Care Home: Abbey Ravenscroft Park

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What the care home does well Because the home is only partly occupied, we could not assess fully how the communal spaces, leisure activities, meal times and other activities of daily living will operate when the home is full. However, the people we spoke to, staff and visitors, were positive about the home and its operation so far. People said the staff looked after them well and said the staff are very pleasant and friendly. They also said: "We are very pleased with the staff and care". "I am happy with the way they care for my relative" "The staff are attentive, patient and very friendly" "My relative has done very well since being here" "The home takes care of people" "I have settled in very well" The home is newly refurbished, with some character features, and has pleasantly furnished bedrooms and communal areas. The home is located near to a busy community, with a range of shops and other facilities within easy reach. Staff were generally happy about the training and level of support. They said: "The home meets its service users` needs" "The home provides the equipment we need" "It gives us training" "All the residents` care needs are met" What has improved since the last inspection? This was the first inspection of the home. What the care home could do better: The home needs to ensure that the documentation it produces is easy to follow and gives people information about how any specialist needs are met. The staff need to ensure that, where equipment is used, risk assessments are fully completed and the staff are trained to complete them. The Manager must ensure that medication audits are carried out regularly and recorded. Should errors be found, action must be taken with the staff concerned.Not all of the recruitment procedures were completed and they must be checked and completed before staff are employed. To support the staff and residents, the specialist training which is required to meet the needs of the residents, particularly dementia training, must be provided to all of the staff team. The staff team need to be supported by having regular supervision sesions with their line manager. The reporting procedures, under safeguarding and Regulation 37 incidents, need to be reported to the Care Quality Commission, as they occur. People`s finances need to be safeguarded by staff signing for all transactions. Key inspection report Care homes for older people Name: Address: Abbey Ravenscroft Park 3-6 Ravenscroft Park Barnet Herts EN5 4ND     The quality rating for this care home is:   two star good 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: Jane Collisson     Date: 2 9 0 5 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 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) 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 31 Information about the care home Name of care home: Address: Abbey Ravenscroft Park 3-6 Ravenscroft Park Barnet Herts EN5 4ND 02084495222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): evelyn@ravenscroftparknursinghome.co.uk Abbey Ravenscroft Park Name of registered manager (if applicable) Mrs Evelyn Ranjini Umamaheswaran Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability sensory impairment Additional conditions: Date of last inspection Brief description of the care home Abbey Ravenscroft Park is a care home with nursing which was registered in January 2009 with the Commission for Social Care Inspection. The home is registered for fifty older people, including those with dementia. The home was opened in February 2009, following an extensive refurbishment of the building, which had formerly been a care home. There is accommodation on three floors. Forty two bedrooms are single and there are four double bedrooms on the second floor. All have an en-suite toilet and Care Homes for Older People Page 4 of 31 Over 65 50 0 50 0 0 50 0 0 0 0 Brief description of the care home fourteen have a private shower. There are assisted baths and shower rooms on each floor. Each of the three floors has its own lounge and dining room. There is one passenger lift to all floors. There is small conservatory, which is reserved for people who smoke, and this leads to the paved garden, with flower beds and seating. The home is located within easy access to shops, local amenities and public transport. There is a well-equipped kitchen, where all the meals are prepared. The kitchen, laundry and staff room are located in the basement of the home. The staff team consists of the Registered Manager, staff nurses and care workers. There is a team of kitchen staff, laundry and domestic staff. The fees range from £650 to £750. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the first inspection of the Abbey Ravenscroft Park home since its registration in January 2009. It was an unannounced visit and took place on 29th May 2009 from 9.30am to 7pm. The Registered Manager was present all day and the Registered Individual attended for the feedback in the evening. A second visit was made on the 5th June to examine further records and to dicuss the progress of the maintenance issues. The inspection took a total of twelve hours. We met with most of the residents and staff and spoke to five visitors during the visits. People are referred to the home by the Local Authorities or Primary Care Trust or may be admitted privately. The home had its first residents in February and there were fifteen people living in the home, one on a respite stay. All but one person had rooms on the ground floor. Most people were sitting in the ground floor lounge during both visits, but people are Care Homes for Older People Page 6 of 31 able to stay in their rooms if they wish to do so and one person was doing this. There were bingo sessions in the afternoon of each visit and a variety of music was available and playing. There is an Activities Organiser. who also does the administrative work in the home. We toured the home with the Manager, including the areas which are not yet occupied. We found that the home has been refurbished to a high standard. However, the communal space on the second floor was noted to be quite limited should that unit have the twelve residents it can accommodate. The sitting area and dining tables are in the same room. We discussed this with the Registered Provider who said that people would be free to use all the other areas of the home and could have meals in their bedrooms if they wished to do so. People speaking to us said they enjoyed the meals, although five of those replying to the surveys said they only sometimes or usually liked the meals. At the first visit we observed the meal at lunchtime, which was a choice of fish with chips, potatoes and peas. One person had a vegetarian option of their choice and there was vanilla ice cream for dessert. The need for meals to suit a persons cultural diet was identified during the inspection and the head cook was attempting to meet this need. He was also attending training so that meals may be provided for another cultural and religious diet should they be required. Visits by religious representatives were being arranged and a staff member was providing information for staff to meet a persons religious wishes. The atmosphere in the home on both occasions was relaxed and we saw a good rapport between the residents and staff. We observed two people using the garden and other people said they had done so. The conservatory, for people who smoke, had been added after the registration of the home and is the exit to the paved garden. The slope was steep, without rails. By the second visit, a new ramp had been built and the rails were being fitted on the day. There had also been a number of hazards in the garden which had been repaired or removed. A gardener had only been employed recently and plants, to provide a sensory garden, had arrived and were ready to be planted. The large fountain was due to be brought back into use and there are tables, chairs and umbrellas so that the residents can enjoy the garden. We sent surveys to people living in the home and had six replies. Nine staff responded to our surveys. The replies and comments we received during the inspection will be referred to in the report. The home has only been open for a short period, with a small number of residents and a new staff team, so the systems have not been in place for long and were evolving as the needs and preferences of the residents were becoming known. Overall, we found that the people living in the home, and their visitors, are satisfied with the support so far. The Registered Providers and the Manager made every effort to address the issues and shortfalls we found on the first visit. We have made eight requirements at this inspection. 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 home needs to ensure that the documentation it produces is easy to follow and gives people information about how any specialist needs are met. The staff need to ensure that, where equipment is used, risk assessments are fully completed and the staff are trained to complete them. The Manager must ensure that medication audits are carried out regularly and recorded. Should errors be found, action must be taken with the staff concerned. Care Homes for Older People Page 8 of 31 Not all of the recruitment procedures were completed and they must be checked and completed before staff are employed. To support the staff and residents, the specialist training which is required to meet the needs of the residents, particularly dementia training, must be provided to all of the staff team. The staff team need to be supported by having regular supervision sesions with their line manager. The reporting procedures, under safeguarding and Regulation 37 incidents, need to be reported to the Care Quality Commission, as they occur. Peoples finances need to be safeguarded by staff signing for all transactions. 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. Most information is available to help people make a decision about moving to the home and was being made more user-friendly. People have their needs assessed prior to admission. Staff are experienced to meet most of the needs of people but more training is required to meet specialist needs, such as dementia. People can visit and try the home prior to admission. Evidence: The Manager provided us with the Service Users Guide and the Statement of Purpose on our first visit. She subsequently updated both, and the Service Users Guide was improved with the use of photographs. However, some of the information in the Statement of Purpose should be in the Service Users Guide. The Statement of Purpose would also benefit from being streamlined. We did not find that there was clear information about the homes dementia registration initially. This included how the needs of people with dementia, or other disabilities and illnesses, would be met by the homes facilities, activities and training. Some of this information was included in Care Homes for Older People Page 11 of 31 Evidence: the revised copies. Both people using the service, and those looking for a placement, such as relatives and social workers, would benefit from receiving information which is easier to use. People told us that they have copies of their terms and conditions. We discussed the assessment procedure with the Manager. We found, in the six files we examined, that assessments had been provided, mainly through the health service. The Manager carries out her own assessment, using the company documentation. The home uses a nursing documentation system which assesses each health need. These include nutrition, mobility, dependency levels, eating and drinking and sleeping. We were provided with a staff training record, which is maintained on the computer, but it was not up-to-date on the first visit. We were provided with a completed copy on the second visit. We noted, and staff confirmed, that while there has been basic training, there had been limited training on dementia, for which the home is registered. This needs to be a priority. We have made a requirement under the relevant standard. We asked about the opportunity to visit the home prior to being admitted. The Manager said that, so far, families had visited as some people had been in hospital and it had not been possible to bring them to see the home. However, there is the opportunity for people to come for a trial stay if this is required. The Manager said that one person was due to visit the following week for this purpose. The Service Users Guide states that there is a four-week trial period. The home also takes people for respite stays and this was being provided during the inspection. The home does not provide for Intermediate Care so this standard could not be assessed. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have care plans which reflect their needs, although these could be more person-centred. Risk assessments are in place for most activities where risks are identified, but some areas require better information. Health needs are met by community services and the homes nursing staff. People say they are treated respectfully by staff. Evidence: We examined six of the care plans. People had a variety of care plans for eating and drinking, mobility, sleeping, washing and dressing. We found that there was also an additional file with information for each person which had further assessments and care plans. There was limited information on the social needs and personal choices. We found that having two systems does not provide clarity. The Manager agreed and said that she was looking to have only one system only so that the information would be easier to maintain. We saw the notes written at the end of shifts, which were written in a satisfactory manner. The home has a general practitioner, who is retained. but we saw that people can Care Homes for Older People Page 13 of 31 Evidence: have a choice if they wish to keep a doctor they already have or to transfer to one in the area. Other health services such as dentists, chiropody and opticians are accessed as required. However, there is limited access to NHS chiropody unless people are taken to a clinic. It is explained in the Service Users guide that chiropody will need to be paid for if not provided by the NHS. Visits by health professionals was seen to be recorded. We did not find that all of the risk assessments were fully completed. In particular, those for bed sides did not show that all of the risks had been considered and whether the use of these was unnecessarily restrictive for some people. The staff nurse in charge, on the first day, undertook to improve the risk assessments and these were being completed at the second visit. The Manager also provided a new risk assessment form for bed sides which will be completed in the future. We noted that risk assessment training is not being held until later in the year. Staff who carry out risk assessments must be trained to do so and understand the hazards associated with equipment, so this needs to be completed as soon as possible. At the present time there was one person with a gastroenterol feed. The Manager and one of the staff nurses are trained to be able to take blood samples and another nurse is to be trained. However, one visitor told us that this was distressing to watch and this should be conducted in private, not in the lounge. Four people are currently moved by hoist. We saw that there were no storerooms for hoists or wheelchairs and one of the bathrooms was being used for this purpose. As the home fills, the home needs to find suitable storage for equipment. The home uses a 28-day Monitored Dosage system for its medication. This is stored in a medication trolley and dispensed only by the trained staff. We found that there were a number of gaps in signatures on the Medication Administration Record sheets we examined. We discussed this with the Manager. She had not started a monitoring system for the medication at the first visit but had undertaken at audit by the second visit. She said that she had discussed with the nurses about the missing signatures, and this must continue to be monitored. Action must be seen to be taken if nurses continually make errors. Only one controlled drug was being used at the time of this inspection which was stored separately and had two signatures when administered. Care Homes for Older People Page 14 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. As the service is new, the activities of daily living are evolving and being tested to suit the residents. Not everyone says they enjoy the meals all of the time but say choice is provided and there is sufficient food. Activities are being provided. Visitors are welcomed. Evidence: Because of home has only recently been opened, and was only one-third full, the opportunities for a full range of activities is limited. However, the person who carries out administrative work is also acting as the part-time Activities Organiser and had a programme of activities for each day for approximately two hours. The Service Users Guide states a full-time Organiser is employed but the Manager said that further hours would be available for activities when the home has more residents. The Organiser has not yet had training, but she organised bingo on the two days of the inspection. One resident confirmed that bingo is held regularly. She is keeping records of the activities individual residents have enjoyed, which we saw. We also saw staff sitting and talking with the residents. One person was enjoying looking a large illustrated book and another was reading the newspaper. A fair had been held in the park opposite between the two visits and people had been taken to participate. Two Care Homes for Older People Page 15 of 31 Evidence: people said that the home arranged activities they enjoyed. The staff said they had celebrated Easter and VE day with the residents. A summer party is planned and peoples birthdays are celebrated. The garden was being improved so that it was safe to walk around. Flowers and tomatoes were ready to be planted and it is planned that part of the garden will be used for vegetables, with a greenhouse provided. There is an area of the garden which has steps to an outside gate and the Registered Provider arranged with the builders, who were present on the second visit, to put a gate in so that the garden has only level access. The staff said that visitors are welcome and we met with five during the visit. There are no restrictions on visiting times except at mealtimes. Each floor has its own lounge but there are no private areas for people to meet. The visitors we met were very positive about the home and the friendliness of the staff. Nearly all of the people who were able to express their views about living in the home said they were happy to live there. However, a number of people with dementia could not express their views about the home but appeared to be settled. We discussed the meal provision in the home with the head cook. The company provides a set menu but he has devised his own menu so that it provides for two choices of main meal. At present, because of the small number of people, he is able to ask them in the morning what they would like. He provides a vegetarian alternative for one person. There were no special cultural needs being met initially but there was a request for more culturally appropriate meals, during the inspection, and the cook was trying to meet this need. He is also on a training course to provide kosher meals, should they be required. On the first day of the inspection we saw that the meal was plain or battered fish, mashed potatoes, chips and peas. A bowl of salad was available. The dessert was vanilla ice cream. The evening menu always has soup and sandwiches and there was also spaghetti hoops on the first day of the inspection. We noticed that, on some days, the dessert is only plain ice cream or yoghurt, without an alternative. The yoghurt available for diabetics was low fat but not sugar free. People we spoke to said that they enjoyed the meals and had sufficient. However, of the six people who replied to our surveys, one said they always liked the meals, three said that they usually liked the meals and two said sometimes. We recommended that the staff who serve are asked to note which meals are popular, or not so popular, so that peoples views can be recorded at the time. The Registered Care Homes for Older People Page 16 of 31 Evidence: Provider said that a new menu is to be devised for all his homes and he has a person who will be overseeing the introduction of this. This menu is devised to take into account nutritional needs. The head cook has many years of experience. The kitchen assistant said that she had not been on Food Hygiene training and this needs to be remedied. The kitchen, housed in the basement, is newly refurbished. The Service Users Guide says that there are kitchenettes on each floor. However, on one floor there is a sink unit and fridge, within a very small area. On the top floor we saw a sink unit within a cupboard. There was insufficient room for a fridge but the Manager said one would be housed in another cupboard. The Manager said that staff will be able to make hot drinks in these areas. There are set times for hot drinks, 10.30am and 3pm, but it also needs to be ensured that people can also have a hot drink between these times if they wish to do so. The staff said that the sandwiches made for the evening meal are also available for anyone who would like a snack during the evening. They said that most of the current residents go to bed fairly early and we saw that most were in their rooms by 7pm on the first day of our inspection. In respect of exercising choice and control over their lives, we saw two people accessing the garden alone, and one choosing to stay in her room. People who come to live upstairs may have less opportunity to access facilities alone, and will need the assistance of staff or families to use the lift and keypads to access the lounges. Staffing levels will need to be sufficient for people to be able to move around as they wish, as it may be of concern to people who are able to access the garden and other communal areas but find themselves unable to do so. This will need to be seen to be discussed with them. The Manager has been training on the Mental Capacity Act but had not yet been on Deprivation of Liberty training. One person has had an assessment carried out regarding this. Another person had expressed feeling restricted within the home. The Manager was aware of this and it was being discussed with family and professionals. There has been one incident of a person leaving the home unaccompanied but the safeguarding meeting found that the home had not been negligent. 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. People are provided with the complaints procedure and say they know how to complain. Clarity is needed about the timescales for complaints. Staff are given information about safeguarding, but management procedures may not be sufficiently robust. Evidence: There have been three complaints since the home opened and a record has been kept of these. Two had resulted in a safeguarding adults meetings with the Local Authority. We recommended to the Manager that she keeps the safeguarding and complaints documentation separately, and in a different format, which she did by the second visit. The timescales for dealing with complaints needed to be included in the Service Users Guide and Statement of Purpose so that people are aware of the procedures should they make a complaint. They are displayed in the hallway of the home but the Manager was advised to ensure that the Service Users Guide also has these, as required by the Care Homes Regulations 2001. Following one complaint, disciplinary action was taken again the staff member. In two further cases, taken up with the Local Authority through safeguarding procedures, there have been complaints that families have not been kept informed of their relatives accidents. The Manager said that action is being taken with the staff to ensure that relatives are informed when accidents occur and the Manager provided us Care Homes for Older People Page 18 of 31 Evidence: with the policies and procedures now in place for emergencies, which included informing families. We saw a notice reminded staff about this in the nurses station. The Manager said the home had, initially, not been informed that two complaints had became safeguarding issues, so the Care Quality Commission had been informed by the Local Authority rather than the home. Safeguarding meetings had been held in both cases. Staff have received training in safeguarding but there needs to be an awareness among management staff of when issues should be reported. We asked the Manager about the residents being able to vote in the forthcoming elections but they had not yet been registered to vote as the forms had not been sent to the home. As it is possible to register people when they are admitted to the home, through the Local Authority, we recommended that new residents provided with this opportunity in future. 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 provides a pleasant environment, which is decorated and furnished to a high standard. Bedrooms have been personalised and people may bring in some of their own items. People have a choice of bathing facilities. The garden is potentially a pleasant area for use but needed to be made safe in all areas. Evidence: The home was only recently refurbished and the interior is redecorated and furnished to a high standard. The ground floor, which is spacious and light, accommodates twenty one people in single rooms. There is a large lounge/dining room. The small conservatory leading from this lounge is solely for people who smoke, although this also provides access to the garden. There is lounge/dining room on the first floor, where there are seventeen single bedrooms. The second floor has a lounge/dining room for twelve people. There are four double rooms on this floor. We found the communal space on this floor to be quite small, with easy chairs and dining space for only ten people. The Registered Provider said that the people on this floor would be free to use the other areas of the home or their rooms for meals. On the first visit of the inspection, which was warm and sunny, the roof lights in parts of the lounge provided very bright light. Not everyone was happy with this and the Care Homes for Older People Page 20 of 31 Evidence: staff said that the Registered Providers are going to provide some covering for these. There is also some air conditioning but people said they find this too cold. There are bathrooms on each floor and there is a choice of assisted baths or showers. Fourteen of the rooms have their own showers and everyone has their own toilet. The bedrooms we saw were pleasantly furnished and those occupied had been personalised with photographs, pictures and ornaments. The Manager said that people can bring in their own items but these would need to be fire retardant. All of the communal areas have a range of pictures, in a wide variety of subjects. These included scenes, flowers, and singers and actors which could provide subjects for reminiscence. There is a lift, which is suitable to be used in the event of a fire, between the top floor and the basement. There is suitable equipment, such as hoists and assisted baths, for people with poor mobility. The Manager confirmed that people needing specialist mattresses, where there is a risk of pressure sores, have them supplied. As mentioned previously, bed sides are used. The home must ensure that a thorough risk assessment is carried out before these are used and only after discussion with the person and their representatives. A requirement has been made under the appropriate National Minimum Standard. All the areas of the home we saw were clean and odour free. There is one domestic staff on duty at present and separate laundry staff. There is a handy person for the group of homes but the Manager said emergencies would be dealt with by calling in local companies. At the end of the first day of the inspection, we were given a list of maintenance work which needed attention. We checked the progress of these on the second visit and found that the majority of tasks had been completed or orders had been placed for further visits from companies to finish them. These included problems with hot or cold water to showers and radiator adjustments. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are generally satisfactory and help to safeguard people. Staff are provided with the basic training courses but more specialist training is required for staff development. People say they have their needs met and staff are friendly and helpful. Evidence: The Manager said that the home carries out its own recruitment. We examined five staff files. A number of the staff are from abroad and have student visas, which we saw, to enable them to study to National Vocational Qualification Level 3. Some staff have trained as nurses in their country of origin but are not qualified to practice as nurses in this country. References were seen but were not always from employers due to staff coming from abroad. In one nurses file, there was only one reference. The staff carrying out recruitment need to ensure that all of the information is in place. POVA 1st and Criminal Records Bureau disclosures were available for inspection. The qualified nurses have their Nursing and Midwifery Councils PIN identity recorded. We saw no training profiles, supervision records or probationary assessments. The Manager had not yet undertaken these, due to the short time the home had been opened, but has plans to do so. Staff nurses are to be trained to undertake one-to-one supervision of the care staff. As staff are new, the opportunity for support, through one-to-one supervision, should be provided as soon as possible. Care Homes for Older People Page 22 of 31 Evidence: There were four care staff on duty on the first day of the inspection in addition to the Staff Nurse in charge. One of the staff was available to provide cover for the first floor resident, but this had not been necessary as the person had chosen to be in the main lounge for most of the time. The rota had not been updated on the first day to include a staff member who was covering anothers shift. The Manager was reminded that the rota must be kept accurately. There are a number of bank staff working and the home is still recruiting permanent staff. Six staff who replied to our surveys felt that more staff are needed, particularly at night. The planned staffing levels, when the home is full, are in the Statement of Purpose. This is to have, on the ground floor, one Registered Nurse and four care workers from 7am to 8pm. From 8pm to 7am, there will be one Nurse and two care workers. On second and third floors, it is planned there will be two Registered Nurses and seven care staff during the day. At night there will be a Nurse and four care workers. The Manager will need to have a system to monitor the dependency levels, as people are admitted, to ensure that the staffing is sufficient. The company has a trainer who provides the induction and ongoing training. The induction takes place over 12 weeks. The Manager had completed the training schedule by the second visit and we saw that the majority of staff had fully completed their induction and the newer staff had moving and handling, safeguarding adults and infection control training. The Manager provided us with the training schedule for 2009. Although there has been no dementia training so far, a variety of training has been arranged including a number of dementia courses starting in July 2009. Other courses included fire safety, food hygiene, Mental Capacity Act and Deprivation of Liberty. There is to be supervision training for the nurses. Although a risk assessing course has been arrange for December 2009, this should be accessed sooner for staff who have not had this training but are carrying out the assessments. Training from the London Borough of Barnet is also accessed. We spoke to staff who said that they enjoyed working in the home and said that they have been offered training since joining. Care Homes for Older People Page 23 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 good 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 experience and qualification to run the home competently. The interior environment is pleasant and safe but the homes garden needed to be made safe for everyone to use. Better financial procedures are needed for protection. Reporting procedures need to be improved to ensure people are safeguarded. Evidence: The Manager is a registered nurse who has twenty years experience. She has previous experience of running a nursing home and has the National Vocational Qualification Level 4 in management. There was a relaxed atmosphere in the home and people, people and staff confirmed that this was usual. The home holds small sums of money for people for their hairdressing, newspapers, toiletries and chiropody. We saw that, when sums were recorded as being withdrawn in the record book, they were not always signed and this should be done to ensure that both residents and staff are protected. Care Homes for Older People Page 24 of 31 Evidence: We saw that monthly visits, undertaken on behalf of the Registered Providers under Regulation 26, had been made for March and April 2009 and were quite thorough. However, the deficiencies in the garden should have been reported and actioned to ensure safety for the residents. The Manager said she had not yet established a system of regular one-to-one supervision to support staff. It was noted that nurses are to be trained to undertake the supervision of staff. To meet the National Minimum Standards, a minimum of six sessions a year need to be held and this should commence with those staff in post since the home opened. Although we did not receive the Regulation 37 notices of accidents and incidents at the time they took place, we did receive them some time after the events. We had not been informed of the safeguarding issues by the homes although there had been some confusion about these. We discussed, with the Manager, the need to inform the Care Quality Commission of any issues, at the time of their occurrence. A letter from the London Fire and Emergency Planning Authority from January 2009 was seen to say that the fire precautions were satisfactory. There is a fire resistant lift which can be used in an emergency and this reaches all floors. A fire risk assessment carried out by an external company was in place. However, there have been no fire drills since the home opened. The induction procedures also states that fire training should be carried out on induction and this has not been carried out. We discussed with the Manager, the need to have one as soon as soon as possible and she was arranging this. We saw that the fire alarms have been tested weekly. All of the equipment being used is new and therefore no servicing was due to be held. We saw information on chlorination and water testing, although some water temperatures were still in need of adjustment. The home had registered with the Environmental Health in respect of its kitchen but had not yet had an inspection. The Commission for Social Care Inspections certificate is displayed and the insurance certificate expires in October 2009. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 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 1 5 The Registered Manager 30/06/2009 must ensure that the documentation provided for people containing information about the needs the home can meet and is produced in a user friendly format. To ensure that prospective residents and others are able to fully understand the facilities the home has to offer and how needs are met. 2 7 13 The Registered Manager must ensure that the risk assessments for bed sides are fully completed and agreed before people have these provided. Staff carrying out risk assessments must have the necessary training. 30/06/2009 Care Homes for Older People Page 27 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 protect people from harm or any unnecessary restriction. 3 10 13 The Registered Manager must ensure that there are systems in place to ensure that all the medication procedures are checked regularly and action taken where errors have been found. To ensure that the records of medication administration are accurately maintained. 4 18 13 The Registered Manager must ensure that any incident which might consistute a safeguarding issue is reported to the appropriate department To ensure that action has eben taken to safeguard people. 5 29 18 The Registered Manager must ensure that all of the information required under the Care Homes Regulations, Schedule 3 in obtained in respect of all staff. To ensure that people are protected by robust recruitment procedures. 30/06/2009 30/06/2009 30/06/2009 Care Homes for Older People Page 28 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 6 30 18 The Registered Providers must ensure that all staff are trained to meet the specialist needs of the work they perform. To ensure that staff have the training to work with people with dementia, and that any specialist training such as risk assessing is undertaken by staff required to undertake the tasks. 30/06/2009 7 34 13 The Registered Manager must ensure that all financial dealings are signed by the staff carrying them out. So that people have their finances protected. 30/06/2009 8 36 18 The Registered Manager must ensure that all staff have access to regular supervision sessions. To ensure that staff are supported in their work, training and development. 31/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 15 That ways are found to ensure that people have the menus they enjoy and staff are involved in helping to provide the Care Homes for Older People Page 29 of 31 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 information. 2 17 That people are registered to vote with the Local Authority as they are admitted to the home. 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). 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