Inspection on 06/10/09 for The Victoria Residential Home

This inspection was carried out on 6th October 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Victoria Residential Home 29/03/10

The Victoria Residential Home 11/01/10

The Victoria Residential Home 01/12/09

The Victoria Residential Home 14/04/09

The Victoria Residential Home 22/04/08

The Victoria Residential Home 06/06/07

The Victoria Residential Home 17/05/06

The Victoria Residential Home 14/12/05

The Victoria Residential Home 18/05/05

The Victoria Residential Home 08/10/04

The Victoria Residential Home 11/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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 Victoria Residential Home Thursby Road Burnley Lancashire BB10 3AU     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: Julie Playfer     Date: 0 7 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 35 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 35 Information about the care home Name of care home: Address: The Victoria Residential Home Thursby Road Burnley Lancashire BB10 3AU 01282416475 01282441447 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Victoria Care Homes Limited care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. The maximum number of service users who can be accommodated is: 41. Date of last inspection Brief description of the care home The Victoria Residential Home is registered to provide accommodation and personal care for 23 Older People and 18 Older People with a Dementia. The home is a converted hospital with a spacious layout. It is located approximately 2 miles from Burnley town centre and there is a main bus route nearby. There are car-parking facilities at the front of the home and there is a public park directly opposite. Accommodation is provided in 30 single bedrooms and 5 double bedrooms on three floors. There is a passenger lift linking the floors. Seventeen of the single bedrooms and one double room have ensuite facilities comprising of a toilet and wash hand Care Homes for Older People Page 4 of 35 Over 65 0 41 41 0 1 5 0 4 2 0 0 9 Brief description of the care home basin. The home is split into three units and is staffed accordingly. The ground floor is known as the Residential Unit and provides personal care for older people. The first floor provides personal care for older people who have a dementia and this part of the home is known as the Dementia Care Unit. There were no residents accommodated on the second floor. At the time of the inspection (October 2009) the scale of charges ranged from £366.00 to £412.00. Additional charges were made for hairdressing and chiropody. Information was made available to prospective residents in the form of a statement of purpose and service users guide. The service users guide was usually given to relatives and/or prospective residents on viewing the home or at the point of assessment. Previous inspection reports can be viewed in the home or downloaded free of charge from the Commissions website at www.cqc.org.uk Care Homes for Older People Page 5 of 35 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: A key unannounced inspection, which included a visit to the home was conducted at The Victoria Residential Home on 6th and 7th October 2009. One inspector carried out the inspection on the first day and two inspectors on the second day. The report refers to we as it was written on behalf of the commission. We last inspected this service on 14th and 15th April 2009. Following the last key inspection, the responsible individual submitted an improvement plan, which set out their planned action to meet the legal requirements set out in the inspection report and the timescales by which the requirements would be met. A meeting was also held with the responsible individual in July 2009 to discuss the improvement plan and the planned developments for the home. At the time of the visit there were 22 residents accommodated in the home. During the inspection we spent time with the residents, looked round the home, read some of the Care Homes for Older People Page 6 of 35 residents care records and other documents and talked to the staff and the manager. We also consulted our records about the service and information we have received over the last six months. As part of the inspection process we used case tracking as a means of gathering information. This process allows us to focus on a small group of residents living in the home, to assess the quality of the service provided. The responsible individual was not requested to submit an AQAA (Annual Quality Assurance Assessment) prior to this inspection because a full AQAA had been received within the last seven months. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Since the last key inspection, the new manager and staff have shown a commitment to improving shortfalls in the service. They have been working hard to make sure the requirements and recommendations are met or made progress towards making the improvements. The manager and deputy manager have worked closely with us to ensure that we have been notified of all significant events and incidents that occurred in the home. This has meant that we have been able to track the progress made to implement the improvements and we have been assured that the residents well being has been monitored. The written documentation given to current and prospective residents had been revised and updated to provide the residents with more detailed information about the service and the staff. The care plan format had been updated to include more guidance for staff about the residents individual needs and preferences. Memory diaries had recently been Care Homes for Older People Page 8 of 35 introduced, which meant the staff were aware of important events in the residents lives. The residents had been encouraged to integrate more and spend time on each unit pursuing activities together. This gave the residents, who wished to participate, with a change of environment and the opportunity to meet other residents in the home. The records of meals served to the residents had been completed by the staff on each unit. This meant the records were an accurate reflection of the food given to the residents and their diets could be easily monitored. New lighting had been installed in the corridors which made these areas much brighter. Where previously fitted, bolts had been removed from the communal areas, which meant the residents had free movement around the units and could use all rooms as they wished. A new bath hoist had been fitted on both the residential and the dementia care unit. This meant the residents had a choice of a bath or a shower. The residents living on the dementia care unit had been given the opportunity to attend meetings together to enable them to discuss their views about the daily routines, meals and activities. A meeting had also been held for the care staff, which gave them the chance to discuss forthcoming developments and ongoing changes in the home. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 35 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 10 of 35 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 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents had their needs properly assessed and they were provided with appropriate written information to enable them to make an informed choice about where to live. Evidence: Current and prospective residents were provided with written information in the form of a service users guide and a statement of purpose. Both documents had been revised and updated to provide more details about the service and reflect the changes in the management team, following the appointment of a new manager. The guide had been distributed to the current residents and a copy was available to view in each bedroom. The statement of purpose and the previous inspection report were accessible for reference purposes in the office. A brochure was also available to provide the residents with an overview of the service. This meant the residents had access to suitable and relevant information about the provision of care and support in the home. Care Homes for Older People Page 12 of 35 Evidence: New residents were issued with a written contract, which included information about the level and payment of fees and their rights and obligations. The contract was easy to read and was presented in a clear format. The residents funded by the Local Authority were also issued with an individual service agreement. This meant the residents and their representatives were aware of the terms and conditions of residence and knew what they could expect from the service. The personal files of four residents were looked at in detail as part of the case tracking process. Three of the residents were accommodated on the dementia care unit and one resident was living on the residential unit. The records showed that a full assessment of needs had been carried out prior to admission by a member of the management team and where applicable by a social worker. Copies of the preadmission assessments seen covered a range of individual needs including personal, social, health and cultural needs. It was evident that admissions were not made to the home in the absence of a full needs assessment, which meant the manager and staff had a good level of information about the needs of prospective residents before they moved into the home. This was particularly evident in the pre admission assessment records of one new resident, which included details about his likes, dislikes, preferences and situations he found difficult to cope with. This ensured the staff had an understanding of how best to care and support this resident to help him feel comfortable in his new environment. Following the assessment of needs a letter was sent to prospective residents and their families to confirm the persons needs could be met in the home. This meant residents were assured that the home was a suitable place for them to live. The manager confirmed that prospective residents were invited to spend as much time as they wished in the home prior to making the decision to move in. This enabled the person to meet other residents and staff and experience life in the home. Following admission, the contract stated that a trial period of eight weeks was offered to every new resident, so both parties could make sure the placement was successful and the residents individual needs could be met. Care Homes for Older People Page 13 of 35 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 residents were cared for in a way that promoted their choice and dignity. However, a lack of consultation about their overall care meant they had limited opportunities to influence the individual service they received. Evidence: We looked closely at four residents files, as part of the case tracking process. From this we could see that all the files contained a care plan, which was based on the persons assessment of needs. Since the last inspection the care plan format had been updated to include more information and guidance for staff. Members of staff spoken to during the inspection said the new care plan format was easy to follow and contained useful information. Personal profile information had been incorporated into various sections of the care plan, to provide staff with facts about the residents past life experiences and significant events. The manager had also recently introduced memory diaries, which at the time of the visit were in the process of being completed. This meant the staff were aware of what the residents considered important about their lives. Care Homes for Older People Page 14 of 35 Evidence: The care plans were supported by records of personal care, which provided information about changing needs and any recurring difficulties. The records had been made on a daily basis, to ensure staff were provided with ongoing details about the residents well being. Charts had also been maintained to record personal care and hygiene, however, these were not always consistently completed. This meant it was difficult to determine the frequency of some personal care provided to the residents. We also noted that a turning chart had not been fully completed for one resident, which meant it was not possible to ascertain if this person had been assisted to change position in line with the District Nurses instructions. Written records seen on the residents files demonstrated that the care plans had been reviewed each month. However, there was limited evidence seen to indicate how the residents and/or their representatives had been involved in the development of the care plan. This meant that the staff may have been missing important information about the residents ongoing wishes and preferences and the residents and their families had limited formal opportunities to influence their care. Healthcare needs were considered and documented during the assessment process. However, we noted that not all healthcare needs had been covered in the new style care plan, which meant the staff had limited guidance about how to monitor and respond to specific conditions. For instance, there were no specific details about how to support a resident with mental health issues and other medical conditions, which were identified in the social work assessment. This meant there was the potential for staff to support the resident in an inconsistent way. The care records seen indicated the residents had access to health care services and all were registered with a GP. Specialist advice was sought as appropriate from health care professionals, such as the District Nursing Team and Doctors. All residents were supported as necessary to attend medical appointments. Since the last inspection, records had been maintained on a regular basis to monitor the residents weight, to ensure any significant fluctuations were noted and acted upon. Potential risks had been considered as part of the care planning systems. However, at the time of the inspection, the manager was in the process of devising new risk assessments, which were not seen on the files case tracked. Further to this the manager acknowledged that it was important to place the risk assessments along with risk management strategies on the residents personal files as soon as possible, to ensure staff managed risks in a safe and consistent manner. Care Homes for Older People Page 15 of 35 Evidence: The residents spoken to felt the staff respected their rights to privacy and dignity. Two residents said the staff were alright and another resident described the staff as really nice. The staff demonstrated an awareness of treating the residents with respect and considering their dignity when providing care. The staff were observed to interact with the residents in a friendly manner and they referred to the residents in their preferred form of address. The staff also encouraged personal choice and helped the residents continue with their preferred routines. Since the last inspection, the female residents on the dementia care unit had been consulted about their choice of underwear and footwear. This had ensured that the residents were able to exercise choice and were helped to wear appropriate underwear and footwear to promote their dignity. Bath hoists had also been fitted in a bathroom on each floor. Whilst these had some limitations, which are discussed more fully in the Environment section, all residents could choose to have a bath on the unit they were living. Policies and procedures were in place to cover the management of medicines and these were available for staff reference in the medication file and the policy and procedure file. The home operated a monitored dosage system of medication, which was dispensed into blister packs by a local Pharmacist. Appropriate records were maintained in respect to the receipt, administration and disposal of medication. Suitable arrangements were in place for the storage and administration of controlled drugs. However, we noted there was a small discrepancy between the controlled drugs register and the stocks held on the premises and not all instructions on the prescription label had been accurately recorded on the medication administration record, which meant there was the potential for error. These findings were discussed with the manager who made immediate arrangements to audit all the medication held in the home and consult the Pharmacist about any discrepancies. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefited from flexible routines, however, activities needed further development in order to provide a stimulating environment. Evidence: The residents preferences in respect of social activities and daily living routines were considered and recorded as part of the assessment and care planning processes. There was evidence in the daily care records of residents going to bed and getting up at different times and this was observed in practice during our visit. The staff sought the residents views throughout the inspection and the residents spoken to felt comfortable to comment about life in the home. There had been some improvements in the provision of activities. Since the last inspection, the residents had been encouraged to integrate more and spend time on each unit pursuing activities together. This gave the residents who wished to participate with a change of environment and the opportunity to meet other residents in the home. On the first afternoon of the inspection, all the residents celebrated a residents birthday and enjoyed watching a magician. Since the last inspection, residents meetings had been held once a month on each Care Homes for Older People Page 17 of 35 Evidence: unit. Minutes seen of the meetings demonstrated that the residents had discussed their preferences about the type of activities provided. Individual activity records had been maintained on the Dementia Care Unit, however, apart from planned events such as the visits from professional entertainers the majority of the activities were passive such as watching the television and listening to music. Staff had not received training on suitable activities for people experiencing a dementia. Therefore activities tended to focus on a particular time slot during the day rather than be part of an ongoing process to motivate and occupy the residents in a meaningful way. As such interaction between the staff and residents was limited. This observation was also made by a relative spoken to during the inspection. The manager acknowledged there was a need to develop activities in the home and had arranged for the staff to receive training in February 2010. In the meantime the manager intended to guide and instruct the staff herself. Activities had not been recorded for approximately two weeks on the ground floor residential unit. It was therefore difficult to determine the level and frequency of recent activities on this unit. The residents were supported to continue with their chosen form of religious worship and such choices were recorded within the care plan documentation. A representative from the Roman Catholic Church visited the residents on a regular basis. The residents had the opportunity to develop and maintain important personal and family relationships. There were no restrictions placed on visiting times and residents were able to receive their guests in private, should they wish to do so. One relative spoken to during the inspection had mixed views about the care provided and the environment of the home. These comments were later discussed with the manager. All the residents spoken to said they liked the food provided. One resident said, The food is very nice. There was a choice of food each meal time and residents were asked prior to each meal what choice they wished to make. Since the last inspection, the menu had been displayed on a white board on the corridor in the dementia care, this meant the staff could inform the residents of the forthcoming meal. Residents were asked their opinion of the food on an ongoing basis and they could make suggestions for future meals. The meal served on the day of inspection was plentiful and well presented. Residents were given support to eat their meals. Drinks and snacks were served throughout the day and at other times on request. Since the last inspection, the staff on each unit had Care Homes for Older People Page 18 of 35 Evidence: maintained a record of meals served to the residents, to ensure the records were an accurate reflection of each residents diet. Care Homes for Older People Page 19 of 35 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 residents had access to a clear complaints procedure. However, staff had limited knowledge of the safeguarding procedures, which meant the residents best interests were not fully protected. Evidence: The complaints procedure was included in statement of purpose and the service users guide. It was also clearly displayed in each bedroom. The procedure contained the necessary information should a resident or their representative wish to raise a concern. The residents spoken to said they could speak to a member of staff if they had a problem. According to records held by the Commission and information supplied at the time of the inspection, three incidents had been referred to the Local Authority under safeguarding procedures and one complaint had been received about the service. Details of the incidents and complaint had been recorded in the complaints file. A letter was received from the Responsible Individual to conclude the outcome of one incident. Policies and procedures were in place in respect to safeguarding vulnerable adults as well as a copy of Lancashire County Councils Multi Agency Policy and Procedure. This documentation set out the appropriate response in the event of any allegations, evidence or suspicion of harm or neglect. However, there were several versions of the Care Homes for Older People Page 20 of 35 Evidence: internal procedure seen, which could cause the staff some confusion. Since the last inspection, the staff had received training on the protection of vulnerable adults, however, two members of staff were unclear about what action to take and where to direct an alert, if the manager was away from the home. It is important for all staff to be familiar with these procedures to ensure the protection of the residents. Care Homes for Older People Page 21 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were provided with spacious living accommodation, however, some aspects of the environment had the potential to compromise the residents dignity and safety. Evidence: The Victoria Residential Home is a converted hospital with a spacious layout. Accommodation is provided on three floors in 30 single bedrooms and 5 double rooms. Seventeen of the single rooms and one double room have an ensuite facility comprising of a toilet and hand wash basin. A large passenger lift provides access to all floors. Communal space is provided in lounges and dining rooms on each floor. All rooms provided sufficient space for the pursuit of recreational activities and the entertainment of visitors. We noted from our tour of the premises that residents had personalised their rooms with their own belongings, which included photographs, ornaments, furniture and televisions. All the residents spoken to said they liked their bedrooms, which they described as comfortable and warm. Since the last inspection, new lounge chairs had been purchased for the lounge on the ground floor. Where previously fitted, bolts had been removed from the communal areas to allow the residents free access around the units and new lighting had been Care Homes for Older People Page 22 of 35 Evidence: installed in the corridors, which made these areas much brighter. As previously mentioned two new bath hoists had been fitted to a bath on each unit. However, the arms on the hoists were fixed, which may pose difficulties for some residents when using this equipment. There was also limited space in the bathroom on the dementia care unit for the staff to use the hoist and there were no handrails on the wall to support residents whilst standing. The seat on this hoist also presented a risk of entrapment. Whilst there were more chairs available on the dementia care unit, some of the arms on the chairs were noticeably stained and some of the chairs were covered in an upholstery, which was not wipeable. This meant that some of the chairs had a very strong odour and were unpleasant to sit in. Arrangements were in place for general repairs and maintenance and a handy man was employed by the home. However, we noted water was leaking through the ceiling in one area on the ground floor and the containers placed on the floor to catch the water, blocked the entrance to a bedroom and toilet. There was no cover on the water outlet in the wet room on the ground floor, which presented a risk to residents using the facility in bare feet and a fire door exit was damaged at the bottom and led onto steps, which had the potential to be difficult to negotiate in poor weather. A window pane was broken on the outside of the small lounge on the ground floor, some carpets especially in the corridors were worn and some wallpaper was scuffed and looked shabby in places. The standard of cleanliness was generally satisfactory throughout the home. However, the tables in the small lounge on the dementia care unit were sticky and there was a general odour on this unit on the second day of the visit. Care Homes for Older People Page 23 of 35 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. The residents were supported by a staff team who knew them well, however, the lack of training in the caring for people with dementia had the potential to impact on the residents quality of life. Evidence: A staff duty roster was drawn up in advance and provided a record of the number of hours worked by the staff in the home. The roster indicated there were usually two care staff working on the dementia care unit and three care staff on the residential unit. There were two care staff on waking watch duty on each floor. Additional staff were employed to carry out domestic tasks such as cooking and cleaning. A recruitment and selection procedure was available and a checklist was used to track documentation required for the recruitment of new staff. We looked closely at the files of two members of staff and the manager, all of which had been employed within the last six months. From the records seen, we noted that all three people had completed an application form and had attended the home for an interview. Two written references had been obtained along with appropriate Police checks for both members of staff. However, although the police check was available for the manager, there was only one reference seen on file. The manager stated this had been obtained, but it was elsewhere and was therefore not available for inspection on the day of the visit. Whilst the staff had provided information about their previous employment, one Care Homes for Older People Page 24 of 35 Evidence: person had not provided full details about her work history. It is important all recruitment documentation is available, to ensure the registered person can clearly demonstrate that staff have been appropriately checked before they start work in the home. Whilst there was no record seen of the managers induction training, there were arrangements in place for care staff to undertake an in house induction programme and they were encouraged to apply for NVQ training. According to information supplied by the deputy manager 13 out of 21 care staff had achieved NVQ level 2 or above. This equated to 62 of the overall staff team. In addition, 4 members of staff were working towards this qualification. This meant the majority of the staff team had achieved the necessary qualifications to enable them to carry out their role effectively. Most of the staff had worked in the home for several years and knew the residents well. The staff spoken to had a positive approach to the recent changes in the home and welcomed the leadership of the new manager, one person said Everything is improving and another person said, I enjoyed the staff meeting, we are now being consulted, which is good. Staff were given the opportunity to attend training courses relevant to their role. An overall training plan and certificates seen on the staff files demonstrated that the staff had received recent training on moving and handling, fire safety awareness and safeguarding vulnerable adults. However, staff had not completed training in relation to the care of older people with a dementia and managing challenging behaviour. This meant that staff had limited knowledge about how to develop meaningful activities and how to respond and manage challenging behaviour. The manager explained that training had been arranged early in the new year and she was giving guidance to the staff in the interim. The home was linked via computer to the LWDP (Lancashire Workforce Development Partnership). This organisation operates an internet based staff training record and plan and provides access to training courses. The system displayed a training record for each member of staff and highlighted when mandatory training was due. This meant the manager could use this tool to plan future training. Care Homes for Older People Page 25 of 35 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 manager had begun to improve the overall management and operation of the home, however, there were still improvements to be made to ensure the residents received a better quality of service. Evidence: After a period of temporary management, the responsible individual had appointed a new permanent manager. The manager was a Registered General Nurse and had a Degree in Health and Social Care and a Certificate in Management. She had also recently begun working towards a Leadership and Management qualification. The manager had many years experience caring for older people in both health and social care settings. She confirmed her intention to register with the Commission, however, this process had not commenced at the time of the visit. The manager had worked in the home for approximately five weeks and had begun to make some changes, however, she explained there were many more improvements she wished to make and to help her with this process the responsible individual had engaged a team of management consultants. Care Homes for Older People Page 26 of 35 Evidence: There was a programme in place for staff supervision and the issues discussed during the meetings were recorded on a suitable format. In addition to staff supervision, senior staff attended regular meetings with the manager. Since the last inspection, the care staff had also been given the opportunity to attend a meeting, which gave them the chance to discuss forthcoming developments and ongoing changes. The service had been awarded a post recognition Investors in People Award in October 2007 and had preferred provider status with the Local Authority. There were some internal systems to monitor the quality of care, for instance the deputy manager had distributed satisfaction questionnaires to the residents, their families and the staff in February 2009. The results had been collated and a development plan had been produced based on the outcomes of the surveys. Residents meetings were held on a regular basis on the residential unit and since the last inspection meetings had been arranged once a month for the residents living on the dementia care unit. The meetings gave the residents the opportunity to discuss their views about daily life in the home, such as the meals and activities. There were no audits seen in respect to the operation of the home, these are important so the manager can check that internal systems are working well. However, the manager intended to introduce regular audits in the near future and as mentioned previously instigated a detailed check of the medication during the inspection. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. A random check of the records of monies held on the premises was found to be correct. The records of charges and payments made in respect of fees were also seen and were complete and up to date. Since the last inspection, the responsible individual had continued to visit the home on a regular basis and had completed a report each month. The reports detailed conversations with the residents and staff and observations of the environment. There was a set of health and safety procedures, in the main policy and procedure file. Staff had received health and safety training, which included moving and handling, food hygiene, first aid, fire safety and infection control. Documentation seen during the inspection indicated the electrical, gas and fire systems were serviced at regular intervals. The fire log demonstrated that the staff had received instructions about the fire procedures during their induction and as part of mandatory training. Arrangements were in place to record accidents and incidents in the home. This Care Homes for Older People Page 27 of 35 Evidence: ensured that the residents condition was closely monitored following an accident or incident. The Commission had also been notified as appropriate of any significant event in the home. Risk assessments were in the process of being drawn up in respect to personal care, however, there were no risk assessments seen in relation to the environment. This meant that potential hazards inside and outside the home may not have been identified and managed in a consistent and safe manner. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 12 16 Following consultation with the residents a programme of activities must be developed on the Dementia Care Unit. This is to ensure that the residents have good access to a choice of meaningful leisure pursuits. 29/05/2009 2 18 13 All staff must be made aware 15/05/2009 of and fully understand the safeguarding procedures. This is to ensure the residents are fully protected from harm. 3 20 16 The furnishings on the Dementia Care Unit must be suitable for purpose. This is to ensure the dignity and comfort of the residents. 15/05/2009 Care Homes for Older People Page 29 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The residents and/or their representatives must be consulted about the development and review of their care plan. This is to ensure the residents have the opportunity to influence the individual service they receive. 30/11/2009 2 8 17 A record must be maintained 30/10/2009 of the incidence of pressure sores and the treatment provided to a resident, including completion of a turning chart. This is to ensure that the manager can clearly demonstrate that residents receive the correct care in line with the District Nurses instructions. Care Homes for Older People Page 30 of 35 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 3 8 13 Clear up to date risk assessments must be available for staff at all times. This is to ensure that staff are aware of how to respond and manage any identified risks in a safe and consistent manner. 02/11/2009 4 8 15 The care plans must provide details as to how the residents healthcare needs are to be met. This is to ensure the staff are aware of how to monitor and respond to these needs. 30/11/2009 5 9 13 All information from 28/10/2009 prescription labels must be recorded on the medication administration record and all controlled drugs must be accounted for. This is to ensure the residents are given their medication in line with the prescribers instructions and a clear audit path can be maintained of drugs handled in the home. 6 12 16 The activities on the dementia care unit must be structured to meet the residents individual needs and preferences. 30/11/2009 Care Homes for Older People Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure the residents live in a stimulating environment. 7 18 13 All staff must be made 02/11/2009 aware of and fully understand the safeguarding procedures. This is to ensure the residents are fully protected from harm. The premises must be kept 15/12/2009 in a good state of repair externally and internally. The leak in the ceiling must be repaired, the water outlet in the wetroom on the ground floor must be covered, the broken window pane must be replaced, scuffed wallpaper must be restored and the damaged fire exit must be repaired. This is to ensure the dignity, comfort and safety of the residents. 9 20 16 The furnishings on the 01/12/2009 Dementia Care Unit must be practical and suitable for purpose. This is to ensure the dignity and comfort of the residents. 8 19 23 Care Homes for Older People Page 32 of 35 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 10 26 23 All parts of the home must be kept clean and be free from offensive odours. This is to ensure the dignity and safety of the residents. All relevant recruitment documentation must be available for inspection purposes, this includes references and details of full working histories. This is to ensure the registered person can clearly demonstrate that staff are fully checked before the commence work in the home. 15/10/2009 11 29 19 30/10/2009 12 30 18 All staff must complete specialist training courses including managing challenging behaviour and supporting people with a dementia in line with the needs of the residents. This is to ensure the residents needs are met. 26/02/2010 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 18 The safeguarding policies and procedures should be reviewed to ensure staff have access to one up to date Care Homes for Older People Page 33 of 35 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 document. 2 22 An assessment of the bathroom facilities should be undertaken by a suitably qualified person for example an occupational therapist, to ensure the equipment is suitable to meet the needs of the residents. Audit systems should be set up to monitor quality of the care provided and the overall operation of the home. Environmental risk assessments should be carried out, to identify and manage potential hazards both inside and outside the home. 3 4 33 38 Care Homes for Older People Page 34 of 35 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. 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