Care Home: Abbeyfield Stangrove Lodge

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What the care home does well The home has a strong emphasis on enabling residents to follow their preferred lifestyles; for example, to get up when they want, and to carry out activities or go out when they want to. This means that residents are not rushed, and and enabled to make their own decisions where possible. There is a recognition that some residents need and benefit from a more set routine, and this is built into individual care plans. The home uses the company`s own training programme called "Pegasus", which promotes person-centred care. Care plans are implemented with input from the resident and/or their relatives as applicable. Care plans contain comprehensive information, and are well managed. The home has good links with the local community, such as local schools and youth groups, volunteer organisations and a local disability care home. This means that residents feel accepted in the local community, and can make friends on a wider basis. Any concerns or complaints are taken seriously, and are dealt with appropriately. They are used as a learning tool to further develop the care in the home. The gardens are well maintained and provide attractive areas for residents to walk or sit. There are good records for ongoing staff training. Most care staff have completed NVQ levels 2 or 3, or are in the process of studying for these. Staff were observed as interacting well with the residents and with each other, and there is a good sense of team work in the home. What has improved since the last inspection? There have been improvements made to the accommodation on each unit during the past year, and this has made the units more attractive. The upgrades have included some new furniture, redecoration, and a new mounted wall television for the main lounge. Outdoor lighting has also been improved, and this includes the visitors` car park. Care plans have been further developed; and additional forms have been created for more specific documentation for residents who are unwell. The home has started to increase numbers of people available to take residents out, or for activities. Some of these are volunteers, and some are "multi-taskers" who can work in different areas of the home as the need arises (e.g. care, domestic, kitchen areas). The staff team has been altered to include a care co-ordinator, and a new home administrator; and there is an increased number of senior carers. What the care home could do better: The care plans could be further improved with some minor adjustments, such as ensuring that abbreviations are not used in daily reports. It would also be helpful to introduce a format for demonstrating how decisions are made for residents who lack mental capacity; showing who has made the decisions on their behalf and how. All handwritten entries on Medication Adminstration Records (MAR charts) should be signed for by two appropriately trained staff. Consideration should be given to the numbers of care staff available on all shifts, in regards to assisting residents who want to go out, or carry out specific activities. For example, to have sufficient staff hours for escorting residents to go out. Job applicants must be requested to provide a full employment history (i.e. from the time of leaving full time education); and there is a requirement for this. Key inspection report Care homes for older people Name: Address: Abbeyfield Stangrove Lodge Manor House Gardens Edenbridge Kent TN8 5EG     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: Susan Hall     Date: 2 1 0 7 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 29 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 29 Information about the care home Name of care home: Address: Abbeyfield Stangrove Lodge Manor House Gardens Edenbridge Kent TN8 5EG 01732864975 01732866435 ruth.mills@abbeyfieldkent.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Abbeyfield Kent Society care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 49. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Stangrove Lodge is part of the Abbeyfield Kent Society, who have a number of care homes in this county. The home is located in a quiet residential area of Edenbridge, which is a historical market town in West Kent. It is easily accessible via motorways; and there are two railway stations and good local bus routes. The home is within easy walking distance of the local shops and other town facilities. Accommodation is provided on the ground floor, and all bedrooms are for single use. The home is divided into four interlinked units, called Windsor, Stuart, Tudor and Malec. There are plenty of communal areas for residents to access and attractive gardens, which have a variety of Care Homes for Older People Page 4 of 29 1 0 0 9 2 0 0 8 49 0 Over 65 0 49 Brief description of the care home seating areas. The home provides twenty-four hour care and support for older people, some of whom have dementia; and care for some younger adults over the age of forty, with dementia. The current fees range from 415.56 to 902.83 pounds per week; depending on the assessed needs of individual residents. Care Homes for Older People Page 5 of 29 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: The home is assessed as having a rating of good, 2 stars. This was a key inspection, which includes assessing all the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us (i.e. CQC) about ongoing developments in the home, and any changes. We received the AQAA back within the specified timescale, and it was very well completed; providing us with comprehensive and up to date information about how the home is running. The visit to the home commenced at 09:00, and lasted until 3:00 pm. The registered Care Homes for Older People Page 6 of 29 manager was on annual leave, and the homes care co-ordinator, who acts as a deputy in the managers absence, was present, and was available throughout the day. During the visit, we talked with fourteen other staff, including senior care staff, other care staff, the administrator, and laundry, domestic, maintenance and kitchen staff. We also talked with the hairdresser; and with five residents individually; and met other residents in the various lounges. During the course of the visit we carried out an observational inspection (called a Short Observational Framework Inspection or SOFI) in Malec lounge. This is a process of observing the care and attention given to a chosen number of residents over a set period of time. In this case, we observed five residents with dementia over the course of one hour, and the findings demonstrated that staff are aware of residents differing needs, and interact well with them. The inspection included viewing all areas of the home, inspecting medication management, and reading documents such as care plans, staff recruitment files, training programmes and some maintenance records. The home was clean in all areas, and seen to provide a comfortable and relaxed environment for the residents. The home keep a good record of complaints, and these showed that complaints are taken seriously and are addressed appropriately. There have been two safeguarding alerts during the past year, in regards to residents who were admitted to hospital with pressure sores. Our findings from this inspection showed that staff are quick to alert the district nurses if there are any skin breaks, so that dressings can be applied as needed. There are good procedures in place for the management of pressure relief. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The care plans could be further improved with some minor adjustments, such as ensuring that abbreviations are not used in daily reports. It would also be helpful to Care Homes for Older People Page 8 of 29 introduce a format for demonstrating how decisions are made for residents who lack mental capacity; showing who has made the decisions on their behalf and how. All handwritten entries on Medication Adminstration Records (MAR charts) should be signed for by two appropriately trained staff. Consideration should be given to the numbers of care staff available on all shifts, in regards to assisting residents who want to go out, or carry out specific activities. For example, to have sufficient staff hours for escorting residents to go out. Job applicants must be requested to provide a full employment history (i.e. from the time of leaving full time education); and there is a requirement for this. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides comprehensive information for enquirers and new residents. Detailed pre-admission assessments are carried out. Evidence: The homes statement of purpose and residents guide are produced in one document, which has all the required information. The document is produced in clear print, with a photograph of the premises on the front. The information states the aims and objectives of the company, which includes to promote equality of opportunity for all residents. Details are provided about items such as the registered manager, the staff and their training, accommodation, services, the admission procedure, the complaints procedure, and religious and social activities. All prospective residents have a pre-admission assessment to ensure that the home will be able to meet their individual needs. These are usually carried out by the manager, or the care co-ordinator. We viewed three pre-admission assessments, and Care Homes for Older People Page 11 of 29 Evidence: these had been well completed, with plenty of detailed information about the persons care needs. Records included details of the persons physical abilities, their sight and hearing, their psychological health, and their personal abilities; such as their ability to communicate, and their social preferences. All residents (or their authorised representative) are provided with a statement of the terms and conditions of the home, and a written agreement in regards to their care. Residents are admitted for a trial period, and a review is held at the end of this time to decide whether or not the placement should be permanent. Wherever possible, residents or their relatives are included in discussions about their care, so that their admission assessments and care plans reflect their individuality. Care Homes for Older People Page 12 of 29 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. Care plans demonstrate that the home provides good personal and health care, ensuring that residents individual needs are met. Evidence: Residents health and care needs are clearly documented in their care plans. We read four care plans, and these have comprehensive data, which enables care staff to carry out effective and individualised care. There is a strong emphasis on person-centred care, using the companys own training programme known as the Pegasus programme. This training is to help care staff to understand that care is not task orientated, but according to individual preferences. This means that residents can get up and go to bed when they wish; have baths or showers as they wish; eat meals at different times; go out of the home (with appropriate support); and carry out their preferred activities. The staff are still going through the training processes, and so this is not completely established as yet. Staff recognise that some residents need or want a set routine, and this is put in place in the light of what is best for each person. Care plan files are very well put together, and contain very detailed assessments and Care Homes for Older People Page 13 of 29 Evidence: care plans for all aspects of care, such as assistance needed with washing and dressing; nutritional needs; continence care; mobility equipment and assistance; socialising; and night care routines. We noted that these contain good details, such as if special cutlery or plate guards are needed at meal times; checking skin care twice daily; toileting needs; and handling equipment needed e.g. slide sheets, bath hoist, handling belt. Residents night care is separately documented, and show how often the resident should be checked at night. This may be as often as every fifteen minutes, or every one or two hours, depending on the need and the reason. Pressure area care is well documented, and residents at risk of developing pressure sores have their skin checked twice daily, and any prescribed creams are applied. Any sign of redness or skin breaks are reported to senior care staff, and the District Nurse is asked to visit to assess any skin break or wound which occurs. Records confirmed that the District Nurses are contacted on the same day for any wound care, and the care staff will cover the wound with a temporary dressing. A multi-disciplinary record is kept on the residents file showing when the District Nurses (or other health professionals) visit. The home has a supply of Spenco mattresses (which are a foam overlay mattress) if someone is at risk of developing pressure sores; and the District Nurses arrange for air mattresses for more effective pressure relief, if their assessments show this is needed. Care plans contain detailed risk assessments, which include items such as falls risks, hearing needs, poor eyesight; and risks associated with communication difficulties, going out of the home, being outside in the sun, and supervision at meal times. Residents who are unwell have additional care, which is documented in special care packs. These have forms to record each positional change, food record, fluid balance, body map, and weekly weight. Weights are otherwise recorded monthly. A daily report is written at the end of each shift by the care staff. These reports were seen to be very detailed, and include entries written throughout the day stating the residents moods, activities, personal care given, meals taken, and any incidents. We pointed out to senior care staff that Tippex must not be used on any documents. We also noted some abbreviations, which are not appropriate. Care plans do not demonstrate how decisions are made on behalf of residents who no longer have the mental capacity to make their own decisions; and this should be implemented, so that how decisions are made, and who has made them, are clearly demonstrated in compliance with the Mental Capacity Act 2005. There is one GP practice in the immediate area, and residents are registered with this practice. A GP visits at least once per week, and senior care staff said that the practice Care Homes for Older People Page 14 of 29 Evidence: is very supportive. Referrals are made to other health professionals as needed. Medication administration is via a monitored dosage blister pack system; with additional packets and bottles of medicines for items which cannot be blister packed. Medication is safely stored in locked cupboards in a clinical room; and there are two trolleys for daily administration. Storage is well managed, and there is evidence of good stock rotation. Controlled drugs (CDs)are correctly stored, and the controlled drugs register is well maintained, and includes regular and random checks for CD stocks. A recent change has been made to administration for the first morning medication round, whereby two senior staff now complete this round, as it is a very full round. This ensures that residents are given their medication at the prescribed times, and is therefore an example of good practice. We viewed all of the Medication Administration Records (MAR charts), and these were mostly well completed. However, handwritten entries were not signed, and we discussed the importance of each handwritten entry being signed and checked by two staff; so as to check for accuracy, and for accountability. We are confident that action is being taken in regards to this, and so a requirement has not been given. Residents are treated with dignity and respect, and staff were observed as caring for residents with dementia, with gentleness and a good understanding of their individual wants and needs. Care staff are able to care for residents who are dying, unless they develop nursing needs. Good standards of general care were evidenced, and staff will sit with residents if they are unwell and wish for company. Some of the senior staff have carried out some palliative care training, but the staff training programme did not evidence this for many staff, and this should be considered in future training programmes. Care Homes for Older People Page 15 of 29 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. The home provides a satisfactory range of activities and outings for residents enjoyment. Residents said they are happy with the food provided. Evidence: The home has some regular group activities with external entertainers, who visit the home on a regular basis. This includes Music for Health, which provides therapeutic music therapy; and an exercise class with music, both of which are monthly. The emphasis is on enabling residents to do the things that they want to do, such as going out, playing games, gardening etc. The different units have very different characteristics, and this is very important so that residents can identify with the unit in the day time where they most feel at home. Malec unit has the most beds, and is for older people with dementia, and this tends to have the hub of ongoing activity throughout the day. Tudor is a small unit for people with early onset dementia, and are therefore in a younger age group. This unit feels much different, with a conservatory leading out into an enclosed garden area, and games and books very much in evidence. Windsor and Stuart are also smaller units, and tend to be quieter. Three residents from these units said during the visit that they enjoyed the peace and quiet on these units; and two said they liked to read a lot, and preferred the quietness. Care Homes for Older People Page 16 of 29 Evidence: Carers chat with residents throughout the day, and try to get involved in anything that interests them. This is currently difficult to establish completely, as more staff are needed for this approach, so that they are more readily available to take residents out or to spend time with them. Residents said that they like to go out to places such as the local pubs and coffee shops, the market, and parks and shops. There is also a trolley shop taken round every week, by volunteers. The home has a sensory room, and this can be used as a place to calm residents who are restless, and also for residents to meet quietly with their family or friends. Pat dogs are brought in weekly, and one resident has adopted the homes rabbit. There is also a cat in the home. During the past year, the home has developed greater links with the local community. Care staff said that some cafe and market proprietors recognise the residents now, and this makes them feel accepted in the town. There are also links with local schools and a Brownie pack, and residents really enjoy their visits. There are excellent forms in place to assess residents individual religious and cultural needs; with questions such as whether or not they wish to practice their religious beliefs, if they wish to take part in church services, if they pray and would like a special room for this, and if they want any specific assistance (e.g. having the Bible read to them). Residents are encouraged to personalise their rooms according to their choice, and this was evident when we viewed the home. Residents said that they enjoy the food, and they have enough choice. There are two main meals and a choice of desserts offered at lunch times, and a choice of different dishes and snacks at other times. The kitchen staff go round to ask each resident each morning, for their meal choices throughout the day. This includes residents with dementia, although they may not be able to voice clearly what they would like, or to remember what they have asked for; but this is a good example for how the home treats dementia residents with the same dignity as those without it. Finger foods and alternative choices are always available for residents; and this can be especially helpful for residents with dementia. The home is currently without a lead chef, and recruitment is taking place for this post. A temporary chef employed by the company was filling in for a few days, and he was assisted by a kitchen assistant who knew the residents well. He stated that fresh Care Homes for Older People Page 17 of 29 Evidence: fruit and vegetables are actively offered each day; and puddings and cakes are home made. The menus showed a well balanced and nutritious diet. The kitchen was seen to be well equipped and well organised. A gold certificate for hygiene has been awarded by Kent County Council. Care Homes for Older People Page 18 of 29 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. Concerns and complaints are taken seriously and are dealt with appropriately. Residents are protected from abuse. Evidence: The homes complaints procedure is straightforward and easy to follow. Anyone with concerns is encouraged to report these to the person in charge of the shift, in the first instance. If they are unhappy with the outcome from this, they are invited to speak to the manager, who will respond to the complaint within seven days. The procedure also includes the details for applying to the companys head office, and for contacting the Commission. We suggested that it may also be helpful to remind people that they can contact Social Services, and could be helpful to include the details of the local adult Social Services department. The staff try to keep in close contact with residents and relatives, so that if they are unhappy with anything, it can be recognised and dealt with quickly. A record is retained of all complaints, and this showed that complaints are dealt with appropriately, and that action is taken to try and prevent a re-occurrence. All staff are trained in the recognition and prevention of different types of abuse; and senior staff were able to show that they understand the protocols for referring any suspicious circumstances to the Social Services Safeguarding Adults team. The staff training matrix confirmed that all grades of staff receive POVA (Protection of Care Homes for Older People Page 19 of 29 Evidence: Vulnerable Adults) training. Care Homes for Older People Page 20 of 29 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 premises provide a comfortable and well kept home. Evidence: The home is divided into four units of differing sizes, but each unit has its own communal areas, and disabled toilets and bathrooms. There is also a shower room which can be used for any residents. Malec, the largest unit, has a large lounge with two areas for armchairs, and another area with a table and chairs for activities. There is a separate dining area. The other three units also have lounges and dining areas, and Tudor has a conservatory as well. The communal areas are quite homely, well decorated, and with good carpets and flooring. Corridors have a variety of pictures, and bedrooms and toilets have signs and pictures on them where appropriate, to help residents with dementia to find their way around. Some of the decor could be further enhanced with more wall items for residents with dementia, and this is being carried out on one unit where a section of corridor is being decorated as memory lane. Residents are able to go to different units throughout the day as they wish. The home has extensive gardens, which are well designed as they are safe and secure, and can be accessed from each unit. There are many different patio and garden areas, as well as a larger area with a barbecue and gazebo. The gardens are Care Homes for Older People Page 21 of 29 Evidence: well maintained with lawns and mature trees and shrubs. All of the bedrooms are now for single use. There were previously three rooms for people to share, but these have been altered to provide larger rooms; one of these also has an en-suite shower. Some of the bedrooms have been redecorated, and all of the bathrooms and toilets have been refurbished during the past year. There is a variety of assisted baths available. New furniture and carpets have been provided in many areas, and some of the rooms now have laminate flooring. The home has a part-time gardener who also carries out day to day repairs, and checks the hot and cold water temperatures, and tests the fire alarms. Other routine maintenance work is carried out by the companys maintenance team. The laundry is staffed by laundry assistants seven days per week, and has two washing machines and two tumble dryers. One of the tumble dryers was currently out of order, and this causes some frustration to staff, as they said that it seems to take a long time for items to get repaired. Clothes and bed linen can also be dried outside at this time of year, but it is difficult to keep up to date with the laundry if a machine is broken, and the weather is poor. The home was clean in all areas, but one or two areas of carpet smelt stale, and are due to be replaced. There is a constant programme of replacing carpets as needed. There are usually cleaning staff on duty for different shifts throughout the day, until 7.30pm; and this is a real help to care staff, knowing that they can concentrate on caring. The numbers of cleaning staff were currently reduced, but we were informed that recruitment for these posts is taking place. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from having a competent, caring, and well-trained staff team. Evidence: Senior care staff are responsible for deploying care staff for different units, and care staff work across the units, so that they get to know all of the residents in the home. There are usually seven to eight care staff on duty throughout the day times, as well as a senior carer, the care co-ordinator, and the manager. They are also supported by domestic, kitchen, laundry, and administrative staff. The numbers of care staff are sufficient for meeting basic care needs, but staff are struggling to meet all residents needs in regards to taking them out, and carrying out activities. Some staff are working in their own time to take residents out, as they have insufficient time to take them out during their work hours, and should not have to do this. There is also an increasing number of volunteers (who are all CRB checked), who assist with daily activities and entertainment. The company have started to introduce staff known as multi-taskers, who are trained in care, kitchen and domestic duties, and who can assist wherever the most need is each day. All care staff are expected to train for NVQ level 2 if they have not already achieved this prior to joining the company; and the majority of care staff have completed this training. Senior care staff are trained to NVQ level 3. Care Homes for Older People Page 23 of 29 Evidence: The home has good recruitment practices in place, and we viewed two staff files to confirm this. The procedures include checks for identity; two written references; POVA first and Criminal Record Bureau (CRB) checks; a health questionnaire; and an interview record. Application forms were well completed, but only request the applicant to provide an employment history for the last ten years, and this is incorrect. Applicants must be asked to provide a full employment history (i.e. from the time of leaving full time education); and there is a requirement to amend this. New staff are taken through a comprehensive induction programme, which includes all mandatory training, such as health and safety, moving and handling, and infection control. We viewed one completed induction record. Senior care staff take responsibilities for different areas, such as medication management, or moving and handling training. One of the seniors is also trained as a trainer for the prevention of adult abuse. The home has a training matrix on the computer, and this showed that the management are reliable in ensuring that staff keep up to date with mandatory training, and also carry out related training (such as training in managing challenging behaviour; and understanding the implications of the Mental Capacity Act). All staff have dementia care training, and the level of training is set according to the job description. Care Homes for Older People Page 24 of 29 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 leads the staff team, and promotes an open and positive atmosphere in the home. Good records show that there is reliable administrative management. Evidence: The manager was on annual leave at the time of the inspection visit, but the care coordinator acts as the deputy in her absence, and was available throughout the inspection. The manager and care co-ordinator are appropriately trained and experienced, and lead the way for the rest of the team. Senior care staff are on duty each day, and are actively involved in working alongside other staff; assisting with training; and carrying out staff supervision. The home has a relaxed atmosphere, and staff were seen to have good teamwork and to interact well with each other. The home holds staff meetings for different categories of staff, as well as general staff meetings, and the minutes showed that all staff have the opportunity to put forward their ideas and concerns. Care Homes for Older People Page 25 of 29 Evidence: The home has a strong emphasis on listening to the residents and what they want, and this is evident in all aspects of the homes life. We carried out a Short Observational Framework Inspection (SOFI), which is a method of formally observing a number of residents for a set period of time. We observed the care of five residents in Malec lounge for an hour during the afternoon, without informing the staff which residents were being observed. We noted that there was good interaction from staff with each of these five residents, and a clear awareness from staff of their different moods, attitudes and behaviours; and the different activities that they would enjoy. The residents generally appeared relaxed and content, and able to wander where they wanted to, or to take part in various activities. The home encourages relatives and visitors to give feedback on a daily basis, and to take part in social functions and formal meetings. The senior staff liaise with relatives as needed. There is a suggestions box in the front hall for anyone who would like to put forward their ideas. The home has monthly monitoring visits from another manager within the company, and this includes reviewing any complaints. This means that the management can actively work towards changing things in response to complaints. Small amounts of residents personal allowances can be stored in the home, and the administrator oversees these accounts. Amounts are kept individually, and the administrator pays for items such as hairdressing and chiropody on residents behalf. The money is also available for residents to purchase items from the trolley shop, or to use when going out. A receipt is written for each item, and all receipts are retained. The accounts are checked and audited every month. One to one staff supervision is delegated to senior staff, and is carried out every two months or as applicable. Staff also have yearly appraisals. Records in the home were seen to be well maintained, and stored appropriately where applicable for confidentiality. Some maintenance and servicing records were viewed, and the AQAA informed us that these are kept up to date (e.g. hoist servicing, fire alarm checks). Accidents in the home are properly recorded, and an accident audit is carried out every month to check for any patterns of behaviour. This enables the manager to take preventative action where patterns are recognised. Care Homes for Older People Page 26 of 29 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 27 of 29 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 29 19 Applicants must be requested to provide the company with a full employment history i.e. from the time of leaving full time education. Regulation 19 and Schedule 2 (amended) states that persons working at the home must be asked to provide a full employment history, with an explanation for any gaps in employment. This is for the protection of vulnerable adults. 31/08/2009 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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