Inspection on 30/04/09 for The Old Rectory

This inspection was carried out on 30th April 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Rectory 23/07/09

The Old Rectory 03/05/07

The Old Rectory 26/04/06

The Old Rectory 10/11/05

The Old Rectory 27/06/05

The Old Rectory 23/11/04

The Old Rectory 26/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Rectory Church Street Tenbury Wells Worcestershire WR15 8BP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Littler     Date: 3 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: The Old Rectory Church Street Tenbury Wells Worcestershire WR15 8BP 01584810249 01584810249 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Chantry Retirement Homes Ltd care home 28 Number of places (if applicable): Under 65 Over 65 28 28 28 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 The home may accommodate one neamed service user under the age of 65 who has both a learning disability and physical disability. The maximum number of service users to be accommodated is 28. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Dementia over 65 years (DE)(E) 28 Physical Disability over 65 years (PD)(E) 28 Old age not falling within any other category (OP) 28 Date of last inspection Brief description of the care home The Old Rectory is registered to provide residential care for up to twentyeight older people who are frail, who may have a physical disability or dementia. Respite care can be provided when a bed is available and in addition two day care places can be provided to people from the local community. The house is an imposing listed building dating back to 1830. Previously a rectory, it is situated within 100 yards of St Marys Care Homes for Older People Page 4 of 29 Brief description of the care home Parish Church and it is also in close proximity to the centre of Tenbury Wells. The home was purchased by Chantry Retirement Homes Limited, in March 2004. Care Homes for Older People Page 5 of 29 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: The service was rated as Adequate at the last inspection on May 30th 2007, and therefore has not been inspected for two years. An Annual Service Review was carried out in May 2008, which indicated that a good service was still being provided. We, the Commission, carried out this unannounced inspection over one day. The manager, Mrs Hope, was on duty and helped with the process. We looked around the home and some people let us see their bedrooms. We spoken to people in the home and to some of the staff. Care Homes for Older People Page 6 of 29 We looked at records such as care plans and medication. We saw how people spend their time and mix with the staff. Mrs Hope sent us information about the service before the visit. This is called the Annual Quality Assurance Assessment, AQAA. It reports on outcomes for people in the home, what changes have been made and plans for the future. It also includes data such as staffing numbers. We sent out feedback surveys to the people in the home, their representatives, the staff and to health and social professionals who visit the home. What the care home does well: What has improved since the last inspection? What they could do better: The Service Users Guide needs to include clear information about the fees, any extra charges and peoples rights when they share bedrooms. Mrs Hope needs to make sure people are only admitted if their main car needs fall under the homes registration categories. Peoples care plans need to include clear guidance about all areas they need support Care Homes for Older People Page 8 of 29 with and show how risks are being managed. All complaints should be recorded to show openly how these were responded to. The programme of guarding to all radiators in the home, for the protection of the people who live there, should be completed. Make the bathrooms more homely and decorate the one on the top floor. Thorough background checks must be made on new staff before they start work to protect the residents. To ensure that the home is run in the best interests of the people who live there, the quality monitoring system should be improved. The AQAA should be more detailed and show that the owners and manager have an accurate picture of the services strengths and areas that need to be developed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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. Prospective residents have information about the home, but this can be improved. People are encouraged to visit and then trial the service. They will be consulted about the support they want and have their needs assessed Evidence: There is a Statement of Purpose for external professionals and a Service Users Guide. The Guide is meant to provide prospective residents with information to enable them to make a decision about their future care needs. The current version could be made much more accessible by the text being larger and the wording plain English. It currently makes statements such as, residents are encouraged to form an association and participate accordingly. It does cover complaints but does not give a contact number for the director it says people should telephone if they are not satisfied with the managers response. The range of fees are not included nor information about what is and is not included in the fees. Regulation 5 states that the fees must be Care Homes for Older People Page 11 of 29 Evidence: included, along with the summary of the last inspection report and the views of people who use the service. The fees for the particular room the new person is occupying are included in the contract they or their representative signs, however this is only issues after the months trial period. There are still shared bedrooms in this service. The Guide should explain how the occupancy of these rooms is managed so anyone making a decision to take a shared room is clear about their rights. Mrs Hope reported in the AQAA that she or the deputy usually undertake the pre admission assessment of any new person. The file of a new person showed that detailed information had been obtained from social services and the hospital. Mrs Hope said she did not complete the in house assessment as in this case she felt she had been given sufficient information. A care plan had been written that included a moving and handling assessment. It is positive that the person had been consulted about her support needs along with her family and health professionals. She said she loves it at the home. A person with chronic mental health needs has been accommodated. Mrs Hope has known the person for many years and health professionals have given ongoing support, however, the service is not registered for people with mental health needs, other than those associated with dementia. The person has already returned to hospital. Mrs Hope needs to ensure that people are only admitted within the registration categories. These should be on display in the home, they are found on the second page of the registration certificate. Care Homes for Older People Page 12 of 29 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. The support provided by staff is personalised and meets peoples daily care and health needs. Their independence is promotes where possible. People, however, cannot be fully confident that their changing needs will be fully reflected in their care plans. There is an ethos of respect, privacy and dignity. This is only compromised by the continued use of shared bedrooms. Concerns are reported and action is taken with the support of local health staff. Peoples medication is being safely managed. Evidence: People were very well presented. The men were clean shaven and peoples glasses were clean. Their clothes are ironed and there were no complaints about clothes being lost or spoiled. The feedback from residents and relatives indicated that the staff treat people with dignity and respect and they feel their needs are being met. A residents friend said, staff are wonderful, my friend does not want to live any longer, but staff are very caring and attentive and always have time. A GP said, they take care to maintain standards. Mrs Hope challenged a relative when they made a discriminatory comment about a resident with special needs. She reported in the AQAA that staff Care Homes for Older People Page 13 of 29 Evidence: have been trained in equality and diversity issues. Seven of the single bedrooms have en-suite facilities that provide greater privacy. There are four shared bedrooms. There are curtains in place but the rooms are relatively small and peoples privacy and dignity must be compromised. To be able to use the required equipment two people are having to share a wardrobe. One man said he had shared with two men who have now both died. He did not feel he was consulted and that people just arrive. Mrs Hope said that people became less concerned about this as they got older. She said people are consulted about who they share with, but there is no record made about this and spare beds in shared rooms are used for respite care. Staff said they did use the privacy curtains but that shared rooms did limit how much privacy can be given. It would be very positive if the owners business plan aimed to end the use of shared rooms in the future as this would better reflect the stated values and aims of the service. Peoples bedrooms are not locked when they leave them, however, those spoken with said they felt their possessions were safe. The individual care arrangements for three residents were sampled. The care plan for a relatively new person could not be found. Mrs Hope said this was located the following day. The files are being looked at each month by Mrs Hope as she described in the AQAA and she has consulted residents about the content. They contained assessments such as nutrition and pressure care but in some cases where risks were highlighted there was no explanation of how this risk was being managed. For example the pressure care assessment, showed a resident who stays in bed is at high risk. There was no specific care plan for this need. She did have pressure areas at the time that the district nurses were treating. Exploration revealed that staff were helping her change position regularly and suitable equipment was in place. The same person can become distressed during personal care and hit out at staff. There was no guidance about how staff should approach her or respond in these circumstances. Discussions showed that heath professionals and the family are involved. Her fire evacuation risk assessment was two years old and indicated that she could still walk. Two people have bed rails fitted but no risk assessments were found. Mrs Hope said the district nurses had arranged for these to be fitted directly from their stores. The nursing files did not contain risk assessments. Following the inspection Mrs Hope provided evidence that a bed rail risk assessment tool has been obtained along with training guidance for staff. She reported that these assessments have now been completed and provided a copy of one. As prompt action was taken a requirement has not been made on this occasion, however, Mrs Hope needs to ensure hazards are always fully assessed in a timely manner. Care Homes for Older People Page 14 of 29 Evidence: The care files did not contain a plan about how peoples social and emotional needs would be met, however the arrangements in the home are very good in this area. Other examples were seen where suitable care is being provided but the plans do not reflect the actual arrangements. The daily log reflects how each persons day has been, and specific information is then transferred to the care plan, for example, if the resident went out or had visitors at home, or details of visits from health care professionals. Charts are also used to show that required care has been given such as regular drinks, position changes, baths and weight checks. Staff said they have read the care plans and are kept informed about changes in peoples needs. They felt that peoples health needs are monitored closely and the home is well supported by the Primary Health Care Team. The Lead Continence Advisory Nurse reported, the service has a positive attitude towards the promotion of continence. They always phone for advice. Privacy and dignity are always respected and they try to maintain peoples independence and dignity. A district nurse said, when we visit all the residents look clean, tidy and well cared for. The manager and senior staff carers liaise well with us and act on our instructions. The medication is stored appropriately and the system seemed well managed. The five senior staff communicate effectively about changes. A monitored dosage system is used. Administration records had been completed to a satisfactory standard and a check of the controlled drugs showed that the balance was correct. Records show that regular medication reviews are undertaken by the GP, and that training is provided for staff on the administration of medication. Staff have been trained to administer insulin and they have also completed an accredited medication management course. Several of the staff have attended palliative care training and links are in place to support people who are dying. The care plans seen did not contain a plan around how people wish to be supported at this time. Care Homes for Older People Page 15 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living at The Old Rectory have complete freedom of choice in regard to their contacts, both within and outside the home, and they are enabled to make choices about all the activities of daily living, how to spend their day and whether to join in the various pastimes. People like the food and have a choice about what they eat and drink. Mealtimes are relaxed social occasions. Evidence: The home had a relaxed and friendly atmosphere. People said they choose where to sit, as there are two lounges. One resident said she likes the staff and other residents. People were observed to interact with each other in one lounge in a friendly manner. The home is very much part of the local community, and its proximity to the town centre is of benefit in this respect. The Old Rectory describes itself as having an open door policy. The involvement of family and friends is actively encouraged. Some people had visitors on the day, staff offered them drinks and were helpful when questions were asked. One visitor told us, my friend has been in the home for a year and I cannot fault it. A daughter said there are no restrictions on visiting. I receive information in between visits if mother is unwell or on new medication. Care Homes for Older People Page 16 of 29 Evidence: Organised activities are regularly available, although some people said they preferred not to join in. A wall chart in the dining room showed the activities for the week. Three activities workers come in each week. One brings their dog, which is popular. Some input is paid and some voluntary. Activities such as knitting, art and games are provided in the mornings. One person drives the tail lift bus and outings are arranged each week, weather permitting. A group went out after lunch and there was a buzz of excitement about this. A small group went on holiday to Blackpool last year and enjoyed entertainment and dancing. Local community activities are accessed, for example a group had gone to see the town band one evening. Some went for a meal in Little Hereford recently and there was also a Christmas meal. The spiritual needs of residents are considered. A monthly service is held at the Home, and people are enabled to attend church, if they wish. Staff said that two people go out independently and they support others to walk around the garden and go into town. Fund raising activities are organised, at which some items produced by residents are sold, and have included coffee mornings and garden fetes. Pupils from the local school also do community projects that involve residents at the home from time to time. Recently some have done projects on the lives of the residents who took part. A display in the hall showed some of the work. Photos are also displayed and there are albums from outings and celebrations that provide a good talking point and memory aid. Residents meetings are held by one of the activities workers and leisure activities are discussed as well as the menus. The meals service continues to be developed. There are currently 14 people in the community who get a Meals on Wheels service. The kitchen is appropriately staffed and the cook was seen asking people for their choices and agreeing different options in a helpful way. The daily menu is one display. Mrs Hope said in the AQAA that a four week menu plan is arranged every quarter and that peoples preferences are taking into consideration. The meals observed were relaxed and unrushed. People had different drinks and aids were used to help people remain independent. The plates were nicely presented and afterwards several people said they had enjoyed their meal. The special dietary needs of residents currently include diabetic and weight lost diets. Care Homes for Older People Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel they can give their views and raise concerns they have. Records of complaints need to be accurately maintained and disclosed to us. People feel safe in the home and staff are trained to help protect them. Poor staff recruitment practices have put people at potential risk. Evidence: There is a procedure for investigating complaints. As mentioned under Choice of Home, the information in the User Guide did not contain contact details for the owners, who a complainant should contact if they are not satisfies with the managers response. Mrs Hope did not explain in the AQAA how these standards are met. She also reported that no complaints have been received. A complaint had been made by a contacts manager from the local authority who had copied her letters to us. The issue was about a resident having to move rooms against her wishes. Mrs Hope made the move because the person could not afford to pay the rate for the room, which had been increased since she moved in. There was no record of the complaint in the home to evidence how this difficult matter was resolved. Mrs Hope said the owners dealt with this over the phone. Two formal letters had been written so it would have been appropriate for any conservations to have been followed up in writing. All complaints should be recorded in the home and the information provided to us in the AQAA about complaints must be accurate to demonstrate the service is operating transparently. Care Homes for Older People Page 18 of 29 Evidence: Mrs Hope was trying to arrange a meeting with another persons social worker because their funding had also not been increased to match the increase in the fees for that size bedroom. Mrs Hope explained that the owners put the fees up annually in the Autumn. This seems unhelpful as social services will always set their budgets from April 1st each year. As stated before the Users Guide must make it clear about how fees will be managed to prevent this type of pressure being put on people in the future. Residents and their families gave feedback that they felt confident that any concerns raised with the management would be listened to and addressed in an appropriate way. People felt that their views were welcomed, and they were aware of the procedure to be followed if they needed to voice any concerns. There is a policy and procedures on adult protection but this was not viewed. There have not been any safeguarding issues raised since the last inspection. Staff spoken with said they would recognise and report and abuse or neglect and that they had received training on this. Mrs Hope has arranged training on the Mental Capacity Act and she and the deputy were due to attend training on the new Depravation of Liberty Standards. Mrs Hope was not aware of the introduction of the Independent Safeguarding Authority on April 1st 2009 and she was not following staff recruitment regulations and has therefore been putting people at potential risk. More detail about this is given in the staffing section of the report. As reported under the health section bedrails were in use without a risk assessment being completed. Care Homes for Older People Page 19 of 29 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 live in a warm, clean, safe, comfortable home that has been adapted to help them be independent. People would have increased privacy and dignity if all bedrooms were single. Evidence: The Old Rectory is located in a quiet area of Tenbury Wells, with easy access to the town centre. The house was converted into a residential home in 1985, and has been developed and upgraded to provide comfortable and reasonably well maintained accommodation.. The grounds, although not extensive, are accessible to residents. There are two pleasant lounges situated on the ground floor, and a large dining room, all of which are suitably furnished. The home smelt fresh and looked clean. There is a lift and some adaptations have been made to enable independence such as wall bars. Occupational Therapists as involved to assess peoples mobility needs. Emergency lighting is provided throughout the Home and a generator is available to maintain power supplies in the event of an electricity failure. Mrs Hope said in the AQAA that the heating and lighting have been improved in the last two years. She said bedrooms are decorated periodically usually when they are vacant. The bedrooms are well ventilated and centrally heated, with each radiator having an individual thermostat, to enable the heating to be adjusted. Two radiators remain unprotected. Care Homes for Older People Page 20 of 29 Evidence: One in the new wet room is quite high so blocking in the pipes may be sufficient to reduce the risk without loosing space needed for equipment. The second is in a bedroom and the person does not want one fitted. Mrs Hope is considering setting up a disclaimer. The bedrooms seen were comfortable. People had some personal items such as televisions, photographs and cloaks. As mentioned it would be positive if the use of the four shared rooms could be phased out. The two seen were small. One man walks directly past the other mans bed to enter or leave his room as the room is a dogleg. One woman who is bed bound is being moved in her bed regularly to enable staff to use a hoist to assist the person she shares with. The home is clean and fresh throughout. The laundry is in the cellar and is well equipped and staffed six days a week. Staff confirmed that they are familiar with the procedures regarding the control of infection, such as the laundry management systems. Bars of soap, which could be shared, were by both baths seen and some toilets did not have any pump soap, so this is an area that needs reviewing. Gel hand cleaner is in the lobby with a sign asking visitors to use it but this was not pointed out by staff answering the door. A maintenance worker is employed. Mrs Hope said in the AQAA that some areas have been decorated such as the main entrance hall, and new carpets are fitted as needed. She has started a programme of replacing the bedroom furniture and fitting rooms with matching new curtains and bedding. This is in an early stage with three rooms competed. A summer house has been purchased to enable people to enjoy the garden but have some shelter. Seven people in single bedrooms have ensuite facilities. There is a shower or wet room on the ground floor and an assisted bathroom on the other two floors. The main bathroom is not homely as it used to store continence supplies and to sort dirty laundry. Other toilets also had continence supplies on display. The top floor bathroom was more homely but the wallpaper is stained and coming off. Mrs Hope reported that the house could be improved more quickly if the local authority fees were increased. Care Homes for Older People Page 21 of 29 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 are being supported by sufficient staff who are being appropriately trained. They like the staff and feel they treat them with respect and listen to them. Recruitment procedures are poor and have put people at potential risk of harm. Evidence: There is a minimum of three care staff on duty throughout the waking day, and at night there are two waking staff. There are one or two additional carers until 10am to help people get up. These staff then go home and come back for the evening shift. There is usually a senior member of staff on or the manager or deputy. As reported above catering, domestic, maintenance and activities staff are also employed. This allows care staff to focus solely on meeting the support needs of people in the home. Some staff feedback reported that the level of staff is sufficient when the home is quiet with some vacancies and without people who have high care needs. But they would have more time with residents when the home is busier if four carers could be on throughout the day. Feedback from the residents about the staff was very positive. Only one person said they felt the staff were pushed at times. Staff were observed to meet peoples needs in a helpful and cheerful manner. Staff feedback indicated that they feel the team all provides a good standard of care. The team has been quite stable with only two people leaving in the last year. Agency staff are not used and Care Homes for Older People Page 22 of 29 Evidence: gaps in the rota are covered by staff working flexibly. The Skills for Care induction is provided for new care staff, and Mrs Hope has systems to monitor what staff training is needed. The staff spoken with confirmed that they have attended relevant training for their role such as Dementia, Adult Safeguarding, Moving and Handling and First Aid. Several staff have recently completed a three month course on health and nutrition. Mrs Hope will use DVDs to refresh peoples knowledge but prefers staff to access external courses when they are learning new areas. Efforts to get an many staff qualified as possible is proving successful as 14 staff now hold an NVQ award approximately 70 percent. Some also hold the level 3 award and others are working towards this. Mrs Hope is an NVQ assessor so can support staff during the process. Staff meetings are not held very often, about three times a year. However, staff seem to keep well informed through the communication systems and this does not appear to cause any negative outcomes for residents. Mrs Hope said she aims to provide staff supervision every two to three months. The files seen indicated that this is not always achieved. This can be an essential tool in staff development and to help protect residents by giving staff the opportunity to speak in private about their work. It would be positive if the frequency of sessions can be increased to at least six per year as detailed in the National Minimum Standards. The files of two recently appointed members of staff were inspected. Essential information was missing from both of them. One person had been started before a clear Protection of Vulnerable Adults, POVA, First check had been received. This must be in place before a worker starts as it is an offence to employ someone who is on the POVA List. Mrs Hope said the worker had not worked unsupervised until the check arrived, this is positive however the arrangement is still illegal. The second worker started at least a month before her POVA First check was received and there were no references on her file. Following the inspection Mrs Hope found one and faxed this to us. It was handwritten on A4 paper with no date on it. It had not been marked to show when Mrs Hope received it and there was no evidence that she had made any enquiries to check it was genuine. The regulations require that two references are in place before a worker starts in post. Registered people must make reasonable efforts to ensure the information they receive is genuine. The quality assurance processes and Regulation 26 visits should include audits of the recruitment process so the owners can be confident that they are meeting their legal responsibilities. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally benefiting from a well run home. There is a positive ethos in the home that promotes a good quality of life for the residents. Some shortfalls have put them at potential risk. The owners and Mrs Hope need to improve the formal quality assurance systems to help ensure that acceptable standards are always maintained. Evidence: Mrs Hope has been in post since the Spring of 2007. She was registered with the Commission in June 2007. She was previously the manager of another local care home and has many years relevant experience. The Deputy has worked in the home for 22 years. Mrs Hope said one of the owners visits the home and meets with her regularly. Incidents have been appropriately reported to us such as deaths and people developing pressure sores. A requirement was made at the last inspection to implement an effective quality assurance system. Peoples views are being activity sought through annual surveys Care Homes for Older People Page 24 of 29 Evidence: and the residents meetings. The owners have still not yet implemented a more formal approach to monitoring. An effective auditing system would have shown up that suitable recruitment procedures are not being followed. It is positive that medication audits are carried out. Audits need to be expanded to areas such as care plans and health and safety. Accidents are only analysed annually, which may be too late to identify a trend. The AQAA was brief in many areas and did not clearly show all the homes strengths and areas for improvement, such as care planning and recruitment. The owners need to ensure this tool is used fully and contains accurate information otherwise an inspection will be needed each year to establish the quality of the service being provided. The best interests of people living in a home are safeguarded by the policies and procedures and record keeping practices. As mentioned above some shortfalls in these area have been identified, for example essential information was missing from care plans and the recruitment procedure had not been followed. The records for one residents finances was seen. These showed that the expenditure billed to the family was appropriate, such as chiropody. Appropriate insurance cover is in place and was on display. A health and safety policy and procedure is in place, and all staff are trained in safe working practices. The fire log indicated that fire safety checks are being carried out, with the required frequency, there is a fire risk assessment and fire drills are undertaken. An emergency evacuation contingency plan is also in place. The last Environmental Health inspection resulted in a Four star rating, which is very positive. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 18 19 All staff in post must have the appropriate background checks in place. New staff must not start in post until all required checks are in place in line with Regulation 19. This is to ensure that people living in the home are protected. 31/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Develop a Service User Guide that contains helpful information in plain English and is printed in large text to help those with poor sight. It should contain the summary from the latest inspection report, details of the fees and any extras people with have to pay, contact details for the owners under complaints, and a sample of the views of people who live in the home. The assessment process needs to make sure the primary need of any person admitted to the service falls within the registration categories. 2 2 Care Homes for Older People Page 27 of 29 3 7 Care plans should include details of how people social and emotional needs will be met and their wishes regarding dying Care files can be improved to include care plans that clearly demonstrate the arrangements in place to meet specific identified needs. The information should be detailed enough to guide staff about how to provide consistent and personalised care. Have a system in place to ensure that hazards such as bed rails are assessed in a timely manner to help ensure peoples safety and wellbeing. Keep a record in the home to demonstrate how concerns and complaints are responded to. The owners should review how fee increases are managed and be transparent with people about how these may affect their right to stay in the bedroom they originally chose. Redecorate the top floor bathroom and make bathrooms more homely. Consider if a corridor door could open the other way to enable better access by the ground floor toilets and wet room. The owners should develop a business plan that will enable the use of shared bedrooms to be phased out. Ensure people do not share soap bars and people can always wash their hands with soap after using the toilet. Ensure the AQAA is fully completed and includes accurate information, such as the number of complaints received. A systematic quality assurance system should be developed to help ensure standards do not fall between inspections. 4 7 5 7 6 16 7 17 8 9 21 22 10 11 12 13 23 26 31 33 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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