Inspection on 15/06/09 for Wall Hill

This inspection was carried out on 15th June 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wall Hill 27/04/10

Wall Hill 18/02/10

Wall Hill 22/10/09

Wall Hill 26/07/07

Wall Hill 14/08/06

Wall Hill 24/10/05

Wall Hill 12/07/05

Wall Hill 23/11/04

Wall Hill 12/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Key inspection report Care homes for older people Name: Address: Wall Hill Broad Street Leek Staffordshire ST13 5QA     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: Linda Clowes     Date: 1 5 0 6 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: Wall Hill Broad Street Leek Staffordshire ST13 5QA 01538399807 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Wall Hill Care Home Limited care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Age: Physical disability - Code PD age 55 and above. Mental Disorder, excluding learning disability or dementia - Code MD age 55 and above. The maximum number of service users who can be accommodated is: 31 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 (OP) 31 Physical disability (PD) 9 Mental Disorder, excluding learning disability or dementia (MD) 9 Dementia (DE) 4 Date of last inspection 4 9 0 9 Over 65 0 0 31 0 Care Homes for Older People Page 4 of 32 Brief description of the care home Wall Hill is registered to provide care and accommodation for 31 older people, 9 of whom may have needs associated with a physical disability, 9 of whom may have mental health needs and 4 whom may have dementia. The home is located close to the centre of the historic market town of Leek in the Staffordshire Moorlands. There is a wide range of community facilities, including shops, restaurants, pubs and other leisure amenities in the town. There is good access to local bus services. The home also has its own minibus which is a well used and popular facility. The home is a twostorey building that has undergone considerable refurbishment to meet the needs of people who use the service. A passenger lift allows easy access to the first floor. Of the 29 single bedrooms available, 26 have en-suite toilet facilities. There is one shared bedroom available. The environment is well maintained and decorated throughout. Attractive communal sitting areas are provided at Wall Hill, with large and small lounge areas with comfortable seating and a large and attractive dining room that opens onto the rear grounds and patio area. People interested in accommodation at Wall Hill are advised to contact the home direct to obtain information about current fees and availability. 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: One inspector carried out this Key Unannounced Inspection. We inspected against the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The objective of the inspection is to evaluate whether people who use the service and their family carers experience services of good quality that offer and promote independence. On the day of this inspection two proprietors (one of whom is also the Registered Manager) were in the home. This inspection took place over a period of nine hours. We looked at peoples assessments and care plans, personnel files, complaints files, medication records, health and safety records and gave a feedback session. Care Homes for Older People Page 6 of 32 Prior to the inspection visit the providers were asked to complete a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to undertake a selfassessment, which focuses on how well outcomes are met for people using the service. The AQAA was returned on time and gave us a reasonable picture of the current situation with the service. We received ten surveys from people who use the service all of which gave positive feedback. Four relatives/carers who returned surveys told us that they are very satisfied with the services they receive at Wall Hill. Several told us that Wall Hill was better than any other care facilities they had been accommodated in. Everyone considered that the staff were respectful, courteous and well trained. We received seven surveys from staff who tell us that they receive training and information from the service so that they can provide effective and individual care. All feel that they have enough support, experience and knowledge to meet the different needs of people who live at the home. We have included comments made in surveys in the body of this report. As a consequence of this visit we identified concerns, mainly with medication, that we have asked the manager to address without delay. From the information provided, we also identified that not all support plans are completed and up to date which may result in staff not being able to provide individual person centred care. We have received no complaints about the services provided by Wall Hill since the last Key Inspection in July 2007. We have made four requirements and six recommendations following this visit. 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: There were medications issues at this inspection. We have asked the service to make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. We have asked the home to ensure that prescribed creams are securely stored and that there are records to show when the creams are administered and by whom. We have also asked for staff who are responsible for the application of creams to have appropriate training and support. We consider that the Manager needs to ensure that she is fully conversant with Safeguarding Procedures that are in place to protect vulnerable adults from abuse. She needs to know how she must respond and who to contact under such circumstances. She must then ensure that her staff team receives appropriate training in order that Care Homes for Older People Page 8 of 32 they may respond to similar situations. We feel that monitoring procedures for medication can be improved to ensure that staff are competent and procedures and records are in place, accurate and appropriate. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides information so that people are able to make an informed choice about whether the home is suitable for them. No person moves into the home without having their needs assessed. Evidence: A requirement was made in the last Key Inspection Report in this outcome area for the home to review its Statement of Purpose so that it provides all the information outlined in the regulations. The home has addressed this issue, although the document could be further improved by including information about the number, relevant qualifications and experience of the staff working at the care home. We consider, however, that this requirement has been met. A further requirement was made in the last Key Inspection Report in this outcome area for the manager to confirm in writing to each person who wishes to use the service that the care home is able to meet their needs. We looked at a random sample Care Homes for Older People Page 11 of 32 Evidence: of files for people who had recently been admitted to the home. We could not find confirmation that the home has written to say they are able to meet the individuals care needs on any of the files. As we have reviewed our inspection process in line with the Inspecting for Better Lives framework we would no longer make this a requirement even though it is still part of the regulations. We do, however, consider it good practice. We have, therefore, made a recommendation in this report regarding this matter. Twenty-seven people were accommodated in the home on the day of our visit, the majority of whom are able to tell us about their lives in the home, although some have dementia or confusion that makes it difficult for them to relay some aspects of their lives in the home. Eight out of ten people who returned surveys as part of this inspection tell us that they received information about the home before deciding about whether to live at Wall Hill. One person said they did not and the other said they did not know. Where possible, people are invited to sample by visiting the home prior to admission. A copy of the homes Statement of Purpose is prominently displayed in the entrance hall. Decisions about permanent admission to the home are not made until the person has been in residence for some six weeks to enable everyone to consider whether Wall Hill is suitable for their needs. The home issues a contract to people who are self-funding that outlines the terms and conditions of residency in the home. We looked at the files of three people who recently moved into the home and found current care plans completed by a social worker prior to admission. Wall Hill has a contract with Social Services to provide Respite/Short Stay facilities and has allocated two of its bedrooms for this purpose. The home does not provide intermediate care and so Standard 6 (Intermediate Care) was not assessed. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all of the plans of care (support plans) that are completed by the service provide enough detail and instructions for staff about how they should manage the current health and social care needs of people who use the service. We are concerned that not all people who use the service receive medication as prescribed which may put them at risk of harm. Evidence: We made two requirements in this outcome area in the last inspection report for the home to ensure care plans are reviewed regularly and that aqueous creams are not stored in communal bathrooms. These have been complied with. There was a calm and peaceful atmosphere throughout the day. We spoke with many people who live in the home and all expressed satisfaction with the care they received. Several people had lived in other care settings and were adamant that they preferred living at Wall Hill. People consider their privacy is respected and that staff are sensitive to their needs. Care Homes for Older People Page 13 of 32 Evidence: Staff we spoke with had an overall understanding of the needs of people living in the home and were seen to be patient and kindly when interacting with them. We looked at the files of three people who had recently been admitted. Each had a care plan from the social worker. Two had a Personal Profile (support plan) generated from the social worker care plan and the homes own assessment but for one person admitted on 28/03/09 this had not been completed. It is imperative that the home provides written information for staff so that they know how to deliver person centred care to the individual. We have, therefore, made a requirement regarding this matter as part of this report. We have also recommended that the home includes a current photograph of the person in their personal files as required by regulations. It would also be good practice to have a photograph of the person on their medication file to aid identification. Personal healthcare needs, including specialist health and dietary requirements are clearly recorded. People are supported and helped to be independent and can take responsibility for their personal care needs. Self-medication is promoted where applicable. People have regular appointments to visit local health care services. We monitored the lunchtime medication round. We are concerned that some medication is not being administered as prescribed. We discussed this fully with the proprietors on the day and outline some of the issues below as illustration: We noticed that the Medication Administration Records did not always show the number of tablets received into the home and the numbers carried over from the previous period as required. If these figures are not recorded it is not possible to follow an audit trail for medicines. One person was being administered Calcichew on the day they were also administered Alondronic Acid in spite of the prescription label being quite specific that both should not be administered on the same day. There were insufficient stocks of prescribed pain relief for two people. One of them was administered Paracetamol not from a packet with a prescription label and their name on but from a loose foil blister sheet. We were not able to determine therefore whose paracetamol this was. The other was not offered pain relief. The home was not recording whether one or two tablets are administered where the prescription label gave this option. As a consequence we could not follow an audit trail for the medicine. We gave advice regarding using the back of the MAR sheet for this Care Homes for Older People Page 14 of 32 Evidence: purpose. We identified that care staff are administering prescribed creams when they are dressing and undressing people in their own bedrooms. We saw prescribed creams in peoples bedrooms on top of bedside cupboards. Prescribed creams must be stored in a locked facility in peoples rooms and there must be accurate records kept to show when the cream is administered and by whom. Care staff who administer prescribed creams must receive appropriate training. We have made requirements regarding medication as part of this report. Surveys tell us that staff are always or usually available when people need them and that the home always or usually make sure they get the medical care they need. Everyone tells us that they like the food served in the home. The surveys ask people what the home does well and we received the following responses: Rehabilitate you. Look after me well. Good activities. Nice food. Friendly staff. Look after everyone. Keep me clean and tidy. I am very satisfied generally with the management and staff. I cannot speak too highly of them. I would recommend Wall Hill to anyone requiring the appropriate assistance. Not a lot but they added I am grateful for being looked after. We received three surveys from relatives all of which were very positive. The following comments were added: Wall Hill Care Home took my relative and myself to hospital a few times last year because I have no transport. It was a big help. Care Homes for Older People Page 15 of 32 Evidence: The home looks after my (name) very well. The home is very clean and always smells very nice. The home is clean. They call the doctor immediately there are problems. Choice of good food. Cheerful and involved carers. Continence problems handled sensitively. Pleasant atmosphere. Attractive surroundings. Always willing to listen and to act on concerns. Care Homes for Older People Page 16 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Routines are flexible to accommodate individual choice. Meals are balanced and nutritious and cater for varying cultural and dietary needs. Community links are promoted. Evidence: The majority of people in the home on the day of our visit were spoken with. People were observed moving freely in the home and garden. Some were sitting under the gazebo in the front garden watching people coming and going. Everyone who responded to surveys confirmed that the home provides activities that they can take part in if they wish. An Activities Programme was displayed in the entrance hallway that showed a range of activities and events. The home has its own minibus which allows people to access and enjoy the opportunities available in their local community, such as shopping or trips. The service facilitates those people who wish to practice their individual religious beliefs. There are ministers who visit the home from various denominations. Care Homes for Older People Page 17 of 32 Evidence: Relatives are welcomed into the home and people tell us that they can receive visitors in communal areas or in the privacy of their own rooms. People tell us they enjoy the meals served in the home. We looked at the menus and found meals to be well balanced and nutritious. We observed the lunchtime meal which was relaxed with staff who were patient, helpful and allowed people the time they needed to finish their meal comfortably. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their relatives are confident that they complaints are listened to and appropriately handled. The service needs to obtain copies of its Local Authorities Safeguarding Procedures in order that it may respond appropriately to any issues of suspected abuse or neglect. Evidence: No requirements were made in this outcome area in the last Key Inspection Report. The service has a complaints procedure which is up to date and readily available in the Statement of Purpose. People we spoke with told us that they would be confident to speak to the manager or staff if they had any concerns or worries. The home tell us that they have received no complaints since the last Key Inspection on 26 July 2007. We have received no complaints about the home. There are policies and procedures for safeguarding people who use the service and staff are aware that where they have concerns they must raise these with the manager. Staff are given information about Whistle Blowing procedures at the start of their employment so that they know what to do if they have concerns about the home. Care Homes for Older People Page 19 of 32 Evidence: The manager tells us that they have made no safeguarding referrals in the past twelve months. We have not received any safeguarding alerts regarding Wall Hill. We discussed safeguarding procedures with the manager. The manager is unaware of Staffordshire and Stoke-on-Trent Safeguarding Protocols and Procedures. It is important that she has a copy of these procedures so that she knows how to respond and who to contact should there be concerns about abuse in relation to anyone who is accommodated in the home. We gave contact information so that she could contact local Safeguarding Co-ordinators to obtain a copy of the current Safeguarding Procedures and have made a recommendation as part of this report for her to do so. The manager is aware of the need to introduce advocacy services should these be appropriate where users may lack capacity. She had a copy of the Mental Capacity Act and Deprivation of Liberty Act. These will advise her how to seek appropriate assistance. People we speak with tell us they feel comfortable and safe in the home. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Wall Hill provides an environment that is appropriate to the needs of people who use the service. The home is well maintained, well decorated, comfortable and clean. Evidence: No requirements were made in this outcome area in the last Key Inspection Report. The home is well equipped with the majority of bedrooms having en suite toilet and wash basins. The majority of rooms are for single occupancy, although there is one shared room available. People tell us in surveys that the home is always clean and fresh. The home was well ventilated on the day of our visit which was a warm summer day. People tell us that the home is usually warm enough for them although one person who responded to the surveys said that they would like the heating increased. No outbreaks of infection have been reported in the past twelve months. Hygiene equipment is available and carpets are regularly deep cleaned. The home is well maintained. New carpets have been fitted in communal areas since the last inspection and in individual bedrooms when required and when new people are admitted. We noticed that there is no mirror in the hairdressing salon that would enable the Care Homes for Older People Page 21 of 32 Evidence: person to see themselves when they are sitting down having their hair dressed. We have made a recommendation about this. One person told us that they would like a bigger garden. There is a large car park which is currently affected by building works which will be completed shortly. The garden is small but well kept and there is seating outside for people to use, particularly on warm days. Management have a good infection control policy. They will seek advice from external specialists such as NHS infection control staff and encourage their own staff to work to the homes policy to reduce risk of infection. All staff have attended Infection Control Training. There are four lounges/seating areas in the home giving people choice of where they wish to sit. The dining room comfortably accommodates everyone living in the home. Tables are set with cloths, napkins and flowers to make mealtimes a pleasant and enjoyable experience. We visited a sample of bedrooms and find these decorated to personal choice and style. At the last inspection we recommended that the first floor bathroom should be better utilized and we note that this has been converted into a shower room. People told us that they like to have the choice of whether to bathe or shower. Although many said they still preferred to bathe for which an assisted bath was available on the ground floor. The home is registered to provide services to four people who have dementia care needs. Some of the existing residents also exhibit some confusion. It is recommended, therefore, that consideration be given to providing signage to enable people to find their way around the home and to promote their independence, e.g. names, photos on bedroom doors and pictures on toilet and bathroom doors. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service benefits from a stable and well-trained workforce. Staffing levels are sufficient to safeguard the welfare of people who use the service. The home recognizes the importance of effective recruitment in protecting vulnerable people who use the service. Evidence: One requirement was made in this outcome area in the last Key Inspection Report for robust recruitment procedures to be carried out including the vetting of work permits. This requirement has been met. The home employs a staff team of twenty five, sixteen of whom provide personal care. Of these 10 have attained NVQ level 2 in Care with three working towards this award. Three have attained NVQ level 3 in Care with one working towards this award. The training matrix shows that staff have attended relevant training, including moving and handling, health and safety, protection of vulnerable adults, dementia awareness. infection control. Staff we spoke to confirm that the service supports them through training. Further Protection of Vulnerable Adults training is planned in the near future. All care staff receive relevant training that is focused on delivering improved outcomes for people who use the service. Care Homes for Older People Page 23 of 32 Evidence: We looked at the files of three staff and found appropriate recruitment procedure with the taking up of references and police checks. Where there were issues the manager had investigated these and satisfied herself as to the persons suitability. Files confirmed that training had been undertaken. Regular supervision is carried out and a record is maintained. Staff we spoke with tell us that regular meetings are held to enable them to talk about practice issues. We looked at the file of the person administering medication on the day and found that she had undertaken appropriate medication training. We received six surveys from staff all of which were positive. Staff confirm that they are given information about the needs of people for whom they provide support or care. All confirm that they have received induction training when they started. They confirm that there are usually enough staff on duty. We asked what does the home do well? and received the following responses: Work to keep up with all the service users needs, providing a healthy and balanced diet. Everything. Keep the home clean, tidy and hygienic. Care for the needs of the residents so that they feel at home. Supply all help and needs for the elderly and make the clients feel at home and at ease. 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 manager has the qualifications and experience to manage the service. Some areas need to be managed more effectively in order that the health and welfare of people who use the service are better promoted and protected. Evidence: Two requirements were made in this outcome area in the last Key Inspection Report for the home to carry out Fire Risk Assessments on all people who use the service and for fire training to be provided to all staff. The home provided documents to confirm that these requirements have been met. People we spoke with were very positive about the home and particularly the proprietors. This is a family run business and people tell us on the day that they are very nice people. The Registered Manager, Mrs Susan Briand, has the required qualifications and experience to run the home. Care Homes for Older People Page 25 of 32 Evidence: Several people told us this home is better than any others I have lived in. There is low staff turnover and several staff have worked in the home for many years. Staff spoken with said they are well supported and like working in the home. A stable staff team gives people who use the service consistency. At the last key inspection we recommended that the home carries out a regular Quality Audit (Satisfaction Survey) in order to seek the views of people who use the service and give them an opportunity to comment about the service they received. We looked at a random sample that were completed in November 2008, all of which gave positive feedback on the service. From information provided we were able to confirm that regular staff supervision takes place and staff tell us that they attend regular Team Meetings. These processes are crucial in monitoring the competence of the staff team. It was noticed that none of the cooking staff had current Food Hygiene Certificates, although two teatime catering staff are booked on courses later this month. Staff who regularly prepare food should have appropriate training. We have made a recommendation regarding this issue. The fire risk assessments we saw did not include advice for staff on evacuation e.g. needs one or two staff or wheelchair, can respond to instruction, etc., and need to be reviewed. This information is vital so that staff can be prepared for any fire emergency. We have made a recommendation regarding this. The medication practices in the home need to be monitored regularly to ensure that staff are competent and confirm that records are accurate and complete. We have made a recommendation regarding this. It was not possible to confirm from the information provided that hoists and the emergency call system were being tested and maintained as required by regulation. We have made a recommendation regarding this situation. There was evidence to confirm that Fire Alarms are being tested weekly and that regular fire drills are taking place. There was evidence to confirm regular maintenance of fire extinguishers, passenger lift, electrical and gas appliances. Care Homes for Older People Page 26 of 32 Evidence: The service holds no cash for people who use the service on the premises. Any transactions are recorded (hairdressing, newspapers, etc) and relatives reimburse the home. Comprehensive records were seen on the day. There is current insurance in place. The Certificate of Registration is displayed in the home as required by our regulations. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Req. 15(1) 17/07/2009 The home shall prepare a written plan giving details as to how the persons needs in respect of his health and welfare are to be met. The plan should be reviewed regularly and at point of change. This will assure people who use the service that they will receive a person centred service for their individual needs. 2 9 12 Reg 12(1)(a) & 13(2). The service shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This will assure people that they are in safe hands. 17/07/2009 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 9 12 Reg 12(1)(a) & 18(1)(c)(i). The service must ensure that all staff responsible for administering medicines, including creams and drops, receive appropriate training and support. This will assure people that they are in safe hands. 17/07/2009 4 9 12 Reg 12(1)(a) & 13(2). The 17/07/2009 service must ensure that it has sufficient stocks of medication to meet the needs of people who use the service. This will assure people that their well-being and best interests are promoted Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose would be further improved by adding the numbers of staff and their qualifications as outlined in Schedule 1 of the regulations. Prior to admission to the home the registered person should confirm in writing to prospective people who wish to use the service that having regard to the care needs assessment the care home is suitable for the purpose of meeting the persons needs in respect of his health and welfare. This will ensure that people who wish to reside in the home are assured their needs will be met. An identity photograph should be held on file as required by regulations. A photograph attached to the Medication Page 30 of 32 2 4 3 7 Care Homes for Older People 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 Administration Record would also promote health and safety for people who use the service. 4 18 The manager should contact the local authority Safeguarding Co-ordinators to obtain a copy of the current Safeguarding Procedures. This will enable the service to respond appropriately to any situations of suspected abuse or neglect. It is recommended that the service considers providing signage to enable people who have dementia or confusion to find their way around the home. This will promote their independence for as long as possible. It is recommended that a mirror is fitted in the hairdressing salon so that people sitting down are able to see themselves. Medication processes need to be monitored regularly to ensure that staff are competent and that records are accurate and up to date. All hoists and the emergency call system need to be tested and maintained regularly to comply with regulations. Fire Risk Assessments should include information for staff on the persons needs in event of evacuation, e.g. can respond to instructions/directions, needs one or two people to assist. Consideration should also be given to any medication that the person takes that may affect their ability to respond promptly. All staff responsible for food preparation must hold a current Food Hygiene Certificate. 5 19 6 19 7 38 8 9 38 38 10 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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