Care Home: Abbeydale Residential Home

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What the care home does well Despite some difficulties with the system being used, senior staff are aiming to provide well informed assessments of people`s needs and guidance for staff on how these needs will be met. People`s diverse needs are being recognised and the care being delivered is able to be flexible so that individual preferences can be met. The food provided is plentiful and is meeting people`s nutritional and dietary requirements. The environment is kept clean and safe. The management team have embraced the help and support from outside agencies and has shown us that it is willing to engage with others for the benefit of the people who use the service. What has improved since the last inspection? The service have reviewed its care practices and management processes since our (the Care Quality Commission) last key inspection in February of this year. Many of the shortfalls identified at that point have either been addressed, are work in progress or have a future date to be addressed by. The processes for ensuring that the home provides a high standard of care and maintains compliance with the Care Home Regulations 2001 have also been reviewed and altered. Some of these have begun, others have yet to prove themselves. Areas of change also include the admission process and subsequent care planning and care delivery. Several members of the original staff team are no longer employed but some existing staff remain. Despite the introduction of new staff and the work required to establish a new care team, the service have done well and there is currently a good mix of skill and knowledge. There are now arrangements in place to ensure staff receive appropriate levels of training and support. Some of this has already taken place and further trainings are either already booked or planned. The new deputy manager, who previously worked in the sister home to Abbeydale, has taken a lead in changing certain aspects of people`s care. People have been consulted and their individual preferences more thoroughly identified and recorded. A change in how people are being approached by the staff and a general improvement in the standard of care and staffs` skill is beginning to result in improvements to people`s general well being. All staff are fully aware of their responsibilities in relation to safeguarding vulnerable adults from harm or abuse. The service`s policies and procedures have been reiterated and there is a general expectation both from the registered provider, us and the local County Council that these will be adhered to. The registered provider has decided to make additional improvements to the information held by staff relating to the whistle blowing procedure. This will make it easier for staff to confidentially raise any concerns they may have. Staff supervision sessions will be in more depth and be more meaningful. This will help to quickly identify any shortfalls in practice but also agree the correct level of support. Staff meetings are being held and communication within the team has improved. Best practice meetings are to be held with Abbeydale`s sister home. The service wants to get relatives and representatives more engaged with what is happening in the home and any future plans. Changes to how the service communicates with both parties will be implemented and this should improve the level of feed back received from both parties. What the care home could do better: The registered provider has a good understanding of the shortfalls within the service and is addressing these. The Improvement Plan submitted by him outlines what needs to be improved on and when this will be achieved. We have repeated three of the nineteen previous requirements and made one new requirement because, either we could not evidence compliance for various reasons or the improvements were still work in progress and the issue had not been fully resolved. None of these we felt, at the time of this inspection, put people at immediate risk or great risk and we are confident they will be fully addressed. The service now needs time to establish and sustain the improvements that have begun. Key inspection report Care homes for older people Name: Address: Abbeydale Residential Home 281 Gloucester Road Cheltenham Glos GL51 7AD     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: Janice Patrick1     Date: 2 6 0 5 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 35 Information about the care home Name of care home: Address: Abbeydale Residential Home 281 Gloucester Road Cheltenham Glos GL51 7AD 01242525107 01242522671 abbeydalerh@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Charlton Care Ltd Name of registered manager (if applicable) Brian Darlison Type of registration: Number of places registered: care home 13 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 sevice users who can be accommodated is 13. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - (Code OP) Date of last inspection Brief description of the care home Abbeydale is an adapted older property situated in the residential area of St Marks, within easy reach of local shops and the railway station. The Home is also on a bus route to Cheltenham town centre. Charlton Care Ltd purchased the home in 2006. Single accommodation for thirteen older people, who require personal care, is provided on two floors. All the bedrooms are in good decorative order and are furnished. Each room has en-suite facilities. On the ground floor there is a lounge and Care Homes for Older People Page 4 of 35 Over 65 13 0 0 9 0 2 2 0 1 0 Brief description of the care home conservatory which acts as space for the dining room. The well maintained garden has easy access for people who are mobile and for those who use a wheelchair. A passenger lift allows access to the first floor for people who cannot use the stairs. There is some off road parking at the front of the property. A copy of the most recent inspection report is contained in an information folder located in the main hall of the home. Current fees range from 500 pounds to 750 pounds. Prices for hairdressing, chiropody and any personal items are available on request. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the service we considered all the information we had gathered since the last key inspection which was carried out on 8th February 2010. This included the last key inspection report and the outstanding requirements. We read the registered providers improvement plan which told us how the service was going to meet these shortfalls. We look at the notifications sent to us by the service since February. These inform us of any accidents, deaths and occurrences that effect service users. We also considered information that has been forwarded to us from other agencies and external health care professionals. Questionnaires were not forwarded to the people who use the service as this was carried out prior to our inspection in November 2009. Two inspectors, one a pharmacist inspector, then visited the service for a total of seven and three quarter hours. We spoke to people using the service and to the staff on duty. Care Homes for Older People Page 6 of 35 Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? The service have reviewed its care practices and management processes since our (the Care Quality Commission) last key inspection in February of this year. Many of the shortfalls identified at that point have either been addressed, are work in progress or have a future date to be addressed by. The processes for ensuring that the home provides a high standard of care and maintains compliance with the Care Home Regulations 2001 have also been reviewed and altered. Some of these have begun, others have yet to prove themselves. Areas of change also include the admission process and subsequent care planning and care delivery. Several members of the original staff team are no longer employed but some existing staff remain. Despite the introduction of new staff and the work required to establish a new care team, the service have done well and there is currently a good mix of skill and knowledge. There are now arrangements in place to ensure staff receive appropriate levels of training and support. Some of this has already taken place and further trainings are either already booked or planned. The new deputy manager, who previously worked in the sister home to Abbeydale, has taken a lead in changing certain aspects of peoples care. People have been consulted and their individual preferences more thoroughly identified and recorded. A change in how people are being approached by the staff and a general improvement in the standard of care and staffs skill is beginning to result in improvements to peoples general well being. All staff are fully aware of their responsibilities in relation to safeguarding vulnerable adults from harm or abuse. The services policies and procedures have been reiterated and there is a general expectation both from the registered provider, us and the local County Council that these will be adhered to. The registered provider has decided to make additional improvements to the information held by staff relating to the whistle blowing procedure. This will make it easier for staff to confidentially raise any concerns they may have. Staff supervision sessions will be in more depth and be more meaningful. This will help to quickly identify any shortfalls in practice but also agree the correct level of support. Care Homes for Older People Page 8 of 35 Staff meetings are being held and communication within the team has improved. Best practice meetings are to be held with Abbeydales sister home. The service wants to get relatives and representatives more engaged with what is happening in the home and any future plans. Changes to how the service communicates with both parties will be implemented and this should improve the level of feed back received from both parties. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improved arrangements should ensure that people are only admitted when their needs have been comprehensively assessed and that these needs will be appropriately met after admission. Evidence: Following our previous inspection in February of this year the service has made new arrangements that will ensure a correct pre admission process is followed. On talking to the staff who would be involved in this, they seemed to have a clear understanding of what is now required. The registered provider has told us that for the forseeable future all potential admissions will be discussed with him before any decision is made. As the service has not accepted any new admissions since February we were unable to fully assess the services compliance with the outstanding requirement. This therefore remains in place and the registered provider will liaise with the Inspector as and when they feel ready to admit again. Care Homes for Older People Page 11 of 35 Evidence: As part of the admission process peoples equailty and diversity needs will be explored and arrangements put in place to meet these. Since our last inspection several existing staff have left although some remain. During this inspection, through observation and other evidence gathered we felt confident that the present staff group had the skills and motivation to ensure peoples needs were appropriately met. Where there are training needs there are now good arrangements in place to address these. The core skills of the care team have been greatly enhanced by the arrival of the new deputy manager. This person was previously working in Abbeydales sister home and is therefore known to the registered provider. She will now remain at Abbeydale. We therefore consider the requirement made in the previous inspection, in relation to shortfalls in staffs skills to be met. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in how peoples care is being delivered will benefit both their health and well being. Improvements to the handling of medicines means that the health of people living in the home is better protected, however some further action is needed. Evidence: The managers informed us that everyones needs have been reviewed since our last inspection. We were told that all the care assessments and care plans relating to these needs have been reviewed and individualised. Initially it was thought that the paper copies of the electronically generated assessments and care plans were also up to date. This was not the case as it was explained that getting the electronic templates up to date had been the priority. Paper copies are kept in case the computer system breaks down. We spoke to the deputy manager who had carried out the majority of the reviews and update work. She confirmed that the electronic versions had indeed been updated and we looked at several examples. We revisited some care plans that we had previously Care Homes for Older People Page 13 of 35 Evidence: read in February. We could see that the content had been amended and where there had previously been generalised or conflicting statements, these were now more relevant and meaningful to the person who was receiving the care/support. The deputy manager explained that this had taken time because the process had included talking to the individual person and sometimes a relative to make sure that their preferences were properly included. There were however some examples where the care plan or assessment still did not correspond with the persons current need, capability or support/care being given. This was discussed in some detail with both the deputy manager and a representative of the registered provider. It was clear that this was not occurring because of lack of skill in assessment or care planning, but may well be due to how the information is fed in to the computer and then how it interprets this. The deputy manager agreed that whilst the system was of help in many ways, in other respects it may not be giving the staff what they require. This was going to be explored further. We are confident that because there are other arrangement in place, apart from the care plans, that people will continue to receive the correct level of care and that this shortfall is not having an impact on the people using the service. There was also evidence to show that the standard of care being currently delivered was constantly being srutinised and reviewed. Three requirements were made in the previous inspection in relation to the recording of assessments and care plans. One has been complied with but we could not fully evidence, during this inspection, that the care plans were always fully updated and that relevant care plans always existed for each need. Therefore one requirement has been made as part of this inspection. The service has begun to address the issues raised by us in February relating to the management of challenging behaviour and the way some staff were then interacting with people in the home. Poor practice and a lack of skill, observed in February, resulted in at least one persons dignity being compromised. Through talking to the deputy manager and the care staff on duty during this inspection, it was clear that a change in approach and standard of care has been established. The deputy manager described some of the specific alterations that she has introduced and which new staff have contributed to. She was confident that this has been the reason for some positive changes noticed in particular peoples behaviour and willingness to allow staff to care for them. Examples include one person, now coming out of her bedroom, where as before she was reluctant to do this. Another person now lets staff help her with her personal hygiene and better continence care now means the person is less Care Homes for Older People Page 14 of 35 Evidence: agitated and cleaner. Two further people have either had their medication stopped or reduced as the incidents requiring this medication to be administered have either reduced or have just ceased to happen. The service have had support from the Care Home Support Team and Community Psychiatric Nurse (CPN) in planning some aspects of peoples more specific care. We also observed a better level of staff interaction and use of activities in the case of one particular person was having a beneficial effect. The deputy manager also explained that when this person becomes anxious to go out, staff take her for a walk after which she is happy to return. We observed an interaction between one other person and a member of staff. Considering the member of staff was relatively new to the service, they communicated in a way that was humerous and light but at the same time was respectful. This resulted in a positive reaction back. We inspected the services records and arrangements for managing risks relating to pressure sores and nutrition. We saw up to date assessments for these and peoples weights were being carried out monthly. The deputy manager confirmed that the weighing scales being used now were new so that the weight shown should be reliable. The requirement previously made in relation to this has therefore been met. Report by the Pharmacist Inspector. The pharmacist inspector looked at how medicines are handled in the home. Improvements have been made, since concerns were raised at the last inspection. We saw an improvement plan and also a monthly drugs audit tool which has been developed to provide a check each month that medicines are being well looked after. People living in the home are registered with a number of different doctors practices. Prescriptions are requested and then checked by staff before sending to the pharmacy. This helps to ensure that the correct medicines are ordered and received. Medicines are supplied using a monthly blister pack system. At present staff look after all the medicines in the home, although one person is able to look after one of their inhalers to help their breathing. This person said they were happy to do this and had an inhaler that was easy to use. However we saw that this had not been included in their care plan and there was no risk assessment in place to check that this was safe. We saw some medicines being given at lunch time. Medicines were taken round the home securely and given in a respectful and safe way. At the time of the inspection three members of staff had received training in giving medicines and other staff are in Care Homes for Older People Page 15 of 35 Evidence: the process of training. We were told that other carers had received a more basic training so that they could apply creams and ointments that had been prescribed for people. A medicines policy is available for staff. The policy is not specific to Abbeydale and action is needed to make sure that it is always applicable to the home. This is so that staff are clear about the safe practices to use. The pharmacy provide printed medicines administration record sheets each month. The records had been completed fully. We checked four peoples blister packs of medicines and found that they agreed with the administration record. However we found that it was not always possible to check medicines supplied in ordinary packs because no record had been made of when they had been started. One box we could check did not balance with the administration record and suggested that three doses signed as given were still in the box. Records for the use of creams and ointments are now kept in peoples rooms with these products. We saw one of these records. There was no record that one cream had been used until the day before the inspection and another cream had been prescribed to be used as directed but there was no information to tell staff how this should be used. Staff must ensure that clear instructions are available and that accurate, complete records are kept. This is to ensure that these medicines are used appropriately, as prescribed. We saw that paperwork is now available for recording additional information about how medicines prescribed to be given when required to ensure they are used appropriately and consistently. We saw that the computerised care plans include one for the use of medicines. We looked at four peoples records and saw that improvements need to be made so that plans are more individual and meaningful. For example one person is given their night time medicines earlier in the evening to take later, before they go to bed. There was a note on the list of current medicines but no care plan or assessment of any risk. One persons record stated that their medicines had been reviewed recently but there was no record of the result of this review. This could lead to changes in medicines being missed. Records are kept of the receipt of the monthly order of medicines however we saw that occasionally medicines received part way through the month had not been recorded. Action should be taken to ensure that all medicines received are recorded. Care Homes for Older People Page 16 of 35 Evidence: This is so that there is an audit trail for all the medicines received into the home. Records are kept of the disposal of unwanted medicines. Secure storage is available for medicines. Suitable storage is available for controlled drugs, which need additional security. Action has been taken to ensure that accurate records are kept of these medicines to show that they have been used safely. A medicines fridge is available. The temperature of the fridge and the medicines cupboard are recorded daily. This means that staff can check that these are suitable for storing medicines. People have locked medicines cupboards in their rooms so that creams and ointments can be kept conveniently. The Improvement Plan tells us that the home wishes to start working toward the Gold Standard Framework later in the year. This includes accredited training for staff in the care of people leading up to the end of their live and aims to improve the care for those that are dying. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An improvement in how peoples choices and preferences are being identified and then responded to will help to improve the quality of peoples lives. Evidence: During this inspection staff were seen spending time with the people who live in the service, generally chatting or engaging in activities. There was a far more relaxed and inclusive feel compared to our last inspection. There has not been a huge alteration to the existing activity program, which does provide set activities each week and includes people coming in from outside the home to entertain. The staff involvement however has very much improved, meaning that in between the set program of activities, people are being supported to socialise and engage according to their capabilities and needs. The deputy manager explained that during the task of reviewing all care plans people had been included in the process. We could see good examples of individual preferences being recorded. The change of approach being adopted by the team (also spoken about in the previous outcome of this report), is allowing for more choice and autonomy to be afforded to the people living in the service. Care Homes for Older People Page 18 of 35 Evidence: Since our last inspection the provision for activities and social integration have been audited by an external person who has given some guidance on what would help the service improve. Two members of staff are to be chosen to become dementia link workers and they will participate in the training held by the local County Council. This role is designed to enhance the provision of care and staffs knowledge in meeting the needs of people who have problems associated with dementia but also poor memory and communication issues. The registered provider has told us that he is planning to designate up to 16 hours per week for a designated activities co-ordinator. This is not yet in place but someone has been identified for the role. The new cook told us how she has spoken to all of the people who live in the home, reviewing their likes and dislikes in relation to what they eat. These were previously recorded but we were told that the new cook is far more involved with the people living in the service. One person confirmed that she often speaks to the cook and particularly likes this cooks bread and butter pudding. The cook was also aware of one persons current gastric problem and told us that she is adjusting the food for this person on a daily basis and fitting in with what the person feels they can manage. The Improvement Plan tells us that staff are to receive future training in specific areas of nutrition and dietry support to include diabetes and the use of fortified foods/drinks. It also tells us that the cook will undertake some formal training relating to her role. A pictorial menu is also to be devised to help some people make a choice at mealtimes. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in staff awareness and the culture of the staff are benefiting people and will help to protect them from abuse or harm. Arrangements are also in place for any complaints and concerns to be openly investigated and for the appropriate action to be taken. Evidence: The arrangements for protecting people from abuse and harm are now understood by all the staff in the home. We spoke to the registered provider, registered manager and deputy manager on this subject and all assured us that these will be adhered to. All of the above senior staff, including one other representative of the registered provider are due to attend the local County Councils enhanced safeguarding adults training in the near future. The two care staff who are new to the service confirmed they had received safeguarding adult training by an external trainer as part of their induction training. We understand that this trainer is accredited to provide this training. The staff members were also aware of the whistle blowing policy and senior staff were very aware of their role in relation to this. The deputy manager confirmed that all staff have been told that they must feel confident in coming forward if they suspect or witness any abuse and said they have been told that their concerns will be taken seriously. Care Homes for Older People Page 20 of 35 Evidence: To further make it easier for staff to whistle blow and contact the right people if they need to, the service will be devising a booklet for all staff members to keep at home, which will contain the procedures and all necessary contact numbers. We understand the home has not received any complaints since our last inspection. The services complaint policy and procedures remain in place. The procedures are in a prominent position within the home. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home that is well maintained and which is kept safe and clean. Evidence: This outcome was not inspected in any great detail as this was done in February of this year. We were aware during this visit of the home looking tidy and clean and there were no offensive odours. Cleaning staff were seen going about their tasks. A representative of the registered provider confirmed that there had been no alterations in how the general maintenance is managed. We observed staff wearing appropriate protective clothing before starting various tasks. Two staff explained to us that they were taking particular precautions in relation to one person until the results of certain tests were known. The deputy manager confirmed that she had taken advice from the local health protection unit with regard to infection control precautions. This demonstrates good and responsible practice and that the required guidance had been well communicated to other staff. The new staff also confirmed that they have received some infection control training. The Improvement Plan tells us that all infection control policies and procedures will be reviewed and arrangements will be made to ensure the home meets the new essential Care Homes for Older People Page 22 of 35 Evidence: steps for infection control. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home benefit from staff being well recruited and by them being appropriately trained and supported. Evidence: There have been several changes to the staffing of the service since our last inspection. The same amount of staff are on duty each day and at night but there are some new staff members. With a few existing staff remaining in post, despite the changes, there is a good mix of knowledge and skill. The registered manager has also been staying in accomodation close by in order to administer medications on evenings and mornings where there are care staff on duty who have not yet received training to do this. We are also aware that either the registered provider or his representative have been within the care home most days. The arrangements for staff training have been audited by the local County Council as well as reviewed by the registered provider. During this inspection, although some of the information being recorded on the services training matrix was incorrect, we could evidence that staff were being provided with the support and training they required to meet peoples needs. This appeared to be an administrative error. Although we are aware of new staff being recruited, as there were no problems in the services recruitment practices in Februarys inspection we did not inspect staff Care Homes for Older People Page 24 of 35 Evidence: recruitment files again. The registered provider however gave us a detailed account of the recruitment process. We spoke to two new members of staff, one was new to care and the other was experienced and already held the National Vocational Qualification (NVQ) in care. They both confirmed completion of various trainings which they have attended as part of their induction training. We spoke to the new deputy manager who explained how involved she is with supporting and training staff. If this level of support continues and staff are provided with further training as well as just the mandatory subjects, then people living in the home will continue to benefit from having their care delivered by knowledgeable and updated staff. Based on the eidence gathered during this inspection we consider the previous requirement made in relation to ensuring staff have the approriate skills and knowledge, to be met. Care Homes for Older People Page 25 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Following a subsequent alteration to how the service is being managed, and if this improvement is sustained, people using the service should be confident that arrangements in place will help to maintain their health and well being. We inspected the records of accidents since our last inspection. These were being recorded in the same type of book as previously seen. These records should be kept in the affected persons personal file and not held in one collective book. This relates to ensuring that records pertaining to individuals re kept confidential. One record of excessive bruising noticed on one person should have been notified to us under regulation 37 but we feel that this was a genuine misunderstanding. The registered provider will now audit a selection of accident reports and view all regulation 37 reports in order to check that all appropriate notifications are being made to us. The registered manager confirmed that no one, currently in the home, has required a referral to the local Deprivation of Liberty safeguarding (DOLs) team Care Homes for Older People Page 26 of 35 Evidence: During our last inspection several areas of the service failed to comply with the Care Home Regulations 2001. Since then the registered provider has kept us well informed about how these shortfalls were being met. The service also submitted a written Improvement Plan formally outlining its plan of action with timescales. During a period of improvement staff affiliated to the local County Councils quality and improvement team carried out audits of the staff training, the provision of social activities for people living in the service and health and safety arrangements. Any advice and support given as a result of these audits has been well received by the registered provider and his management team. This has helped to reassure us that the managers of the service wish to improve the services performance and levels of compliance. The registered manager has attended some trainings and meetings held by the local County Council and local providers support group. He informed us that he has found these to be useful and informative and he will continue to network with other care home managers. In addition to this the registered provider has started best practice meetings between the homes that he owns. The registered provider has spoken to us about changes to his own auditing process which will help him identify any shortfalls at service level. The registered providers monthly visits to the service will be more robust and thorough and will link in to the registered managers supervision and performance reviews. A new format for the registered providers visit (regulation 26 of the Care Homes Regulations 2001) is to be finalised and implemented. The registered manager will make sure that he is auditing in a more robust manner and will report his findings to the registered provider. The new auditing and qualitative processes have been well explained to us and although they have yet to be fully tested, the management team have already gone through an intensive period of re evaluating the services practices and processes. The registered provider told us that these shortfalls will not be repeated. Due to the level of work already carried out and the plans in place we have not repeated the previous requirement made in relation to this. The service has always sought the views of those who live there and will continue to do so. The Improvement Plan tells us that questionnaires are to be in more depth and issued six monthly and one month after someones admission. The service also wish to start a six monthly newsletter aimed at relatives to try and encourage greater engagement with the service. Care Homes for Older People Page 27 of 35 Evidence: We saw records that tell us that staff are being supervised both on a practical level and on a one to one basis. The registered provider intends to be far more involved in checking that this process is taking place. The two members of staff that we spoke to confirmed that they had received supervision sessions from both the deputy manager and registered manager. The home does not keep any personal monies for safe keeping but lockable facilities are available in each bedroom. We did not inspect records relating to health and safety during this inspection as this was carried out in February. We were also aware that the services health and safety arrangements were due to be audited by a representative of the County Council the same week as our inspection. We did recommend that one particular situation requiring a risk assessment, relating to one persons health and safety, be discussed with the person who was due to carry out the audit and advice taken on how to manage this. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 The Registered Persons 30/07/2010 must, following an assessment of someones needs, only offer admission if the home is suitable to meet the persons needs. This is in relation to people that have been admitted with needs that the home is not registered to meet or where the staff do not have the knowledge or experience to fully meet the assessed needs. This is so that people are only admitted to the home where circumstances show that their needs can be both legally and fully met. 2 7 15 Ensure that relevant and clear care plans exisit for each persons needs. This is so that each need a person has is clearly planned and recorded. This also helps to demonstrate a clear audit of care when care plans are kept correctly up to date. 22/03/2010 3 7 15 Ensure that all aspects of 22/03/2010 someones care are fully and correctly reviewed and up dated. This will help ensure that the Care Homes for Older People Page 29 of 35 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 present care being delivered remains relevant to the persons needs. 4 9 13 Always keep accurate, clear, 01/07/2010 complete and up to date records about any medicines (including those products applied topically to the skin) received and administered to people who live in the home that provide full accountability for all prescribed medicines. (This is particularly to address the shortfalls identified at the inspection and included in the text of the report). This is to help make sure all medicines are accounted for, that people receive their prescribed medicines correctly and are not at risk of mistakes because of poor recording arrangements. 5 9 13 Arrange to review the 15/03/2010 assessments used about the various ways in which people who live in the home are supported with taking their medicines so that there is always a full written risk assessment and plan specific for that person that accurately reflects the support that is given and is regularly reviewed to make sure the arrangements are safe for everyone in the home. This is so that risks with Care Homes for Older People Page 30 of 35 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 administering medicines are always accurately identified and safe systems put in place that protect everybody in the home. Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Following a pre admission assessment of someones needs to determine if the service can accomodate these needs, the registered persons must only admit people with needs that they are confident they can meet and which fall within the services registration category. (This requirement originally for compliance by 22/03/2010 could not be fully assessed. This has therefore been repeated) This is so that people can be sure that their needs will be fully met following admission and that the service remains within the category it is registered for and therefore compliant. 30/07/2010 2 7 15 The registered persons must 30/07/2010 ensure that all identified needs have an associated Page 32 of 35 Care Homes for Older People 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 care plan and that the guidance provided in these care plans are specific and clear. (Two previous requirements originally due for compliance by 22/03/2010, relating to regulation 15, were not fully met. This one requirement has therefore been made) This is so that a consistent audit trail of care can be demonstrated and so that staff have written guidance to follow on how to meet peoples needs. 3 9 13 Arrange to view the 30/07/2010 assessments used about the various ways in which people who live in the service are supported with taking their medicines. (This requirement, originally for compliance by 15/03/2010 has not been fully met. Therefore it has been repeated) So that there is always a full written risk assessment and plan specific for that that person that accurately reflects the support that is given and is regularly reviewed to make sure the arrangements are safe for Care Homes for Older People Page 33 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action everyone in the service. 4 9 13 Always keep accurate, clear, 30/07/2010 complete and up to date records about medicines (including those products applied topically to the skin) received and administered to the people who live in the service that provide full accountability for all prescribed medicines. (This requirement originally for compliance by 15/03/2010 has not been fully met. Therefore it has been repeated). This is to help make sure all medicines are accounted for, that people receive their prescribed medicines correctly and are not at risk of mistakes because of poor recording arrangements. 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 9 Review and update the medicine policy and procedures to make sure that all aspects about the management and handling of medicines are specific for this home, are up to date and reflect accepted best practice so that staff have access to good information about the way in which they are expected to handle medicines. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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