Inspection on 28/07/09 for The Martlets

This inspection was carried out on 28th July 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

Key inspection report Care homes for older people Name: Address: The Martlets The Martlets Fairlands East Preston West Sussex BN16 1LJ     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: Edward McLeod     Date: 2 8 0 7 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 Martlets The Martlets Fairlands East Preston West Sussex BN16 1LJ TBC TBC Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shaw Healthcare Ltd Name of registered manager (if applicable) Mrs Marian Eileen Drake Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) 2. The maximum number of service users to be accommodated is 80. Date of last inspection Brief description of the care home The Martlets is a new and purpose built property situated in the village of East Preston, West Sussex, close to local shops and transport links. The accommodation is arranged on the ground floor, first floor and second floor. The first and second floors can be reached by stairs or a lift. The registered provider for the service is Shaw Healthcare Limited, and the Care Homes for Older People Page 4 of 32 Over 65 0 80 80 0 Brief description of the care home Responsible Individual registered for the service is Mr Peter John Jeremy Nixey. The registered manager for the service is Mrs Marion Eileen Drake. Fees range from 420.44 pounds per week to 700 pounds per week. 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: This has been the first inspection carried out at the service. The visit was arranged to assess their compliance with the Key National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The visit took place on the 28th July 2009 and lasted from 9.15 a.m. to 5.45 p.m. In preparing for this visit we looked at all the information that we had received or asked for since the last key inspection and this included:the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The AQAA was received by the due date and included the information we asked for Care Homes for Older People Page 6 of 32 the five Care Quality Commission (CQC) surveys we received from people living in the home which had been completed with the assistance of their family. We also received two CQC surveys completed by members of staff. What the service has told us about things that have happened in the service What other people have told us about the service and relevant information from other organisations. Some of the information received has been included in this report. During our visit we spoke with five people living in the home, five members of staff and the manager. We also spoke with three visiting members of family, and were present during a discussion between a member of staff and a district nurse. Records and policies and procedures we sampled during our visit included the pre admission assessments for three people living in the home the care plans for five people living in the home recruitment, training and supervision records for four permanent staff and four temporary staff working in the home records relating to money held on behalf of people living in the home, activities records, the record of complaints, provider visit reports, and records relating to health and safety and the administration of medication. We observed interactions between staff and people living in the home, including during the serving of lunch. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 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 9 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. 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. Evidence: The AQAA tells us that people receive a statement of purpose and service user guide written in plain English and telling them about the service provided. We looked at the assessments carried out for three people before they were admitted to the home. We found that the persons needs and areas of risk were being assessed, and that the assessment was stating if the home could meet the persons needs or not. During our visit we found that repite care is being provided in the home but that there are no arrangments for the provision of intermediate care. Care Homes for Older People Page 10 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The persons plan of care does not always show that their personal or health care needs are met. The care home could do more to ensure that people are being supported with their medication in a safe way. Peoples right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Evidence: During our visit we sampled the care plans for five people living in the home. We discussed with the manager Mrs Drake that care plans we sampled had not shown clear and detailed guidance to staff on how the person wishes their care to provided and how their care needs are to be met. Care Homes for Older People Page 11 of 32 Evidence: For example, the daily records for one person indicated that they can become anxious and confused. While there was a daily report which showed how one member of staff had been able to reassure the person when they had been anxious and confused, the care plan seen did not provide specific guidance to staff on helping the person manage their anxiety and confusion. The care plan was therefore not ensuring that staff were taking a consistent approach in helping the person manage their anxiety and confusion. The care plan for another person referred to management of their dependence on alcohol. The care plan did not set out in detail the action staff were to take or what plan of care concerning this the person was agreeing to. We also discussed with Mrs Drake that we had found that care plan information was spread over a large number of pages meaning that clear and concise advice to the person receiving care and staff on meeting the persons care needs was not easisly accessible. Mrs Drake said in response that the home will be starting a new format of the How I spend my day record which people will have in their bedrooms and will address how they wish their care and support to be provided. Care plans sampled indicated that care plans are reviewed monthly by staff. The monthly reviews sampled did not indicate that the person receiving the support or their advocate or relative had been consulted as part of the monthly review. The Care Quality Commission (CQC) survey responses we received from people living in the home included comments such as staff (are) very caring, compassionate, and that staff treat patients well and do not talk down to them. People living in the home and relatives we spoke to during our visit said they were happy with the care and support being provided in the home. One person living in the home told us the care is good. The girls work their socks off. Care plans we looked at indicated that generally people are being supported to access the health care they are in need of. Care plans sampled however did not evidence that the health care needs of people with alcohol dependence were being met, or that specialist advice on supporting the person with this had been obtained and included in the care plan. Care Homes for Older People Page 12 of 32 Evidence: The activities records we sampled evidenced that people are being supported by staff to attend appointments such as dental appointments. During our visit we were present during a discussion between a visiting district nurse and a senior member of staff. The district nurse said that the care home staff were doing very well and ensuring that all wounds are being well cared for. The AQAA tells us that medication is audited on a daily basis after each medication round to ensure correct storage, administration and return in accordance with Shaw Healthcare policy and procedures. This was confirmed by care staff we spoke with. A member of staff we spoke to said they believed the arrangements in place were ensuring that medication administration was being done safely in the home. We discussed with a member of staff the guidance staff had on giving medication labelled with the frequency as required (PRN). The member of staff advised us that the reason PRN medication was given each time would be recorded on the care records. We looked at the daily record for one person who had received PRN medication on 25/7/09 but found it had not been recorded there that it had been given or why. Pharmacist inspectors in the Commission have advised that it is good practice to ensure consistency in PRN medication administration that written guidance to staff on when the persons PRN medication should or can be administered be provided. While sampling medication records we found no evidence of this, and discussion with staff and Mrs Drake indicated that the home was not providing written guidance to staff on when the persons PRN medication should or can be administered. Staff we spoke to advised us that all the people in the home are assisted in the administration of their medicines. Staff we spoke with gave examples of how staff support people to maintain their privacy and dignity when personal care is being provided. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Sometimes people who need assistance with meals are not receiving the assistance they need. On some occasions meals are not served on time which can then lead to residents becoming agitated. Evidence: The activities schedule for July 2009 indicated that activities including performers, music for health, residents meetings and a clothes shop had been arranged. Care Homes for Older People Page 14 of 32 Evidence: On the day of our visit a singalong in the morning and bingo in the afternoon were led by the activities support worker. We sampled the activities record for three people living in the home, which indicated that during July 2009 they had joined in activities such as bingo, quizzes, games, painting, singing and a mini bus trip. A member of staff we spoke to told us they found that people with dementia like musical activities and shows, and that the activities support worker does musical bingo which seems to keep peoples interest. Staff we spoke to gave examples of individual activities which the staff team support, such as one person who likes knitting, people who like going to the local shops, and one person who is growing tomatoes. We looked at photographs and reports of the float residents had participated in for the village carnival. The care home also puts on celebrations for other occasions, and a compliments card from a family member we saw said thank you for making St Georges Day such a lovely time for the residents and their family. During our visit we spoke to three relatives of people living in the home, who told us they were welcomed when they visited and that staff contacted them by phone to keep them updated on the care provided. They also said that the relatives meetings which take place in the home are helpful. Mrs Drake told us that up to 10 relatives come for Sunday lunch. Peoples likes and dislikes are discussed at residents meetings, and menus have been changed to fit in with residents preferences. Mrs Drake said they try to keep the menus interesting, and that lamb and mint meatballs have been a recent favourite with residents. We talked with a person who suffers from diabetes and they told us about what the staff do to ensure he keeps to the diet he needs to help manage his diabetes. We sat in the dining area for Nightingale unit, for people suffering with dementia, during the serving of lunch. The main dish choices for the day were fish pie, beef casserole, vegetable bake, and egg or tuna salad. Care Homes for Older People Page 15 of 32 Evidence: Although people were seated at the table, and lunch was due to be served at one oclock, the food arrived at 1.15 pm and the first meal on the unit was not served until 1.24 pm. Some of the people waited patiently for the food to be served, and ate their meal without assistance or distraction. Some of the people became agitated during the wait and there were arguments between residents where staff had to intervene. One woman complained several times about the wait for lunch, and was one of the last people to be served her main meal, this being at 1.35 pm. During the wait four of the residents intermittently got up and wandered around, and were assisted to sit down again although the lunch was not ready to be served. One woman put a whole paper napkin in her mouth and was chewing it during the wait. Later she was puting an empty fork to her mouth as the food still had not been served. All the people except one were given the beef casserole. I asked a member of staff how people with dementia are offered a choice of meal. They told me people choose the day before. I said that because of dementia many people wouldnt remember what they asked for the day before and may not be able to make a choice when asked. The member of staff agreed this was true. It was our observation during the lunch that people who needed assistance with eating were not receiving the help or support they needed. For example, a member of staff was assisting one person to eat, then had to stop to go and assist another person, so the first person got up and wandered away. One person was unable to settle anywhere so ate very little - staff offered prompts but no-one was available to sit with the person to help them concentrate on eating. Staff were seen to be busy but did not have the time required with anyone who needed one to one support with eating. Staff were occupied with serving or waiting to serve meals, asking people to sit down, bringing them back from wandering and so on. Care Homes for Older People Page 16 of 32 Evidence: It was our observation that the long wait for lunch had been stressful for some of the people on the unit, and once the meals were served staff were not able to support the number of people who needed assistance or one to one prompting with eating. It was also our observation that people on the unit were not being offered a choice of meals in a way that was meaningful to them. We discussed with Mrs Drake the problems that had occurred during the lunch we observed. Mrs Drake said after looking at the staff rota that on the unit there had been one experienced member of staff, one member of staff who had only worked in the home for a month, and one member of staff had been from an agency. Care Homes for Older People Page 17 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. If people have concerns about 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. Evidence: We found that the complaints procedure is being displayed in the home. The complaints procedure is also set out in the Service User Guide which people living in the home receive. We looked at the records for two complaints and found that the complaints had been investigated and that the complainants had been advised of the outcome of the investigation and any action taken. The complaints had been addressed within recommended timescales. Training records sampled indicated that staff are receiving training in the protection of vulnerable adults. The AQAA advises us that there are plans for all staff to receive training in the Mental Capacity Act and the deprivation of liberty standards to improve the awareness of staff of this new legislation. Care Homes for Older People Page 18 of 32 Evidence: The AQAA advises us that six safeguarding referrals have been made since the home opened in February 2009 and that three safeguarding investigations have been carried out. Records of safeguarding incidents and their follow up indicate that the home is acting to protect people living in the home. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Their room feels like their own, it is comfortable and they feel safe when they use it. Evidence: The building is new and purpose built with pre-planned safety features. The premises have been decorated and furnished to a high standard. Staff we spoke to told us repairs are carried out in a timely fashion, and the handyman will also help put up pictures and move furniture around for residents. There are three gardens which residents can access, and these are being well maintained. Staff told us that since water features such as a fountain have been added the gardens have been used much more often. On the day of our visit three residents were sitting out in one of the gardens, which has an area for people who smoke. One resident told us that they had asked for a Care Homes for Older People Page 20 of 32 Evidence: carpet to be put down inside the door to the garden to help prevent slips and falls, and that a non-slip carpet had subsequently been provided. The home is arranged into units which each have ten bedrooms, a kitchenette, a dining area and a sitting area. There is a television, DVD and music player in each sitting area. Recent improvements have included each kitchenette being provided with a dishwashing machine. With their agreement, paintings done by people living in the home are displayed in communal areas. All bedrooms have en-suite facilities. There are also communal toilets and bathrooms on each floor, and toilets for visitors. All bedroom, bathroom and toilets visited were found to be clean, odour free and tidy. We visited six bedrooms and found them to be free of clutter and obstacles, and that people had personalised their bedrooms with photographs, belongings and sometimes furniture. One person told us they were allowed to keep a small dog with them. People have their photograph displayed on their door which helps them identify their bed room. Staff told us that where the person does not wish their photograph on the door, this is removed. We visited the laundry room and spoke with laundry staff. Arrangements are in place to try to ensure that people receive their own laundry back. However, the notes from the residents meeting on the 2nd June 2009 record that two people said they hadnt had items of clothing returned from laundry. We discussed this with the manager Mrs Drake who said they were looking into how laundry arrangments could be improved. All areas of the home visited were found to be clean and odour-free. Care Homes for Older People Page 21 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. People would have more safe and appropriate support if there were enough competent staff on duty at all times. People have confidence in the permanent staff at the home because checks have been done to make sure they are suitable to care for them. However, information indicating that all required checks have been obtained for temporary (agency) staff is not always being received by the service which could put at risk people living in the home. People are cared for by staff who get the relevant training and support from their managers. Evidence: At our visit we found some evidence that staff are able to meet the needs of people in the home. For example, one persons daily record which we sampled indicated how the member of staff had supported them when they were agitated and confused. People living in the home who did not have dementia care needs told us that staff worked hard and were helping them meet their needs. During our visit there was some evidence that where people have dementia care needs the staff team was not always able to provide the support needed. For example, Care Homes for Older People Page 22 of 32 Evidence: during the lunch described in the Daily Life and Social Activities section of this report staff were not able to ensure that people were given the time and support they needed to eat in a calm and congenial environment. When we discussed this with the manager Mrs Drake, she referred to the staff rota for the unit on that day and advised us that the staff team had consisted of one experienced member of staff, one inexperienced member of staff, and one temporary (agency) member of staff. The AQAA advises us of the high number of agency staff being used in the home. During our visit we sampled the staff rotas for the 19th July 2009 and found that ten agency staff had been employed in the home on that day. We also sampled the staff rota for the 25th July 2009 and found that ten agency staff had been employed in the home on that day. We discussed with Mrs Drake what the service was doing to ensure continuity of care for the people living in the home with the high number of agency shifts being worked. Mrs Drake told us that interviews for permanent staff were being held every week, and that staff and team leaders were allocated to working the same unit all the time. The AQAA tells us that a high number of staff have completed the National Vocational Qualification (NVQ) in care at least to level 2, and that team leaders are expected to complete NVQ level 3. The AQAA tells us that the service ensure all recruitment checks are complete before a start date is given to a new member of staff. We sampled the recruitment records for four members of permanent staff and found that Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (PoVA) register checks and written references had been carried out, and that new staff were not being started until CRB and PoVA checks and two written references had been obtained. We sampled the information obtained by the service for four members of agency staff who had completed shifts in the home during the week commencing 19th July 2009. We found that recruitment information had been obtained for all four staff, but that for two of the staff it was not recorded if references, CRB and PoVA checks had been obtained by the agency. Care Homes for Older People Page 23 of 32 Evidence: Mrs Drake advised us she would ensure that the agency concerned provide this information. We found that the service was therefore not fully ensuring that non-permanent staff employed in the home were safe to work with the people in the home, and a requirement has been made concerning this. The AQAA tells us that new staff undertake a four day induction programme which includes training in understanding and respecting equality and diversity. One member of staff told us in their CQC survey that opportunities are good for training and taking on more senior roles. The AQAA tells us that recently some staff have completed dementia care and medication traiining and that training is also being offered in equality and diversity and palliative care. Staff training records we sampled indicated that staff are receiving training in the core topics they are required to regularly undertake, such as safeguarding and manual handling. Care Homes for Older People Page 24 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. There are shortfalls in the management of care planning, staffing provision and recruitment, and mealtimes. 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. Evidence: The manager is qualified at NVQ level 4, has achieved the Registered Manager Award, and is experienced in managing a care home. Training certificates displayed in the managers office indicate that she is qualified and continues to update her skills and training, for example in the safe handling of Care Homes for Older People Page 25 of 32 Evidence: medication. Staff and people living in the home we spoke to believe the home is managed well and has a good atmosphere. We found during our visit that the manager is not ensuring that a sufficient number of competent staff were being employed to meet peoples needs, that care plans have a lack of detail that can guide staff on how the persons needs are to be met, and not ensuring that satisfactory checks have been received for all staff. The AQAA tells us that the service has four internal quality audits each year and publish the results around the home. During our visit we found that the service was also seeking the views of people on the service through regular residents meetings (which are well attended) and regular relatives meetings. Improvements that have been made as a result of listening to peoples views have included changing the starting time of supper, and addressing the issue of bedroom doors being difficult to hold open. During our visit we sampled the arrangements for holding small amounts of money for people living in the home. Staff told us they will only hold up to 60 pounds cash per person, which is held in individual wallets with obtained receipts. Where money is withdrawn two staff sign for this. Some items, such as hairdressing in the home, are not individually receipted but covered in a group receipt. A group receipt which we looked at had an entry which we did not at first understand as two amounts were given for one person - £9 and £3. Staff told us the person had paid £3, and therefore £6 remained to be debited from their account. The manager and provider should review if the system of group receipts is fully ensuring that people do not have money debited from their account that they do not owe. Staff told us that balances are checked once per month, and a print-out balance sheet is provided. We sampled the supervision records for three members of staff. These indicated that arrangements are in place for staff to receive regular one to one supervision. We noted together with the manager that records were not available for Care Homes for Older People Page 26 of 32 Evidence: some of the supervisions which appeared to have taken place. The home has told us in their AQAA of the most recent equipment services and tests undertaken, and that an infection control plan is in place. We are also advised in the AQAA that weekly fire testing and regular fire drills take place. During our visit staff told us that a record of bath and hot water temperature records are kept. We found that hazardous materials are stored in a lockable cabinet within a lockable cupboard. Staff training records sampled indicated that staff are undertaking training in health and safety topics such as first aid, safe food handling, manual handling and health and safety. 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 7 15 The provider must ensure 06/11/2009 each service users plan sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the persons health, personal and social care needs are met. The registered person shall make the service users plan available to the service user, keep the service users plan under review and where appropriate after consultation with the service user or their representative revise the service users plan and notify the service user of any such revision. Care plans are not including clear and detailed guidance to staff on how the person wishes their care to be provided and how their care needs are to be met. Monthly care plan reviews 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 are not including the views of the service user or if appropriate their relative or advocate. 2 9 13 The registered person shall 06/11/2009 ensure that up to date guidance on good practice in the administration of medicines is being observed. The home does not provide clear written advice to staff on the administration of medicines to the individual person which are prescribed as required, which can lead to inconsistent and possibly unsafe administering of medicines. The provider must ensure that staff are ready to offer assistance in eating where necessary, discreetly, sensitively and individually, while independent eating is encouraged for as long as possible. People are not always receiving the support they need with eating. 4 27 18 The registered person shall 07/11/2009 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are 06/11/2009 3 15 16 Care Homes for Older People Page 30 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 appropriate for the health and welfare of service users. We found that where people have dementia care needs the staff team was not always able to provide the support needed. 5 28 19 The registered person shall 07/11/2009 not employ a person to work at the care home unless he is satisfied that satisfactory references and checks as required have been obtained for them. We found that the service had not obtained written confirmation that all temporary staff who had been working in the home had received satisfactory checks and references. 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 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. 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