Inspection on 29/05/09 for The Homestead Residential Home

This inspection was carried out on 29th May 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 Homestead Residential Home 22/05/07

The Homestead Residential Home 20/02/07

The Homestead Residential Home 09/11/05

The Homestead Residential Home 16/06/05

The Homestead Residential Home 08/03/05

The Homestead Residential Home 20/07/04

The Homestead Residential Home 10/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Key inspection report Care homes for older people Name: Address: The Homestead Residential Home Wolverhampton Road Prestwood Near Stourbridge West Midlands DY7 5AN     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: Keith Jones     Date: 2 9 0 5 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 32 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 Homestead Residential Home Wolverhampton Road Prestwood Near Stourbridge West Midlands DY7 5AN 01384872555 01384873642 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Elysian Care Limited care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 37 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 37, Old age, not falling within any other category (OP) 37, Physical disability (PD) 37 Date of last inspection Brief description of the care home The Homestead is a thirty seven bedded care home for independent elderly people of pension able age requiring minimal help with personal care and daily living tasks. The Homestead promotes independent living and offers a wide variety of activities and menus to suit all personally assessed needs. The Homestead is not registered for nursing care, but will endeavour to care for people as long as possible within its Care Homes for Older People Page 4 of 32 Over 65 0 37 0 37 0 37 Brief description of the care home category of registration. The frontage of the home provides the main outside sitting area, as this can become a suntrap during the summer months. There are gardens with lawns, fruit trees, and flowered borders to the rear of the building. Set in a semi rural location yet within easy reach of neighbouring Kinver, Stourbridge, and Kingswinford. Accommodation at the home is of a high standard and offers both shared and single bedrooms with the majority having en/suite facility. There are assisted bathrooms and a hairdressing salon. A passenger shaft lift is located off the main hall, there are three lounges, of which two have a television and the dining room is located at the rear of the lounge. The full range of fees were not detailed in the services Statement of Purpose or Service User Guide documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. 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: We conducted this unannounced inspection with the Registered Care Manager, and senior care staff on duty, whose input contributed to this report. Our inspection of the Home allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 34 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with personal care needs. To do this we looked at (case tracked) three peoples files from admission referral to the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process, their input contributed to the subsequent report. We acknowledged receipt of the Annual Care Homes for Older People Page 6 of 32 Quality Assurance Assessment (AQAA), and two survey forms returned that we sent out to people who use the service some weeks before the inspection. We inspected a sample review of administrative procedures, practices and records, confirming satisfactory practice and management. There followed an inspection report feedback, involving the Care Manager and a senior representative of the Registered Providers, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? There is recognition that a more person centred care approach has been generated, and a greater involvement by people who use the service and their relatives. We were informed that a greater emphasis in receiving peoples opinion has resulted in an awareness of expectation and concerns, including the insufficiency in providing meaningful activities and social interaction. There is some evidence of managers having taken on board the views and the importance of socialisation, with the allocation of ten hours of activity time. However there remains much to develop, especially in providing time and resources to people with dementia care needs. During the past year we recognized the efforts to manage a heating problem and maintain the general level of decor and furnishings, although insufficient to meet an increasing wear and tear, and in addressing the needs of people with a higher dependency of care. Care Homes for Older People Page 8 of 32 We have recognized an improvement in the recruitment and induction of new staff, with a more robust process and management approach. Establishing a keyworker basis of working has identified the importance of the staff induction programme, relative to the needs of people using the service, although inadequate staffing levels and maintaining a sound training scheme remains a challenge. 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 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 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 10 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. The needs of people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services Statement of Purpose and Service User Guide, and found them to provide an informative description of The Homesteads aims, objectives, and the way it operated. We acknowledged that the documents were presented to all enquirers, and that information concerning fees payable were not included in the Service User Guide. We examined an example of the Service User Guide produced in large print, which is provided on an as and when necessary basis. Foreign language versions can be made available on request. We advised that an audio and pictorial version would help people to make an informed choice. It is stated in the AQAA, and we recognised that the Statement of Purpose represents the basis on which the home operates upon, offering those people who may use the Care Homes for Older People Page 11 of 32 Evidence: service, and their relatives, the opportunity to make an informed choice about where to live. The format complies with regulation, although needing updating to include changes of organizations and contacts. A comment we received on the day of inspection: I remember being given a form to sign, which told me about the home Our examination of three peoples care records and plans, indicated that each person had an individualised pre admission assessment, the amount of information recorded was adequate in forming an appraisal of that persons needs and capabilities, assessing the social background, and were consistent with dating and ownership of the assessor. We identified that the Care Manager or her deputy, at the point of referral, conducts the pre-admission assessment. We found through our discussions with relatives and people using the service, that their involvement was taken into account, and that they felt included. A relative we talked to informed us: I felt involved and was able to pass a lot of personal information across to the matron about my mum. From our examination of care files we found that the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the person and any special needs. From our discussions it was evident that people are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. No intermediate care took place in the home. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are addressed through the care planning process, generally meeting principles of respect, dignity and privacy. Medicine administration systems and practice are safe. Evidence: We found that care records, through case tracking, showed that this standard is adequately met, maintaining a satisfactory quality process of assessment. The pre admission assessment represented the foundation for an organised care planning process, in association with Social Services reports if available. Each persons health, personal and social care needs are assessed in an individual plan of care, including those peoples, and relatives views, to reflect their changing needs, reinforced through a thorough daily report. There were some inconsistencies in the review process, requiring the establishing of a monthly review of risk assessments and the care planning process. Three individuals care files were examined in detail, each demonstrated essential Care Homes for Older People Page 13 of 32 Evidence: information on the individual, their life style and needs, events and contacts, procedures and actions monitored on a daily basis and reviewed. Effective risk assessments had been completed in areas such as manual handling, falls, nutrition, personal hygiene, and continence. The process has also established a social awareness for each person, which has proved to be useful in enhancing understanding of personal needs. We confirmed through our discussions with staff an effective understanding of need, enabling staff to identify risk areas and put systems in place to reduce risks. We had evidence that physical, psychological and special needs are assessed and documented, along with a satisfactory monitoring process, such as nutritional screening, weighing, hearing, and sight tests as appropriate. The General Practitioner (GP) of choice service is supportive; through which arrangements are made to provide professional support. Case tracking confirmed to us that specialist support and advice are sought as needed, with access to a local Doctor, Dentist, and Chiropodist. Comments we received from several people using the service and visitors: The Homestead is very nice place to live in, although they always seem to be short of staff, but Im very happy with the way that mum is looked after here. I am pleased with how they look after my mum, they always tell me about if anything untoward happens. I have nothing but praise for them . The doctors are always called when my mother needs medical help, giving me peace of mind. Happy with care received, Always someone to talk to about things, The care and support I get is satisfactory for me. If I need help there is always someone available. Staff are very helpful. There was a clear appreciation of the openness and opportunity to contribute. Carers were seen to generally interact with people who use the service with understanding and friendly compassion, although people were seen to be left unsupervised in the lounge areas for significant periods of time. In the progress of meeting people who use the service it was acknowledged that their general appearance indicated that their health and personal care was attentive and effective. Care Homes for Older People Page 14 of 32 Evidence: We found the administration of medicines adhered to procedures to maximise protection to people who use the service. The medicines in use storage was secure, with good environmental controls, including a medicines fridge. Our examination of the record of administration of medicines showed consistency, with no omissions observed. Staff signatures were up to date. Controlled drug arrangements and management are appropriate. Staff training continues to be pursued actively by the care manager with the pharmacy suppliers helping out. We found an effective and smooth process of ordering, receiving, storing, administering and disposing of medicines. Records were seen to be complete and easy to follow through, with no observed breaches in the system. All three people being cases tracked were found to have appropriate medication. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service. visitors and staff, and that relatives have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. In our discussions with people who use the service and staff it was recognised that diverse needs were accommodated within the planning of care, with dietary, religious and personal matters identified, along with the diverse physical needs. Generally the arrangements for care planning are satisfactory with fair assessment, wide based risk analysis and care plans regularly reviewed, and very good daily reports. Cross referencing accidents and events with care plans showed a connection of appraisal, although no regeneration of plans or risks assessments were noted. There were risk assessments in place but not seen to be followed up in practice, with people left in day rooms unsupervised, resulting in one lady we found on the floor in a day room, and could not find staff to help for a significant time. Care Homes for Older People Page 15 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. Peoples rights to live a meaningful life are promoted, and people are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found the daily routine to be flexible and non institutionalised, offering choices for meal times, personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a relaxed and informal atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. We recognise the principle that activities are a key element in the socialisation approach to care, with visitors encouraged to be involved in a partnership style with care staff. The home does not have an activity coordinator, and on talking with the Care Manager it was apparent that there is a recognition to enhance the socialization role, with the allocation of ten hours a week of a carers time to activities. During the course of the inspection we saw staff interact with people in a positive and polite manner at times, and also we observed the lounge areas unattended for long periods, with little in the way of distraction or entertainment for people using the service. Care Homes for Older People Page 16 of 32 Evidence: Comments we received from surveys issued to people who use the service before the inspection: I like the singalongs, but they dont happen so often now. It would be nice for mum to go out occasionally and meet different people. Not interested in activities. The Manager and staff looks after everyone and gets on well with visitors, good relationships with family. It is stated in the Statement of Purpose that personal choice and relative self determination are respected in policy and action. Throughout the inspection we found this to be true. Those individuals rooms inspected showed an influence of personalisation in the inclusion of belongings, some furniture and general decor. Our inspection of the Home demonstrated a degree of expressed individuality in most of the bedrooms inspected. Relatives and friends are encouraged to maintain social links as part of the planning of care. We found that the standards of catering offered a satisfactory service, to which those people we spoke with were very complimentary of all aspects of quality. Menus are organised on a four weekly cycle, offering a wholesome, varied and suitable choice. We observed a very pleasant lunch served during inspection, with choices available between fish and chips and Chicken Kiev. A menu for the day was inspected and seen to offer a wide choice of meals throughout the day, served in a comfortable and clean dining room. The quality and quantity of the food offered on the day was observed to be of a good standard. People interviewed confirmed that that the quantity and quality food provided was good: The food here is always good and tasty, always hot, and the staff are very helpful. and Very good standard of cooking and choice available. Its always set out so nice. We saw that staff offered discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of people living in the home. We confirmed that the cook knew each person using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special (cultural) needs at the time. Care Homes for Older People Page 17 of 32 Evidence: Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed their requirements. 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. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: We examined the complaints policy and found it appropriate, and up to date. There were a few minor concerns, which we feel would be better dealt with through a record of Concerns, Complaints and Safeguarding, to register peoples concerns in a meaningful and effective manner. From our talks with people who use the service, and staff, it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. All people had received information on the procedure to complain, including reference to us. This process was evidenced through the Service User Guide, on examination and case tracking and discussion. We identified that there had been one complaint received by us, dealt with satisfactorily by the Registered Provider, and there have been no allegations made to us since the last inspection. Comments we received from people who use the service through the surveys returned: I do know who to speak to if not happy. There is usually some one to speak to. Care Homes for Older People Page 19 of 32 Evidence: Our discussion with the Care Manager confirmed that there is satisfactory evidence of a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. The policy and procedure for handling issues of abuse was examined, and found to be appropriate. We examined three staff records to confirm that staff were suitably checked through Criminal Records Bureau (CRB), and Protection of Vulnerable Adult (POVA) disclosure. We found staff received training on abuse at induction, this includes the right to Whistle blowing, consistent with the Public Disclosure Act, 1998. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Homestead provides a clean and comfortable environment for the people who use the service. There is a need to maintain the fabric and furnishings of the home to a satisfactory standard to meet all peoples needs. Evidence: The Homestead Residential Home is located on the A449, near Stourbridge. The twostorey property is situated within its own grounds. The home offered a range of single and shared occupancy bedrooms, located on both the ground and first floor, and that people are encouraged to personalise their bedrooms. External access is set off a main road, in beautiful pastoral countryside, to which people take advantage of an attractive garden, lawns and patio at the front of the building, with those pathways safe and maintained. We found to the rear of the property that the patio and surrounding gardens are poorly maintained and managed, with gardens overgrown and littered with debris, and the patio strewn with discarded equipment, poorly maintained and considered to be hazardous. Paintwork and general exterior decor was in need of renewal. The rear exit door is identified as a fire door, yet is not secure or alarmed, offering relative easy access to the rear of the building. We also found the flat roof to be heavily overgrown. We found that internal access was facilitated with suitable fittings of hand and grab Care Homes for Older People Page 21 of 32 Evidence: rails, in adequate, well lit and airy corridors. We have indicated the need to develop the decor of corridors to reflect a growing need to assist people with dementia in pathway location signs, including corridors with themes and easily recognizable colour coordination, linked in with familiar and individulised bedroom doors. Wheelchair access was satisfactory throughout all areas of the home. On admission the Care Manager or her deputy assesses each individual peoples needs for equipment and necessary adaptations. A letter confirming those arrangements was seen in each care file. Efforts had been made to provide a homely atmosphere, and the decor in most areas of home was found to be of an adequate standard, with some evidence of some bedrooms and communal areas looking tired and worn, especially furnishings in lounges which poorly maintained. The home provided three lounge areas that were pleasantly decorated but worn, yet providing comfortable areas where people were able to interact, or to entertain their guests. A pleasant, homely dining area was clean, and conducive to enjoy a good meal. Toilets were located on both floors and were in close proximity to bedrooms and communal areas. We found bathrooms to be in need of a renewal programme, with shower upgrade, a walk in shower room with heavily stained tiles, and one with mould around the bath and poorly maintained. One bathroom was used to store a carpet, another a pair of stepladders, significantly affecting the availability of bathing facilities. A sluice was inspected and found to offer a storage area for equipment and dental materials, with little evidence of use as a sluice. We noted a room earmarked for a linen store, with open access to electrical switches and wiring, and being used for storing personal items. The room was not secure, and represented a major hazard to peoples well being and safety. Bedrooms were generally satisfactorily maintained to peoples personal preferences, although significantly more worn since the last inspection. Some rooms were poorly presented, some with poor outlooks to overgrown and littered areas, and some with poor lighting to offer a dismal aspect to their bedroom. Nevertheless most bedrooms were personalised, with some displaying peoples own furniture, and most with personal belongings. Some of the original furniture is in continuing need of renewal. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the Inspection. We found that this policy has been inadequately addressed over the years, in which provisions for improvement in internal facilities are expected. We noted one bedroom to have been damaged with a water overflow, but some two months down the line it is still awaiting refurbishment. The majority of bedrooms were equipped with en suite, and it was noted that several Care Homes for Older People Page 22 of 32 Evidence: rooms deployed wheeled screens rather than tracked curtains. It was agreed at the last inspection that these represented an unnecessary risk, and be removed. We found that a number of rooms demonstrated an going problem of storage of equipment, large personal items, dressings and pads, littering rooms and creating unnecessary risks. There are six variable height beds available. We noted that there is little in the way of enhancing personal space for people with dementia, in identifying bedroom doors, fitting items of easy recognition and usage, and installing a personal ownership to their rooms. An effective call system was tested, although care staff reacted poorly, taking several minutes to answer the call. A locked facility and lockable bedroom doors are available in each bedroom on request. The locking mechanism to bedroom doors needs to facilitate effective dementia care needs, or allow privacy with easy escape option. However those people we spoke with expressed a sense of belonging and satisfaction in the quality and presentation of their living areas with no one expressing any dissatisfaction. The Care Manager expressed a willingness to meet any reasonable demand for special needs. The kitchen was inspected, and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. The kitchen was clean and considered secure. We spoke with the cook who confirmed to us that she actively engages with people who use the service to determine their needs and little ways. She was aware of the issues of culture, ethnicity and age diversity, having had experience in dealing with a diverse population. The laundry was equipped to a good standard, although we found used linen stacked on the floor awaiting washing. We found that red alginate laundry bags were available for handling soiled linen, and that there were appropriate notices regarding chemical handling openly displayed. Peoples belongings were seen to be handled piecemeal, in an organised process, with no evidence of communal usage. We noticed in the course of inspection that the housekeeping staff did not have a suitable trolley to convey equipment, rubbish or used linen. Heating and ventilation were found to be an on going problem, having had difficulties in maintaining an ambient temperature during the winter, and on the day of inspection the staff were finding it difficult to keep people cool on a warm day. The Provider, we are assured, was addressing these problems at the present time. Care Homes for Older People Page 23 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. Further staff training, monitoring and supervision are required to ensure that staff have the appropriate skills and knowledge to meet peoples needs. Recruitment processes are inconsistent and need review to ensure protection of the people who use the service from harm and abuse. Evidence: We confirmed that there were 34 people living in the home on the day of inspection. We examined three weeks of duty rotas from the 04.05.09 through to the 24.05.09, which confirmed a consistency in care staff deployment. On the day of inspection the staffing levels were: Morning shift 1 Senior Carer and 4 carers (Plus Care Manager). Afternoon shift 1 Senior Carer and 3 carers Night duty 1 Senior Carer and 2 carers. We recognised that the Care Manager is supernumerary to the staffing roster. Flexible rostering with agreed overtime are used to accommodate shortfalls due to sickness or absence. It was evident throughout the inspection that with progressively increased dependency, and a higher number of people with dementia care needs, that staffing levels have not been adapted to cope with those demands. Interviews and discussions Care Homes for Older People Page 24 of 32 Evidence: with people raised concerns regarding the current staffing levels provided within the home. There were situations we observed where is was clear that there was insufficient staff to cope with expected situations and events. We consider that urgent action be taken to rectify this situation in reinforcing the staffing, especially those periods of early to mid morning, evening and night time. There is a growing recognition that the arrangements for activities are inadequate, with people getting ineffective supervision and motivation, to promote socialisation and engagement, especially in addressing dementia care needs. The catering, maintenance and domestic hours were determined and found to be appropriate for the size of the home and the needs of people, however the amount of upgrading in fabric and maintenance will require an extra effort and resource.. Discussions with the Registered Care Manager confirmed that more than 50 per cent of care staff had receipt of the National Vocational Qualification (NVQ) at level II or III, with two staff members currently undertaking the training. There was evidence that a training schedule has been established, and that a significant amount of training is undertaken, although records showed that mandatory subjects have not been adequately addressed to ensure that all staff have up to date portfolios of achievement, and provide a level of qualification to maintain quality of standards. We recognised that all the staff interviewed had received dementia awareness training, and had advised us that they received a good induction programme on starting work at The Homestead. The Provider and Care Manager have established, and continue to pursue satisfactory procedures for interview, selection and appointment of staff. The thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. Three staff were interviewed and confirmed the policies in action. All new staff goes through a detailed induction process, that will ensure that they are going to be the right person for the home, and have been given, and work within, the General Social Care Council code of conduct. We advised that the staff record be reviewed in the way information is organised and presented, and to establish the practice of recording interviews. Discussion with staff demonstrated an inconsistent process of supervised practice, failing to meet the required six sessions a year. Managers and relatives/residents meetings are held on a monthly basis. Staff meetings however do not have an organized structure. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls within the service have had an impact on the quality of the service delivery. There is a need in promote the health, safety and welfare of people using the service, and ensure working practices are in peoples interests. Evidence: The Registered Care Manager had 17 years experience in social care and had obtained the Registered Managers Award, National Vocational Qualification level 2 and 4 and the Assessors Award. Our consideration of the quality of care offered to people is at an adequate level, whilst we have identified in this report our concerns over a number of issues. We recognise that the Care Manager has acknowledged those concers, demonstrating a positive response, and reinforcing her commitment in promoting best practice to improve the service delivery. We also discussed the management and direction issues with the Personal Assistant to the Directors of Elysian Care (The Providers) and established the foundation of those concerns, linked to the need to evaluate a resource plan to meet our requirements and recommendations. We consider that there has been a lack of a strategy and direction to enable staff, people Care Homes for Older People Page 26 of 32 Evidence: who use the service, and relatives to understand the aims of the service and the way in which the service is delivered. There is sufficient evidence to identify lack of leadership in meeting the needs of a changing population of people using the service, and the resources and services to meet those needs. We have observed a decline in the standards of maintenance and development of the home, which requires a more positive quality assessment and monitoring of the service, to include appropriate risk assessments in place for people using the service, through care planning and monitoring, staffing levels and of the general environment. An examination of administrative, monitoring, planning and care records showed to us a satisfactory attitude to effective record keeping. We found them to be generally well maintained in ensuring that the peoples rights and best interests are safeguarded. Records inspected included recent fire prevention, hoists, gas, and water inspections, each were examined and found to be up to date. The Manager offered evidence of procedures and safe working practices including: Movement and handling, Safeguarding awareness and Administration of Medication. The policy and procedure manual has recently been reviewed, but would be of greater help to staff to be further updated to meet new situations, especially in light of changes in Mental Capacity Act, Deprivation of Liberties, and Safeguarding regulations. We found that formal staff supervision had been held on an infrequent basis, were had not been kept up to date. It was agreed that a cascaded staff supervision programme would be reviewed to continue to meet a two monthly target. The accident book was seen and found to be in order, with a regular analysis of trends and frequency. Our examination of those records showed an effective follow through of action taken, including a review of care plans if necessary. Accidents occurring to those people we case tracked were seen to be cross checked with care plans, and logged into day report. We were informed through the AQAA, and by the management that financial arrangements are supervised and administered by the Registered Provider and Care Manager in respect of pocket money, comfort fund and petty cash management. Care Homes for Older People Page 27 of 32 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 28 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 19 23 To take steps to safeguard people who wish to use the garden and patio areas, in maintenance of gardens, fencing, pathways and appropriate disposal of unwanted equipment. To ensure the ongoing safety and improvement of living environment of people using the service. 31/07/2009 2 19 23 That the room used as a linen store be secured when not in use, and electrical conduit boards be boxed in and made safe. This will ensure the overall health and safety of all people in the home. 23/06/2009 3 21 23 he responsible person must ensure that bathrooms are well maintained. and kept available, not to be used for storage. 23/06/2009 Care Homes for Older People Page 29 of 32 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 This will ensure that people will have access to adequate bathing facilities. 4 27 18 The arrangement of staff working patterns should be reviewed to ensure appropriate numbers during peak times of the day. This will ensure adequate numbers of staff are available to meet peoples needs. 5 30 18 That the Registered Provider 30/06/2009 ensures that a programme of staff training is in place . To ensure that staff fulfil the aims of the home and meet changing needs of people using the service 6 33 24 That the Registered Provider 31/07/2009 re-establish an effective quality assurance and monitoring system. To measure the potential outcome of changes in the dependant needs of people who use the service. 31/07/2009 Care Homes for Older People Page 30 of 32 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 1 That the Provider maintain an up to date Statement of Purpose and Service User Guide, to allow people who may use the service to make an informed decision. That the Provider ensures that people are not left in lounge areas without a substantial staff presence, and to establish a formal programme of activities to promote socialisation and inclusion, especially for people with dementia care needs. A Concerns, Complaints and Allegation book be established to more effectively monitor incidents. That the fire exit to the rear side of the building be made secure and alarmed, to ensure the security and safety of people living in the home. To ensure that the general fabric and furnishings and decor standards are maintained, to provide people with a comfortable and safe living environment. That a progressive programme be initiated to upgrade bedrooms and lounges throughout the home to maintain the expected standard of living environment for people using the service. To consider the environmental arrangements for people with dementia, including provision of easy recognition, dignified identification of bedrooms and facilities to enhance their well being. That portable bedroom curtains be discontinued and replaced with tracked curtains, to ensure the health and safety of people living in the home, and staff working in those bedrooms. That the Provider ensures the provision of cleaning trolleys for housekeeping duties. That linen skips are used for the use of accomodating dirty linen prior to washing, to maintain basic infection control arrangements. That the Registered Care Manager ensures that a record og staff interviews be made on and included within the staff record. That the Registered Provider shall ensure that persons working in the care home are appropriately supervised. 2 12 3 4 16 19 5 19 6 24 7 24 8 24 9 10 26 26 11 29 12 36 Care Homes for Older People Page 31 of 32 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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!