Inspection on 10/02/10 for Woodlands Care Home

This inspection was carried out on 10th February 2010.

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodlands Care Home 09/03/10

Woodlands Care Home 16/02/09

Woodlands Care Home 22/07/08

Woodlands Care Home 20/08/07

Woodlands Care Home 30/09/06

Woodlands Care Home 06/03/06

Woodlands Care Home 01/11/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Woodlands Care Home Fairfield Road Broadstairs Kent CT10 2JU     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: Penny McMullan     Date: 1 0 0 2 2 0 1 0 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 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Woodlands Care Home Fairfield Road Broadstairs Kent CT10 2JU 01843860998 01843862865 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 33. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) 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). Date of last inspection Brief description of the care home Woodlands Care Home is a purpose built two-storey building set in gardens next to Fairfield Manor Care Centre, both of which are owned by the same company. Ashbourne (Eton) Ltd is the registered company, which is a subsidiary of Southern Cross Healthcare. Accommodation comprises of thirty bedrooms that are all currently used as singles, but this number includes three larger rooms that can be used as doubles. All bedrooms have en-suite toilet facilities. There is a lift to the first floor and ample bathroom and toilet facilities. Communal areas consist of the main lounge, a very small lounge and Care Homes for Older People Page 4 of 31 Over 65 33 0 1 6 0 2 2 0 0 9 Brief description of the care home dining room. There is a well-kept garden to the side and patio area at the front of the building for residents use. Shared parking facilities are available to the front and the home is located in a residential area on the outskirts of Broadstairs. The home offers personal and nursing care. There is always at least one registered nurse on duty, with a team of carers and ancillary staff that deal with cooking, cleaning, laundry, administration and maintenance. The fees for support from the home are set during the assessment period and are very specific to the needs of the individual, depending on the level of support required and the staffing numbers provided. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was carried out over a period of time and concluded with a visit to the home on 10th February 2010 between 09.30am and 4pm. The last key unannounced inspection was carried out in this home on 16th February 2008 and at that time they were given a quality rating of two star good. An Annual Service Review on the service was completed in January 2010. This review is carried out each year to assess if the service is maintaining their quality judgement made at the previous inspection. Concerns raised by social services safeguarding alerts, the unstable management of the home together with the inconsistency of staff have resulted in this key unannounced inspection being brought forward. Postal surveys were forwarded to the home when we carried out an Annual Review service in January of this year so we did not send out for additional surveys. An Expert by Experience also visited the home in the afternoon to assist us with the Care Homes for Older People Page 6 of 31 inspection visit. An Expert by Experience is a person, who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The Expert by Experience spent time talking to the people who were in the lounge or their rooms and talked to the relatives who were visiting. She had lunch with the people living in the home, observed what was happening, and talked a little to the staff. Further information about her visit is included throughout the report. The care of three people was tracked to help gain evidence as to what it is like to live in the home. A partial tour of the home was made and we also looked at care plans, risk assessments, training records, staff files, quality assurance and complaint records. Five members of staff were also involved in the inspection. The home did not send us their Annual Quality Assurance assessment (AQAA) on time. We rang the home and we were told the Manager had resigned the previous day. The deputy manager said she would make sure the AQAA was sent and it did arrive the following day. The AQAA did not contained in depth information and examples about the service and how it plans to improve and develop in the future. They did not tell us very much about the views of the people living at the home, how the service finds out what they want or what they are doing to make sure their services provides good outcomes for them. It gave us no information on how the home was being managed on a day to day to basis. Improvements are therefore required when submitting the next AQAA. At the previous inspection, one statutory requirement to provide staff with written guidelines to move people safely was made. This was because the majority of people living in the home require more than one carer to support them when they are being moved in the hoist or turned in bed. The guidelines will make sure that the people are moved in a consistent and safe manner and staff are clear of how they must do this. The moving and handling risk assessments did contained full details of equipment to be used and how many carers but no written guidelines of how to move the people are in place, therefore the Regulation have not been complied with. Other serious shortfalls with regard to staffing levels have been identified during this visit. This means that the CQC will issue a warning letter and a statutory requirement notice may be issued to the provider of the service. The notice is part of CQCs enforcement pathway to make sure that improvements are made to the service and that all requirements are fully met or we may take enforcement action. Further detailed information can be found in this report concerning these issues. After the visit we looked at all the evidence we had gathered to say what level of service is being provided to the people living in the home. The overall outcome for the service is adequate. We found that the management of the home and staffing levels have not improved. The Registered Provider has not ensured that the home has been effectively managed since 2008 to sustain good quality outcomes for the people living there. For this reason we met with the Area Manager on 19th February 2010 and served a code B notice. This tells the person in charge of the home that we feel that an offence under the Care Standards Act 2000 may have been committed, and the notice tells the person in charge their rights. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The lack of a permanent Registered Manager is having a detrimental affect on the overall management of the service. Improvements are required in the care plans to make sure they contain full details and Care Homes for Older People Page 8 of 31 are more personalised to individual need. Moving and handling risk assessments do not give staff written guidelines of how to move people safely. Improvements are required when recording complaints. Staffing levels are not consistent to make sure there is enough staff on duty at all times to meet the needs of the people living in the home. The quality assurance programme is not in place to make sure that the people living in the home have an opportunity to voice their opinions and influence their daily lives. Staff supervision is not up to date which result in the staff not being valued or supported to do their jobs well. Senior staff providing supervision has not received training to do this. 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 31 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 31 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. A detailed assessment of needs is carried out before people move into the home so that they can be sure their care needs will be met. The home does not offer intermediate care placements Evidence: We looked at the information provided to people before they decided to move into the home. We spoke to the people living at Woodlands and they told us that they or their family were given information about the home before they moved in. The Manager carries out a care needs assessment to make sure the home can meet the needs of the person. The people and their relatives are invited to visit the home prior to moving in. We looked at two assessments and found that all records had sufficient detail about Care Homes for Older People Page 11 of 31 Evidence: the individual nursing and care needs. People living in the home told us that their relatives had made sure that the home was the right place for them to live. Information from the hospital and care managers is also obtained so that all care needs are included and form part of the persons individual care plan. Care staff told us that the assessments contained thorough information about the persons nursing care needs, however they would like to be more involved in the process by discussing the peoples needs before they move into the home. Care Homes for Older People Page 12 of 31 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. Improvements are required in the care plans to make sure they are person centred and there are written guidelines to move people safely. People can be sure their health care needs will be met and they will receive their medication safely and on time. People are treated with respect and dignity. Evidence: The care plan format for each person contains detailed information about the individual. There are examples of good practice to make sure that peoples needs are met, how they are supported to remain independent as possible and promote their choices. For example, encourage Ms X to choose her own clothes, she can brush her teeth by herself with an ordinary toothbrush. The plan then goes on to say what her preferences are in toiletries and bathing. Further detail is required in other areas of the plan to make sure that staff know how to encourage her and how to manage dressing and moving her, taking into account that she has a left sided weakness. Care Homes for Older People Page 13 of 31 Evidence: Some improvements have been made to the moving and handling risk assessments. The assessments now identify the equipment and number of carers required to move a person. As well as the example above, we saw, in two assessments sampled, detailed action of individual moving and handling support requirements was absent. We spoke to staff and they said they know what to do, but as this relies on word of mouth handover, it is not safe practice. More detail is required so that carers have written guidelines of how to move the person safely and in a consistent manner. This was a requirement from the previous inspection and because the service has not complied with this requirement we will issue the Area Manager with a Code B notice. This is the first step of our enforcement pathway which may lead to further enforcement action being taken. The form also tells the service their rights. Each care plan has a personal profile and information about the individual. The plans are reviewed and updated on a monthly basis and the people are asked to sign that they agree with the contents of the plan. The manager of the home told us that she had already identified the shortfalls in the plans and the organisation is working on a more personalised format of care planning which should be implemented within the next six months. We are not confident that this will be achieved as the management of the home is not yet stable. Peoples health care needs are monitored in the care plan and visits from health care professionals such as Doctors are clearly recorded. Each time a visit has occurred a new care plan is written to make sure staff know how to meet the new health care need. There are regular visits from the chiropodist, optician and dentist. The storage and management of the medication is good and records seen were up to date. The medication is audited on a regular basis to make sure everything is working well and only staff who have been trained administer the medication. Two Registered nurses complete the medication round in the morning to make sure that the people in the home receive their medication on time. It was found that the keys to the medication room are not kept separately from other keys in the home. For safety reasons, keys to the medication room require to be kept separately to make sure that only people who are responsible for the medication have access to the drugs. We observed staff talking to the people in the home respectfully and sensitively. Even though they were very busy in the morning they took time to make sure the people were either settled in the lounge or the dining room. Staff explained to people when they were going to give support and the reason why. When asked if staff respect dignity and privacy a person living in the home said absolutely, oh yes they always Care Homes for Older People Page 14 of 31 Evidence: do. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are able to make choices about their daily lifestyle. They enjoy varied and nutritious balanced meals. Evidence: The Expert by Experience was introduced to the Manager and one of the Carers and was shown the lounge where activities were taking place. Her findings are as follows: There was plenty going on and quite a few residents were in the lounge and the television was on as well (rather loud) because one of the residents who liked watching television, was hard of hearing. Two Activity co-ordinators were present. There appears to be an excellent programme of activities and, on questioning the residents, they appreciate these and take part in them. On the day of my visit, the activities co-ordinator was doing model making with a resident. He was enjoying this and confirmed that this was so. Other daily activities are bingo, nail painting, throw and catch with a soft ball, and sing a-longs. The other co-ordinator plays the organ and he also does one to one board games with the residents in their rooms. A lady resident was playing dominoes with him and she confirmed that she enjoys these sessions. Care Homes for Older People Page 16 of 31 Evidence: The co-ordinator also said that she spends ten minutes a day with each resident who is confined to their room, spends time talking with them or reading the newspaper to them. Residents confirmed that they enjoy this personal contact. A Birthday Party is given each month for all the residents who have had a birthday during the month. One resident said she and her husband, who is not a resident at the home, celebrated their Diamond Wedding Anniversary. They were given a party, the Mayor was invited to the Home and the local newspaper did an article on the couple. The resident said this made a very special day for my husband and myself. There is a good menu at the Home. The present Cook knows all the residents by name and their likes and dislikes. I ate a meal with the residents. This was plentiful, tasty and hot. There was a choice of menu. I noted Carers taking trays to those confined to their rooms. These were hot and nicely served. The Dining Room was not crowded and relatives can eat at the home if they wish. A number spent Christmas Day at the Home and ate with their relative. Residents were not rushed and those needing help were encouraged and helped unobtrusively. The activities co-ordinators were also helping and talking to the residents while they were helping them to eat. Overall the expert told us that the daily living activities and meals in the home are very good. The staff are supportive and have have a good rapport with the people who live at home. People who use the service comment: The food is good, the cook comes round every day to see what you would like. At tea time you can please yourself, sandwiches, soup or whatever you like. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are required to make sure that all complaints are recorded. Systems are in place to make sure people protected from abuse and staff are aware of the procedures for dealing with safeguarding issues. Evidence: There have been five complaints since the previous inspection. Up to August of last year, complaints had been recorded and actioned in the complaints log. There were no further complaints recorded in this log even though there was three sent directly to the Commission. Three of the complaints were raised about the lack of management in the home. There have been three managers since September 2010 and this has resulted in some records not being update. Despite this lack of recording in the log there is evidence to confirm that all of the complaints had been responded to appropriately. Improvements are therefore required when recording complaints to make sure accurate records in place. The people spoken with in the home did not have any complaints, however if they had concerns one said he would speak to his son and another said she would tell a member of staff. There have been three safeguarding alerts since the last inspection, which have been dealt with and are now closed. The home worked with social services to make sure that the service is safe for the people living in the home. The majority of staff have Care Homes for Older People Page 18 of 31 Evidence: received safeguarding training and are aware of what to do if they have any concerns about the care being provided in the home. Recruitment procedures are robust to make sure that people are receiving care from staff that have been checked and are safe to provide the care to vulnerable people Care Homes for Older People Page 19 of 31 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. The home is clean and comfortable enabling the people to live in a safe well maintained environment. Evidence: To make sure that the people living in the home have suitable communal space the Area Manager told us that the organisation is looking at options such as a conservatory or changing the use of a large bedroom to provide the people with another lounge. The maintenance person is employed to carry out day to day repairs and keep safety records in the home. There is a maintenance book to list daily jobs and staff also identify areas in the home which require attention. Since the last inspection, two new sluices have been installed, an industrial washing machine has been purchased, a new nurse call system has been implemented, and all lights in the peoples bedrooms over the sinks have been replaced. A fire risk assessment has been competed and the issues raised in the last Environmental Health visit have also been completed. The laundry room and sluice room were both in good order with appropriate facilities and systems in place to prevent the risk of infection. The home had a pleasant smell throughout and the Housekeeper makes sure that the carpets are cleaned on a regular basis. Care Homes for Older People Page 20 of 31 Evidence: The people have the necessary aids and equipment to assist them in maximising their abilities and improving their comfort and health. Equipments such as pressure relieving cushions are in place to help people maintain their skin integrity. Care Homes for Older People Page 21 of 31 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 people living in the home can not be confident that their full care needs will be met as staffing levels are inconsistent. Training records are not accurate to evidence that the staff are receiving the identified training to do their jobs well Evidence: On arrival in the home there was one Registered Nurse on duty, three care staff, one cook, one kitchen assistant, one laundry person, one housekeeper, one domestic and one handyperson. The manager did not arrive in the home till later as she was out assessing a person who may wish to move into the home. The dependency levels of the people living in the home are high. This is clearly documented in the care plans, with most people requiring one or more carers to support them. The staff rota showed that there was only three staff on duty due to sickness. At the time of the visit there were twenty two people with high dependency needs living in the home, so it is our view that three care staff is not sufficient to ensure that individuals full care needs are met. The Manager told us that the Registered Nurse had tried to cover this shortfall by using existing staff but was not able to do so. The management did get an agency staff member to cover for the afternoon shift, however from looking at the rota this Care Homes for Older People Page 22 of 31 Evidence: did not seem standard practice. In August 2008 the Commission sent a Statutory Requirement Notice to the Registered Provider. This notice is a legal document telling the home to make sure action is taken to comply with the regulations. This letter stated that there should be at least four staff members on duty in the afternoons to meet the needs of the people living in the home. The rota showed that this was not the case on 10th February 2010, as there were only three members of care staff on duty. This shows that the Registered Provider has not complied with this requirement. After looking at the rota for the last month, this was the only time it showed only three care staff on duty. However, two members of staff told us that the rota did not truly reflect the number of staff on duty as it is almost a weekly occurrence that staff members go sick and they run short staffed. We can not be confident that there is always enough staff on duty to meet the full needs of the people living in the home. In January the Commission also received three complaints from staff, raising concerns re the changes to staff working patterns, inadequate staffing levels and excessive number of hours that the Registered Nurses are working. A requirement will be made in this report to make sure that staffing levels are appropriate to meet the needs of the people living in the home, as well as noting evidence of this breach of regulation on the Code B notice. It is imperative that the management keep the people dependency to staffing level ratio under strict review. The Manager is aware of the shortfalls and is trying to address them by recruiting more staff. She told us that agency usage has to be approved by head office before they can cover the shifts. We are unclear if this is being done on a day by day or projected basis, but whatever method is employed, it must not place people at risk from support shortfalls. Staffing levels are being reviewed and with the new recruitment she is hopeful that she will employ more part time carers who will be able to cover in times of sickness and holiday periods. The AQAA states that during the last year eight members of care staff have left the home. The manager told us that she has advertised for new care staff and has five applications for prospective employees. A night time Registered Nurse has also been appointed. She is aware of the shortfalls and is trying to address them by recruiting more staff. She told us that agency usage has to be approved by head office before they can cover the shifts. Staffing levels are being reviewed and with the new recruitment she is hopeful that she will employ more part time carers who will be able to cover in times of sickness and holiday periods. There seems to be a high turnover of staff in the home which has been consistent Care Homes for Older People Page 23 of 31 Evidence: since 2008 and the home is continually recruiting to fill the existing vacancies. The recruitment of new staff puts additional pressure on the permanent staff as they are involved in the induction training for the new carers. The AQAA told us that there are staff eight staff who have achieved NVQ 2 or above. This is fifty per cent of the care staff. There are good procedures in place to make sure that staff are checked when they come to work in the home. This includes full and complete application forms, Criminal Record Checks (CRB), proof of identity and satisfactory written references. This makes sure that the staff are safe to provide care to the people living in the home. The training matrix was incomplete and did not show staff who have completed first aid awareness training. At the time of the inspection the training records did not show who had received any specialist training to meet the needs of the people living in the home. For example, Mental Capacity Training, Deprivation of Liberty Training, Dementia and Diabetes training. The majority of staff have received training in fire, food hygiene, moving and handling, protection of vulnerable adults and infection control. Improvements are required in the recording of the training as staff told us that they had received training in diabetes and dementia but the records seen did not show this. The organsiation do have an ongoing training programme, however with the changes in the management since September there does not seem to be true record in place of the training which has been provided. A requirement will be made in this report to make sure that all staff have first aid awareness training and accurate records are in place to evidence what training all staff have received. There is a competency based induction programme in place to make sure that new recruits have the skills to do their job. We believe that the shortfalls in all of the staffing areas has arisen due to the inadequacy and stability of the management of the home. Care Homes for Older People Page 24 of 31 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. Improvements are required in the effective management of the home, including the quality assurance programme, to make sure the home is run in the best interests of the people who live there. Staff are not receiving regular supervision to make sure they are supported to do their job well. Peoples finances are protected and the health and safety of the people living in the home and staff is promoted and protected. Evidence: There has been a reorganisation of the management levels throughout the organisation. There is a new Responsible Individual and Area Manager. The Area Manager has been in post four weeks. Since 2008 there has been four Managers in the home, three since September 2009 Care Homes for Older People Page 25 of 31 Evidence: and there is currently no deputy manager. The current manager of the home is on secondment from another home within the organisation and has agreed to stay and manage Woodlands until a new manager is appointed. The Area Manager told us that he is in the process of recruiting a new manager for the home and further interviews are to be held shortly. The deputy manger position will also be considered. The management of the home has not been stable since 2008 and it is clear from this visit and evidence in this report that this is having a detrimental affect on the home. The current manager has been in post for four weeks and is qualified and experienced. She has already made improvements in health and safety and recruitment of staff. She is aware of the shortfalls in the home and is working her way through these issues. There is a lot of work to make sure the home is run in the best interests of the people living there. The recruitment of a permanent manager will take some time and this has been an ongoing issue since 2008. The Area Manager told us he has recognised that the home has lacked effective management and has arranged for an internal two day quality assurance visit to identify the shortfalls in the service. We therefore require the Registered Provider to confirm in writing the outcome of this quality assurance and what arrangements will be put in place to support the home during this period. Staff told us that they are problems with the lack of management in the home, they said that it is hard to work consistently with different managers who have their own ways of working. There is a quality assurance programme in place but due to lack of management this has not been implemented since the previous inspection. This does not give the people who live in the home an opportunity to voice their opinions and have an influence on the day the day running of the home. Staff supervision is not up to date. The Registered Nurses supervise the care staff and have not received supervision training. Due to the changes in the managers the Registered Nurses have also not received supervision. There are systems in place to protect the peoples financial interests. The records are audited on a regular basis and all transactions are recorded with receipts attached. The service continues to provide the staff with core and induction training. The Health and Safety records were in good order, with checks for water temperatures and fire equipment. The fire book was up to date and in good order. All of the required safety checks on the equipment in the home have been carried out. The Accident Book was Care Homes for Older People Page 26 of 31 Evidence: in good order and recorded what actions needed to be taken; however previous completed accident forms are not being filed in individual personal files and remain in the Accident Book. The manager told us that this would be addressed to make sure this confidential information is stored correctly. Care Homes for Older People Page 27 of 31 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 7 15 To ensure the care plan 31/03/2009 provide staff with clear moving and handling guidelines. The daily records are legible and reflect the care given at that time. To ensure that the people and staff are safe when moving people. To ensure that records are clearly written to provide staff with details of what care has been provided. Care Homes for Older People Page 28 of 31 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 27 18 The Registered Provider to 28/02/2010 make sure that at all times suitable qualified, competent and experienced persons are working in the care home in such numbers as are appropriate for health and welfare of service users. To make sure that there is enough staff on duty to meet the needs of the people living in the home. 2 30 18 The Registered Provider to 31/03/2010 ensure that staff receive first aid training. To make sure that staff have the appropriate training to meet the peoples needs. 3 30 17 The Registered Person shall maintain in the care home the records specified in Schedule 4 (6)(g) a record of all training undertaken including induction training. 31/03/2010 Care Homes for Older People Page 29 of 31 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 To make sure that an accurate record of all training is in place to evidence that the staff have received appropriate training to do their jobs well. 4 33 24 The Registered Provider shall establish and maintain a system for evaluating the quality of the services provided. To make sure that the home is run in the best interest of the people who live there. 5 36 18 The Registered Provider to 31/03/2010 ensure that persons working in the care home are approrpaitely supervised. To make sure that staff are supported to do their jobs well. 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 31/03/2010 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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