Inspection on 09/10/09 for The Shrublands Centre

This inspection was carried out on 9th October 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

The Shrublands Centre 19/11/09

The Shrublands Centre 27/09/07

The Shrublands Centre 06/03/07

The Shrublands Centre 19/10/05

The Shrublands Centre 23/06/05

The Shrublands Centre 01/02/05

The Shrublands Centre 20/09/04

The Shrublands Centre 20/01/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: The Shrublands Centre Faringdon Road Cumnor Oxford Oxfordshire OX2 9QY     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: Ruth Lough     Date: 0 9 1 0 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 Shrublands Centre Faringdon Road Cumnor Oxford Oxfordshire OX2 9QY 01865865561 01865861945 ncollins@oxfordprivatecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Jane Quartermain Name of registered manager (if applicable) Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The number number of service users to be accommodated is 7 The registered person may provide the following category 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 category: Old age, not falling within any other category (OP) Physical disability (PD) Date of last inspection Brief description of the care home The Shrublands Centre is a family owned and managed residential home for older people. The home is located in a rural location some 5 miles from the City of Oxford. All rooms are single, two of which have en suite facilities. There are pleasant gardens and an outdoor swimming pool for residents use during the summer months. The Care Homes for Older People Page 4 of 32 Over 65 7 0 0 7 Brief description of the care home weekly charges for this service range from £600.00 to £650.00 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 was an unannounced key inspection process carried out as the last assessment of the quality of the service by the commission, was in September 2007. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and any returned surveys to the commission before a one-day visit to the home. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The AQAA from this service was returned within the required timescales and gave a brief overview of what they provide and what they have developed to improve the Care Homes for Older People Page 6 of 32 service over the last two years. The registered manager was not present when we visited the service on 9th October 2009, between 11:15 and 18:15. During the day the records for care planning, recruitment, and administration of the service were assessed. Six people using the service were involved with the inspection process. We met with four staff, and one visitor who was present in the home. The people who use the service and the staff who are employed in the home were also consulted about their opinion of what is provided, through surveys. Of the 3 people who are in receipt of support that we contacted 2 had responded at the time of writing this report. Staff, healthcare, and social care professionals were also contacted through surveys sent to the home to distribute. However, none responded. From this visit it was found that there were a number of areas that they will need to improve to protect the people they support resulting in five requirements being made to ensure that the service carry them out. A number of good practice recommendations were given at the time of the inspection visit and can be found in the body of this report. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents cannot be confident that they will be given sufficient documentary information about the services on offer as to assist them make a choice to live there. They also cannot be confident that their needs will be thoroughly assessed as to assure that the service will be able to meet them. Evidence: Mrs Quartermain, provided a copy of the most recent Statement of Purpose and Service User Guide. This was used to assess what information prospective residents are given to assist them to make an informed choice to use the home. The documents that were provided appear to have a date recorded as last reviewed in 2007. However, details in the content show some but not all information is correct to the present staff team. The main areas of required information have been included but there is only a brief outline as to whom the service intends to provide support and accommodation to, which are people who are, elderly, disabled or have dementia. Care Homes for Older People Page 10 of 32 Evidence: The criteria given that is used for admission to the home is that the person applying for a place completes an assessment document and the service will assess their needs following this. The description of the range of care and support they can expect to be provided with is very brief, offering residential care and rehabilitation. It clearly states that it does not provide nursing care which is accessed from the District Nurse team. In the documents provided to the commission there is nothing to show that prospective residents should expect the companionship of three dogs that are resident in the home or that some of the communal spaces such as the dining room and conservatory will be used for the purpose of an associated domiciliary care service owned by Mrs Quartermain. It is also not highlighted that some of the bedroom accommodation is on the first floor and residents who intend to live there must be sufficiently fit and able to use the stairs as there is no lift. The information about the complaints procedure summary is incorrect as to the contact details of the commission. The people living in the home provided information about the decision making they made to come and live in the home. One person stated that a stay of respite which was advised by a medical practitioner which resulted in the decision to make the home their permanent residence. Others said that they sampled other services and this was their preferred place and they have enjoyed the experience greatly since their arrival in the home. It was apparent that the opportunity to visit the home was supported by the staff and provider and that individuals were involved as much as possible in the final decision that the service was the right place for them. The records for two residents were reviewed to see the quality of the assessment process that is carried out by the service before a decision is made that they will be able to meet the individuals needs. Both records showed that the assessment documents although request a broad range of information to be obtained have not been completed sufficiently. One form was almost blank and there was no other supporting documentation provided to show that the Registered Manager or Mrs Quartermain had sought further information from any medical practitioners caring for the person concerned as to assure that they will be able to meet their needs. From information given both residents had been living in the home for over a year. Care Homes for Older People Page 11 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 people who are in receipt of support cannot be fully confident that they will obtain the care and support the need as the quality of the record keeping does not ensure that staff are given the necessary instruction to do so. The practices for safekeeping and the assessment of risks for the administration of medications in the home do not protect residents. Evidence: The people we spoke with were very complimentary about the care and support they were provided with. They also confirmed that they were assisted to obtain the medical care that they may require and routine health checks for their dental, hearing, and eyesight needs. The sampled care records show that staff are provided with the basic personal information about the persons next of kin, GP and any other health or social care practitioners involved with their care. A summary of the key information about the person including some personal choices of their daily routine is given as to assist staff have an overview of the person concerned. The care plan documents consist of Care Homes for Older People Page 12 of 32 Evidence: providing information about the main areas of support people may need, topics include personal care, moving and handling, meals and mealtimes. We were informed that these records were used in conjunction with the general risk assessment document which covered various aspects of individuals lives. From reviewing these documents and through discussion with the provider there are a number of areas of care and support required that are not reflected. This was particularly relevant to specific mental health and nutritional needs which have a significant impact upon the people concerned. The weak information in the assessment process which should highlight their medical and mental health needs has not assisted in giving staff comprehensively documented information of the person they care for. What was good was the focus in the daily records written by the care staff about the outcomes and experiences people had which showed a good picture of their daily choices they made and the care that they received. The information, storage and some of the practices for medication administration were reviewed. This was to see if safe processes are in place ensuring that they protect the residents they support and that that the home comply to legal requirements in regard to its responsibilities for this. Individual care plans were also reviewed to see what information, instruction and risk assessments are in place for people to receive their required medication. We were verbally informed that one resident keeps and manages their medication independently and has done so since they commenced living in the home. The service manages the other six residents medications which are supplied by a local pharmacy in NOMAD boxes, a weekly pharmacy pre-dispensed method of administration. We looked at the storage facilities in the home for the medications administered on residents behalf. The medication cupboard, although suitably secured and appropriate for the safe keeping of medications it was sited in the laundry room. This is contrary to guidance given in, The Handling of Medicines in Social Care (Royal Pharmaceutical Society of Great Britain) and does not ensure that the medications can be kept at the required safe temperatures, protect them from moisture and against the possible spread of infection. These concerns were passed back immediately to Mrs Quartermain and a requirement was made for alternate storage within 7 days. The information in regard to the care support, risk assessment and reviewing of the safety for the person who manages their own medication was also assessed. This was to see if they are still able to manage these appropriately and the system for this protects both the individual and the companions they live with. From looking at the care records for this person there is nothing noted in the planned care for ensuring that the person receives their prescribed treatment from their GP. Neither was there a Care Homes for Older People Page 13 of 32 Evidence: recorded risk assessment as to them being capable to do so. The safekeeping practices for some of the medication for this individual appear to quite relaxed, as some of the items that were prescribed had been left unattended in their room. The concerns about the lack of a documented risk assessment as to support the Registered Managers decision that safe practices were in place for this person to continue to manage their own medication was passed back immediately to Mrs Quartermain. They were requested to complete a review and risk assessment for this within 7 days from the inspection visit. The care plans we reviewed did not hold much information about personal choices that the individual had about their care and support should their health deteriorate or at the end of their lives. This is an area that they could develop in seeking and recording the wishes of the person concerned as to support them being carried out if they are unable to voice them themselves. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are supported to have the lifestyle that they choose. Evidence: The people involved in the inspection very positively expressed that personal choices of how they wish to conduct their lives was listened to and acted upon. Choices of when they got up in the morning, when and where they ate their meals and if they wanted to join in with what was going on in the home were all emphasized as important to them. They also stated that the friendliness and being part of the small family group was a significant part of why they liked living there. They also stated that their privacy was protected and if they chose to remain in their room this was also respected by staff. We looked at the information in the two sampled care records to see what is noted about personal choices and daily routines as to identify if staff are given sufficient information about how the people concerned like to conduct their lives. From looking at the summary document which gives a brief overview of the individual there is some information about choices for key times of the day. However, this information did not reflect what staff and residents were able to verbally inform about their preferred pattern of their day or week or their activities they were involved with. The only Care Homes for Older People Page 15 of 32 Evidence: indication in the records was the detail written in the daily outcomes completed by the staff supporting them. The Responsible Individual was advised to look at expanding this recorded information as to ensure that there is a consistent approach by all staff to meeting individuals choices and needs for their daily lives. From what information that was available and from discussion with residents and staff there were a mixture of events and activities provided in the home. Some were more orientated around individuals going out with support or continuing with external activities independently or with their families. The information in the AQAA stated that they had improved the outdoor swimming pool for residents to use, although it was difficult to establish if any of the residents actively used this facility. Other information given was that they had replaced some of the games available for people to use. Residents stated that they enjoyed TV, films and some board games and individual pastimes such as reading. They also provided information that a local member of the community came weekly to conduct a church service with them if they wanted to participate. Arm chair exercises sessions are provided on a weekly basis and a musical entertainer visits the home every 3 months. Some residents also enjoy cooking, scrabble and bingo as part of their regular activities. We were provided with information about how the meals and menu planning for the home are carried out. Much of the planned meals were flexible to seasonal changes and personal choices. From what residents were able to inform that if they did not what was planned alternatives were swiftly provided. Comments made were that they enjoyed the food that was on offer, one resident put in a returned survey, The food is very good. They confirmed that they were offered two cooked main meals each day, tea, coffee and snacks were available whenever they wished. The main meals are usually taken in the large kitchen area, the dining room appears to not be used for this purpose. However, it was very apparent that residents enjoyed the atmosphere of having their meals there where they could observe and participate in part of the preparation and clearing away of the meals. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the service can be confident that their concerns or worries will be listened to but they cannot be assured that all the staff have the competencies, skills or knowledge to handle any possible harm or abuse should it occur. Evidence: During discussion with residents it was clear that they felt very confident that any concerns or worries they may have would be listened to and acted upon. They gave very positive comments about Mrs Quartermain and stated that all the staff were approachable. One resident put in a returned survey, as to what the home did well, Very good at listening. The home provided information that they have record two formal concerns during the last 12 months which were investigated within a short period of time from when it was made. As previously stated when reviewing the information given in the Statement of Purpose and Service User Guide, the contact details of the commission is incorrect in the summary of the homes complaints procedure that is given to residents. They were advised to amend the details accordingly to ensure that residents have the most up to date information as soon as possible. We looked at the training provided to staff for Safeguarding Adults from possible abuse as this was an area highlighted during the last inspection that not all staff had Care Homes for Older People Page 17 of 32 Evidence: obtained recent training. From information provided by the training coordinator and Mrs Quartermain, of the 7 care staff employed only 4 have had Alert to Abuse training during the last 2 years, 2 others have not had training for at least 3 years. One member of staff who has been working in the home since 2005 has, according to the records provided, not received any training in this topic. There was no information given as to the training that the Registered Manager has obtained as to ensure that the person in charge of the day to day running of the service has the necessary skills and knowledge to act should concerns arise. Information given in the AQAA states that refresher training for this topic is intended to be provided over the next few months. What could be seen was the planning for staff to be updated on The Mental Capacity Act 2005 and implications for providing care and support. However, this will not provide staff with sufficient information or give them a good understanding of the local interagency procedures that they may have to instigate if they have concerns about the well being of a resident. Care Homes for Older People Page 18 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. That the home is maintained well and meets the current needs of the people who live there. Evidence: The service is provided in a large family home in a rural setting approximately 5 miles from the centre of Oxford. The building is set back from the main road and views to the rear of the local countryside for residents to enjoy. Of the seven bedrooms, six give the occupants very good spaces to use, two of these are en suite. The seventh bedroom is smaller but is still comfortable and can accommodate sufficient furniture and fittings for the person to use. The bedrooms are situated on the ground and first floor. The first floor is only accessible to people who can continue to use the stairs safely and independently. To the rear and side of the building parts of the grounds are used by the domiciliary care service company that the provider, Mrs Quartermain is responsible for. Therefore there is at times the traffic of vehicles passing through the driveway to the offices and car park of service behind adds a little interest to residents to observe. There is plenty of space for visitors to the home to park their cars safely away from the main road. The garden areas to three sides of the home are usually accessible to residents, although repairs are currently being made to some of the pathways to Care Homes for Older People Page 19 of 32 Evidence: ensure that they are safer to use. There is a heated swimming pool in the garden to the side of the property. However, it was not clear at the time of the inspection how much this is actually utilized by the people living in the home at the present moment. In the information given in the Statement of Purpose and the Service User Guide residents are informed that they have the use of the large dining room and conservatory. From observation during the day it appears that these areas are not used much by the residents in the home and we were told that the DCA(Domiciliary Care Service) use this space for training, staff meetings and other activities. The provider has used part of living room adjoining the lounge for managing the administration of the service. This arrangement although not necessarily appropriate and could ffect confidentiality is enjoyed by all the residents as it adds to the informal and family atmosphere that the service provides. Much of residents time is also spent in the large kitchen which they use as part of the shared communal spaces in the home. We were also informed, by Mrs Quartermain, that the redecoration and refurbishment of the kitchen was planned as soon as they are able to do so as there were aware that the flooring is worn and some of the kitchen units and furnishings need replacing. Throughout the home it appears generally maintained well, comfortable and homely. Bedrooms, bathrooms and communal areas are kept decorated, clean and tidy. Some care should be taken to make sure that the link corridor on the first floor is free from house hold items and redundant furnishings being left there. The residents have been supported to personalise their bedrooms with their own furniture if they wish and ornaments and possessions. At the last inspection visit it was stated that the service were planning on obtaining planning permission to provide a further en suite bedroom in the home. From discussion with Mrs Quartermain these plans have not gone ahead and were still under review. One area they will still need to develop is the protocols for transporting soiled linen to the laundry room that is accessible internally only through the kitchen, as there is no independent access from the other living areas of the home. Alternative routes were discussed as to achieve safe processes in the future. We looked at the general practices in the home for managing the control of infection. Liquid soap and paper towels could be seen in the majority of the communal areas where people need to wash their hands. The single downstairs toilet that is used by staff and residents had only a linen towel in place instead of a paper towel dispenser Care Homes for Older People Page 20 of 32 Evidence: which Mrs Quartermain stated had been removed recently whilst redecoration was taking place. They were reminded to replace this as soon as possible as to maintain good hand hygiene around the home. Care should also be taken to not store towels and disposable items such as pads, aprons and gloves in the communal bathrooms and toilets as to minimize the spread of infection around the home. A large amount of these items were found to be stored in the downstairs shared bathroom. Likewise, there appeared to be some personal toiletries belonging to residents kept there. These were removed and alternative storage found for them or returned to their respective owners before the end of the inspection visit. Mrs Quartermain was given a recommendation to revisit the topic of the management of the control of infection with staff as to ensure that good practices are put in place in the future. We were informed that this was part of the planned training for some of the staff. 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. That the homes staffing levels meet the current needs of the people who live there. The people who use the service cannot be certain that the recruitment practices and training of staff will ensure that the have the necessary skills and knowledge to carry out their roles to support them. Evidence: The residents involved in the inspection process were complimentary about the staff who care for them. They particularly made special reference to Mrs Quartermain who they felt was very supportive to them. A comment in one of the returned surveys was made to what they thought the home could do better, Employ longer term night staff. We looked at the current rota on display in the home to see what the staffing levels were and if sufficient numbers of staff at peak times of the day when residents were most actively requiring support. From what could be seen that was recorded there is a core team of care staff present in the home. During the day there were at least two staff present and at night one member on duty, one on call and sleeping in the building. Seven members of staff were recorded as part of the normal rota. What was not noted was the full name of the person concerned, when the Registered Manager was present in the home, and when extra staff are brought in to cover shifts as was Care Homes for Older People Page 22 of 32 Evidence: seen during the day of the inspection. In the information given in the AQAA it was given that of the 7 carers employed 4 had obtained an NVQ 2, since the completion of the this and the inspection visit to the home this has not changed. Although there was no information about the domiciliary care staff used as bank staff when required. We looked at a sample of recruitment and employment records to see if robust practices are carried out that protect the residents living in the home. Two records were initially reviewed a third was produced when it was identified that an extra member of staff had come on duty in the afternoon of the inspection. All three records showed that the member of staff had been initially employed or recruited as a domiciliary care worker with Oxford Private Care Ltd, the company that is based in the grounds of the home. All three records showed that they had completed application forms, some with greater detail than others, completed health declarations and Criminal Records Bureau and Protection of Vulnerable Adults list checks had been obtained. For one there had been only one reference obtained from an employer who had retained the member of staff for just over 3 months, a reference from a previous professional long term employment in care had not been sought. We were informed that this would be available before the end of the inspection to verify that all checks were in place. However, this was not provided. The quality of some of the accompanying records were varied, some showed evidence of a formal interview of the candidate. There was insufficient information available to show the decision making that the person was suitable for the role they were employed for or the transition to the care home staff team. From information given by Mrs Quartermain they intend to use the services of the domiciliary care service for their recruitment and training of staff and they have recently improved the documented records to provide supporting evidence for this. However, this could not been fully seen in the records reviewed during the inspection process. We also looked at the training information available about the induction, shadowing, and mentoring for new staff. From what evidence was available in the information in their contracts that there is a 3 month probationary period, but this was not evident in the sampled employment records. There were some supporting information to show that staff were taken through the Common Induction Standards and the training record for all the staff show that they have completed this. The service has an employment checklist in place to assist them ensure that they have the required information obtained about the member of staff. From looking at this they have not used these as effectively as they could. Care Homes for Older People Page 23 of 32 Evidence: We were provided with the training information for the seven members of care staff identified on the duty rota. Information was also given about a manager who is part of the team, but not on the rota. From this it could be seen that a number of staff were not up to date with the necessary health and safety training they should have to carry out their roles. Some staff were recorded as using previous training acquired before coming to work in the home, where topics such as First Aid and Food Hygiene had not been revisited for 4 years. What could be seen was that the services training coordinator had commenced plans to implement a new training programme to ensure that staff have the necessary training they require. 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. The service is not always run or managed in the best interests of the people living there. The gaps in the record keeping, leadership for the day to day management of the service and some of the safe working practices carried out, do not support that there are always good processes in place. Evidence: Comments from residents included; Very pleased I came here! Generally the home is well run. During the last inspection process in September 2007 it was identified that the Registered Manager, who registered in July 2007, was not in control of the day to day management of the service. We were informed at that time that a new manager would be applying to take up this role as to be able to support the service appropriately. Care Homes for Older People Page 25 of 32 Evidence: Having reviewed all the information held by the commission in regard to this service there is no evidence that this has occurred. As previously noted, in this report, the recorded duty rota does not indicate when the Registered Manager Lucy Dallimore is present in the home for the day to day management of the service. Neither was there any documentary evidence that there was a person actively leading the management of the service on a daily basis. Mrs Quartermain stated that she herself was present in the home seven days per week to manage the service which was confirmed by some of the residents involved with the inspection process. It was previously seen at the last inspection process that they have formal methods, through surveys and residents meetings, for seeking the residents opinion of the services provided. A copy of the last process using surveys, in 2009, was reviewed and showed that residents overall were pleased with what they were provided with, the only concern expressed was by one relative about the management of the 3 dogs living in the home. From information given by Mrs Quartermain, she responded to the expressed concerns formally by letter putting forward actions taken to rectify them. We were also informed that there are 4 weekly staff meetings and occasional residents meeting, although supporting evidence for these were not provided. What was evident through discussion with some of the residents that they always felt included in what was going on in the home. From information provided the home does not handle any monies on residents behalf, the usual practice is to invoice them for additional expenditures made, such as incontinence pads, hairdressing, papers or the services of a chiropodist. At the last inspection process a recommendation was made to carry out formal supervision meetings per year with staff. It was apparent from the documentary evidence given and some of the employment records reviewed that this may not of occurred with the frequency that is recommended. For one new member of staff who commenced in the home at least 3 months previously there was no evidence that any form of supervision or mentoring had taken place. We looked at what the home has in place to ensure that there are safe working practices carried out in the home. As previously highlighted the practices for the management of the control of infection in the home have not been carried out as effectively as possible, the large amount of linen, disposable goods and personal toiletries, all indicate that staff do not necessarily have a good understanding of their responsibilities. It was also apparent that care had not been taken about the Care Homes for Older People Page 26 of 32 Evidence: management of cleaning liquids around the home. There were a number of items such as bleach, cleaning solutions etc. that were seen to have been left in bathrooms, toilets and en suites, and not managed under the Control of Substances Hazardous to Health Regulations (COSHH) 1988. The records for the Food Safety in the home show that they adhere to good practices. 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 9 13 That the registered person 16/10/2009 shall make arrangements for the recording, handling,safekeeping, safe administration and disposal of medicines received into the care home. You have a responsibility to ensure that those residents who wish to manage their own medications can do so only through a monitored robust risk assessment process that protects both themself and the others living in the home. 2 9 13 That the registered person 16/10/2009 shall make arrangements for the safekeeping of medicines received into the care home. You should make sure that medications are stored in an appropriate place that will not cause damage to them 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 through excessive heat or moisture which could render them ineffective or cause harm to the person who takes them. 3 29 19 The registered person shall 15/11/2009 not employ a person to work in the home unless that have satisfactory evidence that they are fit to do so. You have a responsibility to ensure that you carry out the necessary employment checks before a new member of staff is employed in the home. You should ensure that you hold satisfactory evidence that the process you use is robust and protects the people under your care. 4 31 8 The registered provider 15/11/2009 should ensure that there is documented evidence that there is an appointed person to manage the home on a day to day basis. You should ensure that there is a recognised person in place to manage the service on a day to day basis. The duty rota should clearly state who is leading the management of the home. 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 5 38 13 That the registered person 15/11/2009 shall make arrangements for all parts of the home to which service users have acces are so far as reasonably practicable free from hazards to their safety. You should ensure that items that should be managed and stored in accordance to COSHH 1998 Regulations. 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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