Inspection on 28/05/09 for The Homestead

This inspection was carried out on 28th May 2009.

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

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

Other inspections for this house

The Homestead 15/05/07

The Homestead 26/10/06

The Homestead 15/05/06

The Homestead 09/03/06

The Homestead 27/10/05

The Homestead 18/03/05

The Homestead 27/09/04

The Homestead 30/03/04

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 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Homestead 101 West Bay Road Bridport Dorset DT6 4AY     The quality rating for this care home is:   zero star poor 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: Susan Hale     Date: 2 8 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 30 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 30 Information about the care home Name of care home: Address: The Homestead 101 West Bay Road Bridport Dorset DT6 4AY 01308423338 01308423338 adrianbutler@hstead.eclipse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Susan Patricia Butler,Mr Adrian Charles Winslow Butler care home 13 Number of places (if applicable): Under 65 Over 65 13 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 The Homestead residential care home is registered to provide care and accommodation to a maximum of 13 older people over the age of 65 years. The home is owned and managed by Susan and Adrian Butler. The Homestead is situated halfway between the Market town of Bridport and the seaside resort of West Bay, approximately 1 mile from both places. The accommodation for residents is arranged over two floors.There is no passenger lift and therefore the home mainly accommodates people who retain sufficient mobility to manage stairs and/or manage to use the stair-lift. There are 11 single and one double bedroom. The Homestead is a pre-existing home (prior to implementation of National Minimum Standards) with 7 bedrooms providing space above 10 square metres and 5 with less than 10 square metres. There are bathing and toilet facilities on both floors and 4 single and the 1 double room have en suite toilet facilities. Communal rooms comprise a ground floor lounge and dining room. The home has a sunny and attractive sensory garden to the front, with pleasant areas to sit, which is well used by residents in the warmer weather. The rear garden is steeply Care Homes for Older People Page 4 of 30 Brief description of the care home sloped, set to lawn with a vegetable patch, which is not used by residents due to inaccessibility. A parking area is available for visitors at the front of the house.The current fees range from 323 pounds to 500 pound. Additional charges are made for hairdressing and chiropody. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). 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: zero star poor 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: The inspection was undertaken by one inspector over the course of one day in May 2009. Twelve people were living in the home on the day of the visit. The focus of the inspection was to look at relevant key standards which focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good, adequate and poor. The judgement descriptors in the seven sections are given in the individual outcome groups and these are collated to give an overall rating for the quality of the service provided. Surveys were sent out to health care professionals, staff and residents. Responses were received from eight staff, six professionals and three residents. The responses Care Homes for Older People Page 6 of 30 have been collated and are incorporated into this report. The home completed an annual quality assurance assessment (AQAA) and information provided in that is also referred to in this report. We looked at four care files in detail, the staff files of three members of staff, undertook a tour of the building and looked at all the documentation relevant to the running of the care home. The inspector spoke to , Mrs Butler, two members of staff and six residents. What the care home does well: The home has a website which gives information about the services provided for prospective residents and their families. People are encouraged to view the home and spent time there before making a decision about residency. Robust pre admission assessments are in place to make sure that peoples needs are assessed and the home is clear that they can be met before they move in. All residents have a detailed, person centred care plan that is tailored to their individual needs and gives clear instructions and guidance to staff on how such needs will be met. Residents are seen very much as individuals and Mrs Butler and the staff are aware of equal opportunities good practice and this is very much part of the culture of the home. A professional who visits the home commented that the care I have observed is genuinely given, heartfelt and of a very high standard. Another professional commented that The Homestead was a very good home. Appropriate risk assessments are in place to make sure that any risks are identified and measures put in place to reduce these. Residents have access to relevant health and medical professionals whenever necessary and the home has effective professional working relationships which make sure that residents receive prompt and effective health care. Aids and adaptations including pressure relieving equipment are provided whenever necessary. Medication practice is safe and makes sure that peoples health needs are met. People are treated with respect and their right to privacy and dignity an integral part of the culture and care practice at the home. The routines of the home are as flexible as possible and take into account residents choices and preferences to make sure that they have as much control as possible over their day to day routine. Residents are encouraged and supported to maintain contact with their friends and family and visitors are made welcome to the home and encouraged to visit on special occasions such as birthdays or social events. The meals served at the home are nutritious, well-balanced, home cooked and residents are very satisfied with the quality and variety of food served. Residents are offered the opportunity to make suggestions for inclusion in the menu. Policies and procedures are in place to make sure that people who live and work in the home can raise any concerns or complaints and be assured that they will be taken seriously and addressed. The Homestead provides a clean, tidy and homely environment that current residents are satisfied with and meets their expectations. Residents are encouraged to personalise their rooms to reflect their own lifestyle choices and preferences. Care Homes for Older People Page 8 of 30 The staffing levels at the home allow person centred care to be delivered in an unhurried way that meets the individual needs of each resident. There is a low turnover of staff which means that care provided is consistent and staff are familiar with individuals needs. All staff spoken to and surveyed were enthusiastic and positive about their work at The Homestead. One resident who completed a survey commented that the care at the Homestead could not be bettered. The accommodation and staff are first-class. Another resident commented that I receive very good care here and Im very happy. The training programme at the home is extensive and ongoing and staff are encouraged to take up opportunities that will benefit their career development and skills and provide positive outcomes for residents. The health and safety of the residents and staff are protected by policies and procedures. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –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. The home provides information for prospective residents and their families to enable them to make an informed decision about residency. People do not move into the home until their needs been assessed and it has been confirmed by the home that they can be met. Prospective residents are encouraged to visit the home so they can make an informed decision about residency. Evidence: The home has a web site which enables prospective residents and their families to obtain information and see photographs of the home before making an enquiry. Three people responded to our survey said that they received enough information before they moved into the home. Care Homes for Older People Page 11 of 30 Evidence: We looked at the care plans of two people who have moved into the home since last inspection. Robust pre admission assessments are undertaken before people move into the home and used to draw up a plan of care. The home encourages prospective residents and their families to visit The Homestead and spend time there before they make a decision about moving in. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care provided is person centred, flexible and able to meet the individual needs of people who live at The Homestead. Residents have access to all the relevant health and medical professionals whenever necessary and the home has close and effective relationships with external agencies. All the necessary aids and adaptations to improve residents health or quality of life are provided whenever necessary according to need. Appropriate risk assessments are in place to support peoples health needs and also to support individuals choices and preferences. Medication practice is safe and promotes residents health and well being. Residents rights to privacy and dignity are an integral part of the care practice at The Homestead. Care Homes for Older People Page 13 of 30 Evidence: We looked at four residents care plans. Care plans covered the recommended range of topics and any additional individual needs whenever necessary. They were person centred, detailed,tailored to the individual and contained clear guidance and instructions to staff on how individuals need should be met. Individuals personal and health care needs were recorded and it was clearly detailed how these will be delivered. Records showed that staff were aware of and respected peoples individuality and care plans were tailored accordingly. Care plans had been regularly reviewed and updated as necessary so that they were reflective of peoples current circumstances.Residents are involved in care planning and are asked whenever possible to sign their agreement to the way that care is delivered by staff. Appropriate risk assessments were in place in relation to nutrition, moving and handling and pressure sores and these have been regularly reviewed and updated when necessary. Additional risk assessments were in place in relation to the environment and individuals needs and circumstances. One member of staff commented that the home also involved service users families in their care as we get to know them very well as we are a small welcoming home. Another member of staff commented that they felt that the home did well in supporting service users family and friends. Three residents who completed our survey said that they always received the care and support they needed. Eight members of staff who completed our survey said that they were always given current information about the people they looked after. Residents are provided with appropriate pressure relieving equipment including mattresses and cushions and any other aids and adaptations according to need. One professional who visits the home and completed our survey said that Mrs Butler is very good asking for help or equipment for people who live at the home. It was clear from looking at a care records and talking to residents that they had access to district nurses, GPs, and any other health and medical professional whenever necessary. Six professionals who visit the home completed our survey five said that the home always sought advice and acted upon it in relation to residents health needs and one said that the home usually did. Four people said that individuals health needs were always met by the home and two said that they usually were.Three residents who completed our survey said that they always received the medical support they needed. We looked at the way medication was managed in the home, the home has an efficient medication policy, procedure and practice guidance. All staff have access to this Care Homes for Older People Page 14 of 30 Evidence: information and are clear about their role and responsibilities. All staff have completed accredited training to make sure that they have the skills and knowledge necessary. Records seen were well kept and audited regularly by Mrs Butler. Patient information leaflets were retained, a sample list of staff signatures was available and Mrs Butler told us that all creams and ointments are discarded after 28 days and new stock obtained. Controlled drugs were stored and recorded correctly and securely. Six professionals who visit the home completed our survey,four said that the home always respected individuals privacy and dignity and two said that they usually did. One person commented that staff awareness of privacy and dignity is very good by all. They always know to protect service users by closing doors, knocking on doors, and closing curtains. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines of the home are flexible to suit the needs and preferences of people who live in the home. Activities are provided and tailored to suit the choices of the people who live in the home. Visitors to the home are made welcome and are invited to take an active role within the home if they want to. The home offers a variety of nutritious home-cooked food that meets residents dietary needs and takes into account their likes and preferences. Evidence: People spoken to on the day of the inspection told us that they got up and went to bed at times to suit themselves and that staff were aware of their preferences. This was confirmed by observation during the visit as people were having breakfast at different times to suit their own choice. Care plans detailed the way in which individuals wished to spend their time and how staff would support them with this. Six professionals who Care Homes for Older People Page 16 of 30 Evidence: completed our survey said that the home always or usually supported individuals in making their own choices relating to daily living. One professional commented that service users choices, preferences and wishes are promoted and encouraged at every opportunity. Residents are encouraged to maintain contact with their families and friends. People spoken to told us that their visitors are made welcome and are free to come and go at any reasonable time. The home does not employ an activities organiser and this is undertaken by all members of staff. A weekly programme of events was in place which included cards, films, exercises and television. A volunteer visits the home once a month to do art and craft work with residents. The donkey sanctuary visits, an entertainer was booked to come in September 2009, some people are taken to the local garden centre and two residents are supported by staff to go to the local Alzheimers singing group. One resident told us that they would like more opportunities to go out of the home and that this would give me something to look forward to every month. Three residents completed our survey, one person said there was always activities they could take part in, one person said that there usually was and one person said there sometimes was. It was very positive to see that information about the new legislation about the Mental Health Act and relating to the deprivation of liberty and how it may affect older people living in care homes was provided for residents and visitors. The home has been awarded a five star rating from the Environmental Health department. The food is all home cooked and the cook and staff are familiar with individual residents dietary needs, likes, dislikes and preferences. We saw that there was a plentiful supply of a wide range of good quality food. Mealtimes are seen as a social event and looked forward to by residents. Mrs Butler told us that a clear policy is in place to protect mealtimes as a positive occasion for residents and that care tasks including medication administration is not undertaken at such times.Mrs Butler told us that on a residents birthday they are able to choose their favourite meal at lunchtime and can invite their friends and family to join them. The home provides a birthday cake and one resident who had been on holiday during their birthday told us that they had been presented with the cake on their return. All three residents who completed our survey said that they always liked the meals at the home.Staff were observed offering unhurried discreet assistance to residents at mealtimes. Care Homes for Older People Page 17 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. The home has an open culture that allows residents to express their views and concerns. Residents felt safe and confident that if they raised any concerns they will be listened to and taken seriously. Policies and procedures for safeguarding the people who live in the home are available and give clear specific guidance to those using them. There are clear systems in place for staff to report concerns including to external agencies if necessary. Evidence: The home has a complaints policy that is readily available to any resident or visitor to the home. The policy gives details of the timescale within which a complaint would be investigated and includes the commissions contact address but does not make clear that complainants can approach the commission at any stage of a complaint. The home nor the commission have received any complaints since the last inspection. Mrs Butler told us that a suggestion box is made available at residents meetings so that they can put forward any comments or suggestions anonymously if they want to. All the residents spoken to during the visit were very clear and confident that they could raise any concerns with Mrs Butler or any member of staff and that they would be listened to and taken seriously. Three residents who completed our survey said that Care Homes for Older People Page 18 of 30 Evidence: they always knew who to speak to if they were not happy and knew how to make a complaint if they wanted to. All eight members of staff who completed our survey said that they knew what to do if they were aware of any concerns residents may have. A whistle blowing policy to make staff aware of how to raise concerns if necessary was in place. Policies and procedures to protect the people living at the home are in place and the home had a copy of the locally agreed procedures.There has been one safeguarding incident since the last inspection, this was very well managed and dealt with appropriately and promptly by Mrs Butler. The home has a managing physical aggression policy but this didnt give information about the reasons why people may be aggressive for example if they are unwell or have dementia and did not give clear guidance to staff on how to defuse such situations. However, during the inspection staff were observed working very well with one resident effectively to defuse potential difficulties. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is kept clean, tidy and free from odours and provides a homely place to live. Residents are encouraged and supported to maintain their own lifestyle and standards within the space constraints of their private room. Unguarded radiators may present a potential risk of burns and scalds. Infection control measures are in place to reduce the risk of cross infection but these require further development. Evidence: The home was clean, tidy and free from unpleasant odours. Residents are encouraged and supported to personalise their rooms and can bring in their personal belongings within the space constraints of their rooms. Three residents completed our survey and said that the home was always fresh and clean. The AQAA told us that since the last inspection the sitting room has been refurbished and the lighting improved in the dining and sitting room. The yellow bathroom has been refurbished, and a new bath lift fitted. two bedrooms have had new carpets, and some sinks in private en suites have been replaced. Care Homes for Older People Page 20 of 30 Evidence: The rear garden is steep and inaccessible for residents but they are able to use the front garden and furniture is provided .Access to the home for people who need to use a wheelchair is via a side entrance. The home has a programme of routine maintenance and the AQAA told us that private rooms are redecorated and refurbished on vacation. However, some areas of the home are looking tired through wear and tear, some carpets were ruched which could present a trip hazard and the home would benefit from updating the environment. Mrs Butler told us that plans were underway to replace the dining-room carpet with laminate flooring and the carpet in ensuite toilets would be replaced with washable flooring. We noted that the majority of radiators in the home are not covered and are not guaranteed low surface temperature. Although some risk assessments were in place, progress to cover them to reduce the risk of burns and scalds has been slow. An immediate requirement was issued that required the home to risk assess uncovered radiators and to tell us how they planned to reduce the risk until they were covered or replaced. Mrs Butler responded promptly with an action plan on how this will be addressed. Infection control measures were in place and most staff have completed training. The AQAA told us that senior staff complete a monthly audit relating to infection issues and information about hand washing was seen throughout the home. However, we noted that not all bins were lined and that waste bins in communal bathrooms, toilet and the kitchen were not foot operated. Hand wash and paper towels were available in some communal facilities but not all. Toiletries were seen in a communal bathroom contrary to good practice. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment processes are poor and do not safeguard the interests of people living at the home. All the staff who work at the home are qualified to at least NVQ level 2. The service ensures that all staff receive relevant training that is targeted and focused on improving outcomes for residents. Evidence: A staff rota was in place and there were three carers and a cook on duty on the day of the inspection. It was evident from talking to staff and checking the AQAA that the home has a stable staff team with some staff having worked at the home for many years which provides continuity of care to residents. Three residents completed our survey and they all said that staff listened and acted on what they said, two said there was always staff available when they needed them and one said that there usually was. Six professionals completed our survey, two said that the staff always had the right skills and experience and four said that they usually did. Seven staff completed our survey six of whom thought that there was always enough staff available and one said that there usually was. Six said that they always had the right support and knowledge to meet peoples needs, and one said that they felt they usually did. Care Homes for Older People Page 22 of 30 Evidence: We looked at the personnel files of three members of staff who had started since the last inspection. On the first file the person had started work at the home before a satisfactory POVA First check, CRB check or two references had been received. A risk assessment was in place which detailed that the person had started because another member of staff was unable to work and it was deemed safer to employ the person without the necessary checks being undertaken rather than use agency staff or be short staffed. Mrs Butler also told us that the person had been supervised by stafff at all times. On the second file looked at there was no POVA First, CRB disclosure, application form or references although the person had been working at the home since 2007. On the third file looked at there was an application form, record of interview,POVA First check, satisfactory CRB disclosure and two references. However, the person had worked at the home for four days before the POVA First check arrived and the references were not in place before the person started work. All the staff are qualified to NVQ level 2 with some having achieved or currently undertaking NVQ level 3. All new staff complete the Skills for Care common induction standards and have access to a wide range of training tailored to meet in the needs of people who live in the home and individuals staff skills and knowledge. All the staff spoken to told us that they were encouraged and supported by Mrs Butler to attend wide-ranging training. Mrs Butler is currently undertaking training in palliative care and all staff qualified to NVQ level 3 will also do this in the near future. One professional who completed a survey told us that Mrs Butler was very proactive in supporting staff with their awards and supporting mandatory and optional training. They went on to comment that the staff work extremely hard. The teamwork is superb and thisshows through the continuity I see regularly. All staff were due to undertake training on equality and diversity soon after the inspection. Eight staff completed our survey and they all said that the induction covered all aspects of the job very well. They all confirmed that they had access to up-to-date relevant training to help them understand and meet the needs of residents. Staff comments included the manager advises me on what courses to go on and is very good at informing us about what we need in the way of training, my manager supports me in doing courses that would benefit the residents and myself, training is very good and new courses and updates offered regularly . 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by a committed manager/provider who creates an open and positive atmosphere which supports good care practices for residents. Poor recruitment practices potentially puts the safety and well being of residents at risk. The home regularly reviews its performance through quality assurance systems which include people who live and have contact with the service and the home is run in the residents best interests. Health and safety is taken seriously to make sure that people living in working at the home are safe. Evidence: The home is managed by the registered provider and manager Mrs Sue Butler supported by a consistent staff team. Mrs Butler has many years experience in the care sector and has achieved the registered managers award and regularly undertakes Care Homes for Older People Page 24 of 30 Evidence: training to update her knowledge. Recent training includes palliative care, dementia, and diabetes. Mrs Butler completed and returned to the AQAA within the required timescale. It was very well completed and gave us detailed information about how the home is organised and run including future plans to improve the service. The judgement in this outcome group reflects the poor recruitment process and the lack of checks made before people start work at the home contrary to the Care Home Regulations 2001 and good practice. The AQAA told us that a member of staff had started work without a satisfactory CRB check had been obtained but that a POVA First check had been obtained. However, the staff file showed that the member of staff had worked in the home for four days before the POVA First check was obtained. This was discussed with Mrs Butler during the inspection and her understanding of the importance of obtaining the correct documentation, i.e. two references and a satisfactory POVA First check to make sure that residents are safeguarded from the risk of unsatisfactory people working at the home was poor. Mrs Butler also did not acknowledge that other staff employed in the home whilst not undertaking care tasks, had contact and ready access to residents so their employment must be subject to the same scrutiny to make sure people who live at the home are safe. Mrs Butler regularly undertakes quality assurance audits on a wide ranging list of relevant topics and the results are collated and made available to residents and visitors to the home. The findings are then used to inform the homes practice and service delivery. We looked at the latest audit undertaken in December 2008 the result of which showed a high level of satisfaction with the service provided. Residents meetings are held and minutes taken. We were shown the minutes of a meeting held in January 2009. Residents were advised of the forthcoming visit from the donkey sanctuary and a musician, both in January. People were asked to put forward any suggestions for food they would like to to see included on the menu and these were recorded and passed on to the cook. It was clear from the minutes that residents are consulted about any changes planned such as the replacement of the dining room carpet and their views sought and taken into account. The home does not manage personal finances for any of the residents, this is undertaken by their families or a solicitor if necessary. All staff have completed mandatory training and the AQAA told us that staff receive regular supervision and support. Eight staff who completed a survey said that they regularly or often had discussions with Mrs Butler. An accident book was in use and had been correctly completed and entries cross Care Homes for Older People Page 25 of 30 Evidence: checked with care plans were all found to be correct. Record showed that appropriate action had been taken when accidents have occurred. A very good falls audit was in place to identify risk areas in times and to develop very clear strategies to reduce the risk to individuals. The last inspection report was freely available for current and prospective residents and their families. Records showed that health and safety policies and procedures are in place and staff have received relevant training to make sure that they and residents are safe. Information supplied in the AQAA told us that all the equipment was regularly serviced and safe to use. Record showed that fire safety equipment was regularly checked. Health and safety taken seriously to make sure that people living in working at the home are safe Care Homes for Older People Page 26 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 27 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 1 25 13 The registered person shall 05/06/2009 ensure that any unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. This refers to uncovered radiators which must be risk assessed. This is to reduce the risk of scalding . Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 13 The registered person shall 30/07/2009 make suitable arrangements to prevent infection and the spread of infection at the care home. This relates to the provision of paper towels in communal bathrooms and toilets. This is to reduce the risk of cross infection. 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. Care Homes for Older People Page 28 of 30 No. Refer to Standard Good Practice Recommendations 1 16 The complaints policy should make clear that complainants are able to contact the commission at any stage of a complaint. The managing physical aggression by residents policy should be reviewed and updated to make sure it is person centred and reflect current good practice advice. The whistle blowing policy should include the contact details of the care quality commission. Carpets that are ruched should be refitted or replaced to reduce the risk of falls. All bins in communal bathrooms, toilets and kitchens should be foot operated to reduce the risk of cross infection. All waste bins should be lined. Residents toiletries should be kept in their private room to avoid the risk of cross infection. 2 18 3 4 5 18 19 26 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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