Inspection on 01/12/09 for The Grove and The Courtyard

This inspection was carried out on 1st December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grove and The Courtyard 25/08/09

The Grove and The Courtyard 15/12/08

The Grove and The Courtyard 03/01/08

The Grove and The Courtyard 12/01/07

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Key inspection report Care homes for older people Name: Address: The Grove and The Courtyard 341 Marton Road Marton Middlesbrough TS4 2PH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jean Pegg     Date: 0 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Grove and The Courtyard 341 Marton Road Marton Middlesbrough TS4 2PH 01642819111 01642819103 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bramble Care Homes Ltd Name of registered manager (if applicable) Mrs Beverley Denise Grimes Type of registration: Number of places registered: care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 55 The registered person may provide the following category of service only: Care Home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Older Person Code OP 15, Mental Disorder Code MD 26, Dementia Code DE 19 - maximum number of places 55 Date of last inspection Brief description of the care home The Grove and The Courtyard is a purpose built care home providing care for three different client groups, within four separate units. Care Homes for Older People Page 4 of 30 Over 65 0 0 15 19 26 0 2 5 0 8 2 0 0 9 Brief description of the care home The Grove Suite incorporates a 15 bedded unit for older people. The Lodge provides 14 nursing beds for people with dementia. The Cleveland Suite provides 14 beds and The Courtyard 12 beds for younger adults with a mental disorder of a neurological cause. All rooms have ensuite facilities which include toilet and wash-hand basin and some rooms include a shower. The home is located centrally in Middlesbrough; it is on a busy main road, close to public transport, shops, public houses and churches. The weekly fees for The Grove and The Courtyard are: £420 for residential care and EMI nursing care up to £550 for private clients. Specialist residential fees are £541. Please contact the manager for more information about fees and what they include. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 unannounced visit to The Grove and The Courtyard took place on the 1st December 2009. Prior to the visits being carried out the home completed an Annual Quality Assurance Assessment (AQAA). Two inspectors carried out the site visit and a pharmacist from the Care Quality Commission (CQC) was in attendance. The inspection of the home included a tour of the building, a look at a sample of documents and records, which the home is required to keep, and discussions with people living and working at the home. Comments from which have been included throughout the body of the report. We also carried out a Short Observational Framework for Inspection (SOFI), which is a methodology we use to understand the quality of the experiences of people who use Care Homes for Older People Page 6 of 30 services who are unable to provide feedback due to their cognitive or communication impairments. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. It allows us to get an insight into the general state of well-being of individuals and staff interaction with people who use the service during the observation. In addition to the visit we also sent out surveys to people who live at the home, work at the home and who have professional contact with the home. We observed that people living in different units of the home had differing experiences and opportunities for stimulation. We will illustrate these differences within the report. A Random inspection was completed for this home on 25 August 2009. The requirements made following this inspection have been met. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Staff working on the older peoples units should be better trained and deployed to ensure that peoples needs are fully met. People should be encouraged to sign their care plans to show that they have read them and agreed with them. Care plans should clearly state if care staff or health staff are responsible for monitoring health care conditions of individual people living in the Care Homes for Older People Page 8 of 30 home. All medication must be given as prescribed and should be ordered in time so that people do not go without medication. Accurate records must be kept for all medicines including controlled drugs. On the older peoples units, consideration should be given to how staff can better support peoples dignity and independence at all times. More opportunities for stimulation should be offered on the older persons units. There is nothing going on here. Nothing to do. The choice and variety of food offered is poor. We were told Sometimes it is alright and sometimes it is not. It doesnt always look nice, they have a lot of things I dont like here. We dont get offered a biscuit or cake when we get drinks. More specialist training opportunities should be offered, in particular training related to mental health and dementia care. The annual survey could be improved by including the views of the people who live at the home and other social and health care professionals that have contact with the home. Accurate and up to date records must be kept, for example, records that should be maintained by the kitchen, financial records of people living in the home and records of incidents of difficult and challenging behaviour. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information about the home is available to help people decide if it is right for them. People have their needs assessed. Peoples experience of having their needs met differs between units. Evidence: Information about the home is available for people to help them decide if the home is right for them. We saw glossy brochures on display in the entrance area of the home. In our survey we asked people Did you receive enough information about the home to help you decide if this home was the right place for you, before you moved in? Of the eighteen people who responded, fourteen people said yes. We also asked people if they had been given written information about the homes terms and conditions (sometimes called a contract) five people said yes, six said no and three said that they did not know. We were shown copies of signed contracts that were held in the main office. All of the care files looked at during the inspection contained a pre-admission assessment to ensure that the home is able to meet the persons needs. The Care Homes for Older People Page 11 of 30 Evidence: assessments viewed were well written and provided clear person centered information which is then used to develop an individual care plan. We asked the two social and health care professionals that returned surveys to us. Do the care services assessment arrangements ensure that accurate information is gathered and that the right service is planned for people? One said usually and one said sometimes. We spent time observing practice and talking to people in both the older peoples units and younger adult units. In one of the younger adult units, we spoke to a care manager who was visiting the home following an incident. They told us that staff on the Cleveland Suite had been the best at managing a named individuals care. This person had had a number of previous placements. The care manager said that staff followed advice from the mental health team and followed the care plan to the letter. We also spoke to people on the Courtyard. One person told us that the staff understand people with a psychiatric illness. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individualised care plans are written for each service user. Health needs are met by health care professionals. Some improvements are needed in the management of medication. Some people are not supported in a dignified manner during meal times. Evidence: The care plans viewed on all units were well written, person centered and focused on peoples strengths and capabilities whilst respecting any areas of need that people may need support with. One younger adult told us They have sat down and gone through my care plan. On the older persons units, care plans were being reviewed regularly with input from the individual or their relatives where appropriate. Some care plans on the younger adult units needed to have signatures showing agreement with the content of the care plan. These signatures should be from either the individual concerned or their representative. In the main, risks which had been identified within assessments and care plans had Care Homes for Older People Page 13 of 30 Evidence: been recorded within risk assessments. On the dementia care unit, the management of difficult or challenging behaviour needs to be better recorded so that accurate records are maintained. There was clear evidence that input is sought from a range of health professionals where this is required. This included district nurses, dietitians, OTs. On the younger adult units, there was some confusion as to who was monitoring the blood sugar levels of an individual. For example care staff or the district nursing service. Roles and responsibilities for monitoring conditions must be clear within care plans to prevent any omissions occurring. This was discussed with the manager of the home. Nutritional screening is undertaken and weights are monitored. In our survey we asked people if they received the care and support they needed. Eleven people said always and three said usually. We also asked if the home made sure that people got the medical care they needed. Twelve people said always and one person said usually. One person told us Dont know, never needed it yet! In our survey. we also asked the social and health care professionals if peoples social and health care needs were properly monitored, reviewed and met by the care service. They both said usually. There is a good, detailed medicine policy in the home covering all aspects of medicines management. This means staff have access to up to date information on legal requirements and guidance. Monthly audits are completed but these need to be updated and a good record should be kept of action taken as a result. For most of the people living in the home that self-administer medication there were risk assessments and weekly reviews in place to make sure the person is able to safely administer their medication as intended. However some people who were selfadministering creams did not have the relevant risk assessment. There were good records kept of fridge and room temperature on all units. However there were some medicines with a limited use once open with no date of opening marked on the pack. The dividers between the MAR charts contained a good photograph and information on allergies and when required medication. This reduces the risk of medication being given to the wrong person. No significant gaps were found on the MAR charts indicating medicines are mostly given as intended. A small number of MAR charts had medication not given because Care Homes for Older People Page 14 of 30 Evidence: there was no stock available. It is important to make sure that the quantity of medication is regularly checked so that a prescription can be ordered in plenty of time to prevent people being without. There were some handwritten entries and changes made to medication which were incomplete. To make sure there is an accurate record the quantity supplied, the date of entry, the signature of the person making the entry and where possible a witness signature should be included. For change of dose or cancelled medication the date and the name of the person authorising changes to medication should also be recorded. The controlled drugs cupboard appears to meet regulations and all stock balanced with records. In our survey we asked people if the care staff and managers treat them well. All four of the people who given this question said always. The social and health care professionals who returned surveys to us said that the care service usually respected peoples privacy and dignity. During our visit, in general, we did not see or hear anyone being disrespectful to the people living at the home. On the dementia care unit we did witness some practices that might impact on the dignity of people. For example one staff member was trying to feed four service users at the same time. This does not demonstrate good practice in relation to dignity at meal times or enabling people to maintain independence. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people that live in the younger adults units experience a more stimulating lifestyle than those that reside on the older persons units. The quality and variety of food on offer in the home is poor. Evidence: When we looked around the younger adult units, there was evidence of different activities in place. Each person had a personalised activity timetable. One copy was kept on their file and one in their bedroom. This includes times when each person would be completing laundry and housework tasks. Notice boards in the units had programmes of activity displayed on them. We were told that activities tended to start at 11am due to the level of assistance needed with personal care tasks. A list of activities was also available in the older persons units. The home records all activities which have been carried out. On the day of the inspection the activities coordinator was taking pictures of people which were going to be used to make Christmas cards. Comments from people included, Theres nothing going on here, nothing to do. I like reading and staff do come in and talk to me, They take you to the shop, if you want something and I dont bother with activities, I like to watch TV. Care Homes for Older People Page 16 of 30 Evidence: People in the younger adult units also take part in holidays, the most recent being to Edinburgh in September. We were told that training sessions are being provided to service users on the younger adult units and that the topics are decided at the monthly community meetings. The training is aimed at helping some service users gain voluntary employment. For example health and safety related training. One younger adult told us that they were doing voluntary gardening work for an organisation. Other service users attend college to do information technology training. A computer is available on the unit to help them with this. Although the home has a minibus, we were told that trips out were limited by the fact that only two staff members are able to drive the bus. A lot of people who returned surveys to us said that they would like more trips out. We observed a number of visitors to the units during our visit. We were told We get visitors sometimes, now and again. I get visitors daily. The social and health care professionals that completed surveys for us made the following comments about activities. They could provide an increase in social activities on the nursing and residential unit, enabling service users access to outside resources. and Very impressed with the daily structure on the Courtyard. Service users are encouraged to express (views) and get involved with daily planning re activities. Staff ensure the clients have a say towards maintaining their independence. In the Annual Quality Assurance Assessment, the manager has written that they continue to work with the individuals to identify dreams and aspirations, incorporating the information into lifestyle plans. One younger adult we spoke to said that staff are always there to help. I have learned to be more independent. If you say you cant do something, they say try.... People on the older persons unit were asked if they were supported to make decisions and choices, comments in response include, I choose to get up early and go to bed early, I have a choice about where I eat my lunch and what I want to eat and We are not allowed to sit in the large lounge in the nursing unit anymore, although we still go through to that unit to eat our lunch. We observed lunch being served in both the older people and younger adult units. We were disappointed with what we saw. The menu showed that there should have been liver and onions or pork chops on offer for lunch. Liver and onions had been prepared but there were no pork chops on offer. Instead the alternative was burger and chips or Care Homes for Older People Page 17 of 30 Evidence: sausage and chips. We looked in the kitchen store cupboards, fridges and freezers. We did not find any fresh fruit or vegetables in store neither did we see any out in the units. We saw some frozen vegetables and a small number of tinned spaghetti and tomatoes. We discussed our concerns with the manager who promised that more fresh fruit and vegetables would be made available the next day. The comments that we received about food were mixed but were in the main negative. For example we read in the minutes of the community meetings held that the younger adults had asked for more fresh fruit and smoothies to be provided. Only half of the people who returned surveys to us said that they liked the food. People that we spoke to said the following Food is OK but seems to be going down hill. Less portion wise and sometimes not enough. Biscuits are not always available and sometimes there is no juice. and Sometimes it is alright and sometimes it is not. It doesnt always look nice, they have a lot of things I dont like here. We dont get offered a biscuit or cake when we get drinks. Get plenty to drink. I have my own . Get a cup of tea when we get up and again mid morning then in afternoon if staff not busy. In the younger adults units people were able to choose where and when they wanted to eat. However, in the dementia care units we noticed that there was no menu displayed, some food was served onto plates but not given out immediately, increasing the risk of cold food being served. Two people did not get their dinner because they were asleep and some sat with their dinner in front of them for long periods of time, again increasing the risk of cold food. The dining experience differed on both units, but the quality of food and choice offered was the same. We spoke to the manager about our observations and concerns. Within forty eight hours we had been provided with an action plan that addressed issues of food and the dining experience. It is expected that the results of this action plan will be seen during the next inspection visit. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are responded to and allegations and concerns about the home are investigated and lessons are learned. Evidence: We looked at the complaints file and saw that since January 2009 there have been eight recorded complaints. Each complaint had been responded to. We asked service users if they knew how to make a complaint. Twelve said Yes and two said No Since the last inspection visit the Care Quality Commission have received two expressions of concern about the home. Both of these concerns were referred to the local authority adult protection team. The management of the home assisted with the investigations into the concerns and implemented action plans in response to the findings. The Care Quality Commission also completed a random inspection visit in August 2009 to inspect around some of the areas raised in one of the concerns. The requirements and recommendations made following this visit have all been met by the home. We were told that a new company trainer has been appointed and that they would be carrying out safeguarding training for staff within the home. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained and free from unpleasant odours. Evidence: We looked around the building and found that it was in a good state of repair. The home comprises of four individual units called The Grove and The Lodge (Older persons units including dementia nursing care) and The Cleveland Suite and The Courtyard (both younger adults with mental health problems.) The home was generally clean and the younger adult units were free from offensive odours. There was evidence of personal possessions in individual bedrooms. The older persons units had pictorial signage to make finding toilets etc easier for people. The Environmental Health Officer visited in April 2009 and the Fire Officer visited in October 2009. When we checked the records of temperatures that should be maintained by the kitchen staff we found that they were incomplete. This may be in breach of food hygiene regulations and our concerns were passed onto the manager for her to action. We looked at the laundry facilities and kitchen facilities. The laundry had suitable equipment in place to ensure that linen and clothing could be washed at the correct temperatures to reduce the risk of infection. The Annual Quality Assurance Assessment indicated that thirty two staff had received training in infection control and that the home had an action plan to deliver best practice in the prevention and control of infection. Care Homes for Older People Page 20 of 30 Evidence: The people who live at the home told us that the home was always fresh and clean. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs staff in sufficient numbers but needs to consider the deployment of staff to meet individual needs. Opportunities for training need to improve and better records of training maintained. Recruitment records are well maintained. Evidence: The home employs qualified nursing staff that work in the dementia unit, care staff that work in the older persons unit and younger adult units and support staff that work throughout the home. For example kitchen staff, domestic, maintenance and administrative staff. Staffing levels on the both younger adults units were identical in that there were four staff on duty until 4pm, three staff from 4pm until 8pm and two staff on night duty. The maximum number of service users on an individual unit is 14. During our visit, there were generally sufficient staff around to provide support to people. In our survey we asked people are the staff available when you need them? eleven said always two said usually and one said sometimes. One of the social and health care professionals that returned surveys to us said that more staff were needed so that when district nurses visit, if lunchtime or medication rounds etc, there is someone available to go with the nurse, as they need to be escorted. The action plan sent to us by the manager addressed this issue through a different arrangement for the deployment of staff. Only ten of the forty nine care staff employed in the home have completed their Care Homes for Older People Page 22 of 30 Evidence: National Vocational Qualification in Care at level two or above. We looked at ten staff files. In the main, recruitment records were well maintained and contained all of the required information. For example, application forms, references and criminal record bureau checks. We were told that ten staff have completed the Skills for Care Induction Training. We spoke to a member of staff who told us that they had received an intense induction where they were introduced to everyone, looked at care plans and given peg feed training at the local hospital. They also told us that they had been observed completing tasks on ten occasions before being left to work alone. We looked at the training matrix that records staff training in the home. The matrix showed what training had taken place but the record was incomplete in that it did not show records of any fire drills that had taken place, neither did it show any records of specialist training for example Mental Health or Dementia Care related training. We were told that a new company trainer had been appointed. We would expect to see an improvement in the variety of training offered and the records of training kept during our next visit. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance systems within the home do not take account of all stakeholder views. Some records maintained by the home were inaccurate. Generally maintenance records were good and staff receive supervision. The management are responsive to criticism. Evidence: The home has a qualified and experienced manager who is registered with the Care Quality Commission. Concerns raised with the manager during this inspection have been voluntarily responded to within forty eight hours of the visit. The Annual Quality Assurance Assessment document indicated that they would continue to carry out a quality audit to identify how they are perceived by their customers. When we asked to see the results, only three relatives had returned surveys in November 2009. We were shown evidence of previous completed relative surveys, but these were not dated. We talked about extending the survey beyond relatives to gain a wider perspective of views about the home. Staff meetings take Care Homes for Older People Page 24 of 30 Evidence: place and a comments box was available in the entrance hall. The younger adults have a joint community meeting. We were shown copies of the minutes of these meetings. Regulation 26 reports are completed by the area manager. We were shown a copy of the September report that the home had a copy of. We checked seven records of money held on behalf of people who live at the home. Five of the seven were incorrect. We were told that a full audit of monies held on behalf of people would be completed the next day. We saw evidence that staff working in the home receive regular supervision. The home has copies of the regulation 37 notifications that it sends to the Care Quality Commission when significant events occur. As stated earlier records to record any incidents of difficult or challenging behaviour must be kept up to date. Staff must receive clear guidance and training to deal with this. We looked at a sample of the maintenance checks and service contracts and found that the majority were completed and in date. As stated earlier, records that should be maintained for the kitchen were incomplete. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Care plans must clearly identified the roles and responsibilities of professionals involved in monitoring individual health conditions. This will ensure that monitoring tasks are completed when necessary and individual service users do not run the risk of not having their needs met. 31/12/2009 2 9 13 All medication must be administered as prescribed and be available to administer from. Accurate records must be kept for all medicines including controlled drugs. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. 31/12/2009 Care Homes for Older People Page 27 of 30 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 3 37 17 Records used to record any incidents of difficult or challenging behaviour must be kept up to date. Staff must receive clear guidance and training to deal with this. This will ensure that an accurate record of a persons behaviour and wellbeing is maintained. 28/02/2010 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 4 Staff working on the older peoples units should be better trained and deployed to ensure that peoples needs are fully met. Care plans should be agreed and signed by either the individual concerned or their representative. Handwritten entries and changes to MAR charts must be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. To maintain the dignity of service users at mealtimes, staff should only assist one person at a time. The manager should continue to monitor the implementation of the homes action plan in relation to the quality and variety of food offered within the home. The manager should monitor the implementation of the homes action plan in relation to improving the dining experience including table settings. The manager should monitor the implementation of the homes action plan in relation to the use of menus both Page 28 of 30 2 3 7 9 4 5 10 15 6 15 7 15 Care Homes for Older People 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 written and pictorial. 8 19 Accurate records of food temperatures and fridge and freezer temperatures should be maintained in accordance with Safer Food Better Business Guidelines. Staff should be encouraged to complete their National Vocational Qualification in Care at level two or above. More specialist trainig should be provided for staff working with people with mental health problems and dementia. Accurate records of staff training should be maintained. Annual surveys should include all stakeholders. For example, service users, relatives and other social and health care professionals that know the service. Accurate records of money held on behalf of people who live at the home should be kept. 9 10 11 12 28 30 30 33 13 35 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 30 of 30 - 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!