs are met very well and they have access to their GP and other health professionals when required. The manager said that links with specialist healthcare professionals is good. There is appropriate moving and handling and pressure relieving equipment in the home and no residents have pressure sores. Care practice was observed to be appropriate during this inspection and carried out in a calm, efficient manner. There is a policy and system in place for the use of medicines in the home, the policy requires updating to include reference to the Handling of Medicines in Social Care document which the manager said staff adhere to. The document was not available to staff on the day of inspection. The policy also needs to state the homes specific practice for the use of insulin, topical creams, oxygen and so on. A monitored dose system is used and works well. Some people are administering their own medicines. We were told that they have been risk assessed to do so and have signed a consent form. Consent forms were seen in the care files but it was not evident that comprehensive risk assessments are taking place and are reviewed regularly. The level of support and responsibility of the care worker should be written in the individuals care plan. It should include how to monitor whether the person continues to be able to self-administer their medicines without staff invading their privacy. Auditing and record keeping for those self administering was discussed with the management team. The storage of controlled medicines does not comply with current legislation. The purchase and fixture of a cupboard that complies with legislation is required and the detail was discussed with the manager who began to address this straight away. The storage of medicines requiring refrigeration is satisfactory with appropriate records maintained. It was noted that the room where medicines are stored gets very warm and could affect the efficacy of some medicines. An air conditioning unit was ordered for the room before the end of this inspection. Records are kept of all medicines entering and leaving the home. There were no gaps observed in the administration records. Two members of staff must always sign handwritten instructions on the charts and the manager said she would ensure this was done. Homely remedies are not in use at present and there is no approved list. For people prescribed to have medicines administered, when required, we found that Care Homes for Older People Page 15 of 32 Evidence: there were no care plans in place about the use of this medicine, or any directions on how to make an assessment if this medicine is required. The manager said this would be addressed. People with diabetes have little care planning for their management, information regarding blood glucose monitoring and insulin administration should be included, even when self administering. There are relevant reference books for staff and patient information leaflets are available for staff or residents to refer to. Care staff do not receive any formal medicines training on induction and this was discussed with the manager. Medicines training forms part of the NVQ course and staff administering medicines in the home have attended training in the safe handling of medicines. Peoples privacy was upheld during this inspection. People using the service said they are treated with respect and their privacy is upheld at all times. There is a policy for respecting peoples privacy and dignity and there is a section in the statement of purpose. Care Homes for Older People Page 16 of 32 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. A good range of activities are provided, links with family and friends are encouraged and people are helped to maintain their independence and live a life of their preference. Evidence: We spent time with one of the two activities co-ordinators and looked at the information and records maintained. We were told that organised activities take place every afternoon and some evenings, armchair exercises take place daily. The Salvation Army visited for a sing along on the evening of the first day of this inspection and the activities co-ordinator said they were surprised at the number of residents joining in, they ran out of hymn books. Other activities include art and crafts, Music for Health, clothing sales, singing, bingo DVDs, word games, quizzes, manicures and monthly Holy Communion. When the co-ordinators are not working we were told the care staff do activities and spend one to one time with residents. Posters were seen informing people of activities taking place, visiting entertainers and trips out. Records of attendance were seen along with some notes of peoples reactions. Attendance is very good but compliance with data protection when keeping records was discussed. A very informative newsletter was shown to us; this is produced every month and distributed Care Homes for Older People Page 17 of 32 Evidence: around the home. We were shown how it has improved over the years. People using the service said there is always something going on and that the activities and entertainment are very enjoyable. They spoke highly of the co-ordinators and said they feel fortunate to have such a good service. There is a record of visitors to the home and there were visitors in the home during this inspection. People said they could receive visitors in private and at any time. Visitors spoken with said they are always made welcome in the home and can call in when they like. People said they can choose when they get up and go to bed. They said they choose what clothes to wear and how they spend their day. They said they can stay in their room or go to the lounges. Everyone was suitably dressed in clean clothes. The bedrooms were homely and personalised with people s belongings and furniture. There is a four week menu and residents said other things are available if they do not want what is on the menu. The chef said special diets are catered for and at present include gluten free, vegetarian, diabetic and dairy free. Fresh vegetables and fruit are included each day. Snacks and drinks are available between meals. Everyone said the food is good and they have plenty to eat. The lunchtime meal was served in the dining room but people could eat in their bedroom if they preferred. The meal was unhurried and the setting is pleasant. The manager said that wine is served with the lunchtime meal if people would like it. Care Homes for Older People Page 18 of 32 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. There are suitable policies and processes in place for complaints and adult protection to ensure that people using the service are safeguarded. Evidence: There is a suitable complaints policy in the home and a method for recording complaints, the action taken and the outcome. Residents and relatives said they could approach the staff or manager if there was a problem. There have been four complaints to the home in the past year one of which was upheld. Concerns have been raised to the Commission, some anonymously, regarding care provision, individual choice, call system, equipment, staffing and recruitment. Some issues have been referred to the manager to deal with and some are being looked at during this inspection. Thank you letters and cards are kept in the home. The manager said that she and the staff have attended safeguarding adults training some of which is done through packs provided by a training company. She said all new staff receive some training regarding abuse during induction. There is a copy of the local inter-agency procedures in the home and the home has a suitable policy. There have been two safeguarding referrals to the Department of Adult Social Care and one Care Homes for Older People Page 19 of 32 Evidence: is currently being investigated. Care Homes for Older People Page 20 of 32 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. The home is clean, well maintained, decorated and furnished to a good standard, there are no unpleasant odours, making it a pleasant place to live and work in. Evidence: The inspector toured the building and found the home to be home warm, homely, comfortable and clean with no offensive odours. The sun lounge seems to be utilised by most people but there is another comfortable lounge that they can also use. There is a room designated for hairdressing, it is also used for manicures and visits by the chiropodist. The grounds are extensive and well maintained. There are dove cotes and manager said there are guinea fowl roaming around. The garden is accessible to people using the service and has hand rails and ramps to make it easier and safer for them to walk around. The bedrooms are personalised with peoples belongings and some people have their own furniture. Most people have their own television in their room. All the bedrooms have a lockable box fixed into a drawer so people have somewhere safe to keep valuable items. Telephone lines can be installed in bedrooms if people so wish and the bills are sent directly to the them. Specialist equipment was seen available for those Care Homes for Older People Page 21 of 32 Evidence: who require it. There are call bells in all rooms and some people have been assessed to use a pendant system. This is a small pendant worn around their neck so they can call staff from anywhere in the home or grounds. The kitchen is a very good size with a separate preparation kitchen. There is ample storage space for food and equipment. Provision for staff is good, with a large staff room and individual lockers for safe storage of personal belongings. The laundry is large with two industrial washing machines and a tumble dryer. The laundry staff are responsible for all personal clothing, sheets and bedding. People have a choice about duvets or sheets and blankets on their bed and they can bring in their own bedding if they prefer. Laundry is collected daily and the laundry holds named baskets for each person for clean and ironed items to be returned. People spoken with said the laundry service is very good and items rarely go missing. Protective clothing is supplied for staff and they were seen wearing aprons and gloves. Hand washing facilities for staff are suitable and there are relevant policies in place for infection control. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable staffing levels for the number of residents and evidence that staff hold NVQ qualifications and attend regular training to enhance their knowledge and skills, enabling them to provide a good service to residents. Recruitment of staff does not evidence equal opportunities and processes need to be more robust to ensure that people using the service are safeguarded. Evidence: The staffing rota showed that generally there are five care staff in the mornings, four in the afternoons and evenings and two at night. We were told that sometimes an extra carer comes in from 17.00-22.00 to help the night staff. Some of the care staff are senior carers and there is a care co-ordinator who works daytime shifts. There is a manager, a deputy manager and an operations manager as well. People are employed to organise activities and there are administration, catering, domestic, laundry, maintenance and gardening staff employed. The cooks are employed to work all day so care staff do not have to prepare meals. Generally everyone spoken with thought there were enough staff and everyone said the staff are very kind and caring. 83 of care staff are qualified to at least NVQ level 2 in care, with several holding a level 3 qualification and one with level 4. We were told that one of the senior care staff Care Homes for Older People Page 23 of 32 Evidence: also has a qualification in psychology. There has been a high turnover of staff in the past year and the manager said this has been for various reasons. She was reminded that the Commission should be informed if staff are disciplined or dismissed as there could be issues that may affect the welfare or safety of the residents. Twenty staff files were examined, eighteen of these were for people employed since the present manager has been in post. It is a concern that many of the posts were not advertised internally or externally and four had no job specification or job description to show the knowledge and skills required for the job. Some people had only one reference on file, some were written to whom it may concern and in some cases references were supplied by staff already working at The Grove. Several people did not have a reference on file from their previous employer and several references have been supplied by the same referees. Interview records are in most files and some people had more than one person doing the interview, however not all records are dated or signed and most lack detail. They do not show that gaps in previous employment have been investigated. Criminal Record and POVA first checks were seen and were dated prior to the date of employment recorded in the files. There is no evidence that criminal convictions recorded on CRB disclosures are investigated and risk assessed prior to a decision being made to employ the person. This was discussed with the manager who said she was aware of convictions on certain disclosures and had discussed them with the employees. She said she would ensure that a record is maintained in future. Sixteen files held a photograph of the employee. The filing system has improved since the last inspection with all employees information now held in individual files rather than in various places. The Skills For Care Induction programme has been introduced for new care staff and the booklet was seen. We were told that staff are also supervised during the induction period. Training files are held for each employee and hold copies of certificates of training attended. A training matrix was seen that detailed courses attended with the date. Statutory training apart from health and safety was up to date. A training company is used for some training with learning packs to work through and test papers that are sent to the company for assessment. Other training is provided in house or at external venues. Staff said there is plenty of training available to them. A member of staff said he had done a course in moving and handling with a previous employer that enabled him to teach the subject. There is no evidence in his file that this is a suitable qualification for training care home staff or that the employee has kept this up to date. This was discussed with the manager who agreed to investigate Care Homes for Older People Page 24 of 32 Evidence: this. Care Homes for Older People Page 25 of 32 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 manager has shown competence in running the home but needs to ensure that areas such as recruitment of staff respect equality and that checks are robust to safeguard people using the service. An appropriate system is in place for managing peoples monies but needs to be reflected in the homes policy to ensure staff are informed and directed correctly. Systems are being developed to monitor and improve the service for residents and staff and safety checks are undertaken to ensure the health, safety and welfare of residents, staff and visitors. Evidence: The manager of the home has been in post since May 2008 and is in the process of registering with the Care Quality Commission. She has achieved NVQ qualifications in care at levels 2, 3 and 4. She has also achieved the Registered Managers Award. She said she attends courses applicable to her role and also uses the internet and care magazines to keep up to date. She has made a significant amount of changes at the home since she has been employed and both residents and staff said she is a good Care Homes for Older People Page 26 of 32 Evidence: manager. One person said she leads the team well and is not afraid to put things right. The manager appears to have made some significant improvements over the past year and generally manages the home well. She must however ensure that the recruitment of staff respects equality and illustrate that the selection process is fair and open. Recruitment checks must be thorough, any convictions must be investigated and two appropriate references obtained prior to employment of staff. See the previous section of this report. There are some quality assurance systems in place to monitor and improve the service. Questionnaires were seen that had been completed by residents and their relatives. They were positive about the home and the service provided. The manager said she intends to set up an auditing system, at the moment only the medicines are formally audited. Various meetings take place on a regular basis, these include staff meetings, head of department meetings and residents meetings. Minutes are held and show that people can air their views. One of the registered providers visits each month to inspect the home and writes a report in compliance with Regulation 26 of the Care Homes Regulations 2001. The manager has completed an Annual Quality Assurance Assessment (AQAA) and returned it to the Commission within the allotted timescale. We were told that people can choose to manage their own finances or their representative can do this on their behalf. The administrator also holds small amounts of money for some people in a safe so they can access this for personal spending. Four people can access the safe and out of hours would need to be contacted. Written records were seen for all transactions and the accounts were periodically checked and countersigned. Receipts were seen for purchases; the numbering of these was discussed to make auditing easier. There is a policy for the management of residents monies but it needs to be updated and state what the home actually does and how people can access their money in the evenings and weekends if they so wish. This was discussed with the manager and the administrator who said they would address this. The management said they endeavour to ensure that working practices are safe. Relevant service checks take place and certificates were seen, the AQAA also lists the dates of the most recent checks. The PAT testing for small appliances was due to be done. The records show that staff receive statutory training regularly and kitchen staff have all received food hygiene training. The environmental health officers report was seen, dated 05/02/09 and an upgrade of the breakfast units was recommended. We were told this is being dealt with. Accident reporting complies with data protection, there were ten accidents reported for April 2009. The fire safety log and training record was up to date. The fire and health and safety risk assessments have been completed. The cupboard for storing hazardous substances was locked. Information Care Homes for Older People Page 27 of 32 Evidence: about using these products was available for staff to refer to when needed. The water temperature in the home is thermostatically controlled and Legionella testing has taken place. Incidents that affect the health, safety and/or well being of people using this service are reported to the Commission as required by Regulation 37 of the Care Homes Regulations 2001. The manager said that the home s policies and procedures are all being reviewed and updated. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15(1) Unless it is impracticable to 30/09/2008 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user?s needs in respect of his health and welfare are to be met. This requirement is outstanding from the last inspection (Due by 31/08/07) All medicines must be stored 30/08/2008 in accordance with the current storage regulations to prevent unauthorised access so potentially leading to non-availability of medicines for people in the home. This includes any medicines that require refrigeration. These must be dated when opened and disposed of if the recommended opening time expires before the medicine is finished. The registered person shall 30/09/2008 make arrangements, by training staff or by other measures, to prevent service users being harmed or Page 29 of 32 2 9 13(2) 3 18 13(6) Care Homes for Older People suffering abuse or being placed at risk of harm or abuse. This requirement is outstanding from the last inspection (Due by 31/08/07) 4 29 Sch. 2 The registered person must 30/09/2008 ensure that all relevant and necessary employment checks, including criminal records bureau checks, two written references and dates of employment, are I place prior to appointing new staff. This was a recommendation at the last inspection The Registered Person shall 30/09/2008 establish and maintain a quality assurance system that will identify shortfalls in meeting the Regulations and establish the residents? level of satisfaction with the care services they receive in the home. This must also be extended to all visitors to the home including health and social care professionals, to establish their level of satisfaction with the care services being provided in the home. The results of all the surveys undertaken must be published and available to prospective residents and the CSCI. 5 33 12Sch1 (10) Care Homes for Older People Page 30 of 32 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 9 13 The storage of controlled medicines must comply with current legislation To ensure safe storage that complies with the law. 21/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should be more detailed to fully inform and direct the care staff on how individualised care is to be provided. Care Homes for Older People Page 31 of 32 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!