Care Home: Acacia Care Home

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• St Vincents
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• Winton House
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• The Maypole Nursing Centre
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What the care home does well People who live at the home stated that `it had a friendly atmosphere, I feel safe and well cared for and the garden is useful and well looked after. I like sitting out in it and the staff bring out drinks for me`. Another person who lives at the home stated `it has a lovely, welcoming atmosphere. All the staff are really nice and always helpful. I would not wish to be in a nicer place`. All evidence indicates that the home ensures that people`s health and care needs are met. The home employs appropriate numbers of care staff many of whom have a care qualification although they have not completed all mandatory or service specific training and updates. Care staff stated that they felt that `the home considers the needs of all its clients and that communicates well between members of staff and provides good support in any given problematic situation`. Another stated `I feel the home meets the needs of the residents attending to most aspects of their care and providing a happy and relaxed environment`. An external health professional made positive additional comments in a comment card adding `the home cares for residents` and `I would have my mother there`. What has improved since the last inspection? This was the first inspection of a new service. What the care home could do better: Four requirements are made following this inspection. The registered person must ensure that all pre employment checks are completed prior to staff commencing work at the home. At a minimum this must include two written references, including their current or most recent employer and a check that a person`s name is not on the list of people who should not be working with vulnerable adults whilst waiting for the return of the full Criminal Records Check so that unsuitable people do not work at the home and people are safe. The responsible person must ensure that all medication is correctly stored at all times. It is recommended that when care staff add to medication administration records or write in new people`s medication to a blank form that two staff do this and initial these to show who has written or amended the record sheet which is used by staff when administering medication. This is to ensure that people are safe and receive their medication as prescribed by their doctor. The responsible person must consult with service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation and mental stimulation to ensure that people do not become bored and lack mental stimulation. The responsible person must ensure that all staff have undertaken all mandatory and service specific training including updates to ensure that staff have the necessary skills to meet people`s needs and keep them safe. Key inspection report Care homes for older people Name: Address: Acacia Care Home 1 Arthurs Hill Shanklin Isle Of Wight PO37 6EW     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: Janet Ktomi     Date: 2 9 1 0 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 33 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 33 Information about the care home Name of care home: Address: Acacia Care Home 1 Arthurs Hill Shanklin Isle Of Wight PO37 6EW 01983863845 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Julie Nicola Coombs The registered provider is responsible for running the service care home 12 Name of registered manager (if applicable): Type of registration: Number of places registered: 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 12 The registered person may provide the following category 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: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Acacia care Home is located in Shanklin close to the town centre and the beach. The home is in a large older property providing eleven single bedrooms one with ensuite facilities. Appropriate communal rooms, bathrooms and WCs are provided. Bedrooms are located on the ground and first floor and all are accessible via stair lifts. Pleasant Care Homes for Older People Page 4 of 33 Over 65 0 12 12 0 Brief description of the care home flat gardens are located to the rear of the home laid with paths and seating available. The home has a pet cat. The home is owned and managed by Mrs Julie Coombs. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the first key inspection of the home since the new registered provider/manager purchased the home in May 2009. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 29th October 2009. All core standards and a number of additional standards were assessed. The visit to the home was undertaken by one inspector and lasted approximately six hours commencing at 10.00am and being completed at 4.00 pm. The inspector was able to spend time with the staff on duty, was provided with free access to all areas of the home, documentation requested and people who live at the home. The registered provider/manager was not present at the time of the unannounced visit Care Homes for Older People Page 6 of 33 to the home. The inspector telephoned the registered provider/manager following the inspection to clarify some information and provide feedback from the inspection visit. Prior to the inspection visit the registered provider/manager completed the homes Annual Quality Assurance Assessment (AQAA) and information from this is included in this report. Information was also gained from the homes service file containing notifications of incidents in the home. Surveys were sent to the home for distribution prior to the inspection visit. Four were received from people who live at the home, one from a relative of a person who lives at the home, four from people who work at the home and one from external health and social care professional. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Four requirements are made following this inspection. The registered person must ensure that all pre employment checks are completed prior to staff commencing work at the home. At a minimum this must include two written references, including their current or most recent employer and a check that a persons name is not on the list of people who should not be working with vulnerable adults whilst waiting for the return of the full Criminal Records Check so that unsuitable people do not work at the home and people are safe. The responsible person must ensure that all medication is correctly stored at all times. It is recommended that when care staff add to medication administration records or write in new peoples medication to a blank form that two staff do this and initial these to show who has written or amended the record sheet which is used by staff when administering medication. This is to ensure that people are safe and receive their medication as prescribed by their doctor. The responsible person must consult with service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation and mental stimulation to ensure that people do not become bored and lack mental stimulation. The responsible person must ensure that all staff have undertaken all mandatory and service specific training including updates to ensure that staff have the necessary skills Care Homes for Older People Page 8 of 33 to meet peoples needs and keep them safe. 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 33 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 33 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. All people are assessed prior to moving into the home to determine that their individual needs can be fully met however as staff have not received all mandatory or service specific training there is a risk that staff may not be able to met their needs. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. Evidence: A senior member of staff explained the homes admission procedure and the preadmission assessment for a person admitted shortly before the inspection visit was viewed. The inspector discussed admissions with care staff and with some people who live at the home. The senior member of staff on duty at the time of the unannounced inspection Care Homes for Older People Page 11 of 33 Evidence: explained the homes admission procedure. If an initial inquiry from either social services or from a person or their family indicates that the home would be able to meet the persons needs the manager or deputy will arrange to visit the person, either at their home or in hospital. A comprehensive pre-admission assessment is completed including where appropriate members of the persons family and professionals involved in their care. The person is provided with information about the home and where practicable is invited to visit the home before making the decision as to whether to move in on an initial trial basis. When the person is unable to visit the home a relative is invited to view the available room and facilities at the home. The home has an assessment tool that covers all the relevant areas necessary for the home to decide if it is able to meet a prospective persons needs. The staff member was clear about the level of care needs the home can accommodate. The staff member also stated that someone from the home will also visit and if necessary reassess people who have been admitted to hospital before they are discharged back to the home to ensure that their needs can continue to be met. Discussions with care staff confirmed that they felt they had enough information about new people admitted to the home. The home has only admitted one person since the new provider/manager purchased the home in May 2009. The pre-admission assessment for this person was viewed and the inspector spoke with the person during the inspection visit. The person confirmed that the provider/manager had visited them in hospital and asked lots of questions and told them about the home. The person stated that they had not received any written information about the home. The person was admitted at short notice from hospital and therefore there was no opportunity for the person or a relative to visit the home prior to admission. The pre-admission assessments viewed contained sufficient information to demonstrate that the home would be able to meet the persons needs. Although staff stated that they felt they had the skills to meet the needs of people living at the home they had not undertaken all mandatory or service specific training and as such may not have all the necessary skills and knowledge to meet peoples needs safely. People living at Acacia Care Home tend to be long term, however the home could provide respite or short stay accommodation if a suitable room were available. The same admission procedures would be used for respite or short stay admissions as for long term admissions. Care Homes for Older People Page 12 of 33 Evidence: The home does not provide dedicated accommodation for, intermediate care or specialized facilities for rehabilitation. Care Homes for Older People Page 13 of 33 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. The health and personal care, which a person receives, is based on their individual needs. The home has the necessary storage facilities for medication however on the day of the inspection not all medication had been locked away in the medication storage cupboard placing people at risk. People are treated with respect and their dignity and privacy is maintained. Staff at the home have not received all the mandatory and service specific training which places people at risk of not having their needs met. Evidence: Three care plans were viewed, one for a person admitted to the home since the new registered provider/manager purchased the home in May 2009 and the others for people who have been living at the home for a longer time. The inspector discussed with staff, and people who live at the home how care needs are met. Surveys Care Homes for Older People Page 14 of 33 Evidence: completed by an external health and social care professional, service users and staff are also considered as is the AQAA completed by the registered provider/manager. The home has a care planning format that provides booklets incorporating care plans, risk assessments and reviews. People have a detailed plan of care that related to the persons assessment. The care plans follow a comprehensive format and are individualised and person centred being written in plain language providing detailed information as to how needs should be met. Plans are reviewed on a monthly basis, where possible with the person whose plan of care it is. Care plans contained relevant risk assessments and management plans including nutrition, manual handling, falls, pressure areas and any individual risks. Risk assessments viewed appeared appropriate to the persons needs. The home has stand on scales and monitors most peoples weight on a monthly basis with records being seen. Care staff spoken with said that communication about peoples needs was good. The home uses a key worker system. The inspector was able to talk with people who live at the home who stated that they felt they received the care and support including medical care they need. Four comment cards were received from people who live at the home and they all stated that they received the care and support including medical care that they require. An external health professional completed a comment card and stated peoples health care needs are monitored and met by the care service and that peoples privacy and dignity is respected. Three staff members completed surveys and stated that they always (2) and usually (1) received up to date information about the needs of people they support and that there are always (1) and usually (2) enough staff to meet peoples needs. Care plans contained individual manual handling assessments. Most people who live at the home do not require manual handling. The senior staff member stated that the home has a stand aid although this was not required by anyone living in the home at the time of the inspection. Training records showed that not all staff have completed all mandatory or service specific training. This may place people at risk of not having their needs fully or safely met. People stated that they felt that staff always treated everyone who lives at the home with dignity and respect. Observations of staff interactions indicated that people are Care Homes for Older People Page 15 of 33 Evidence: treated with respect and their right to dignity maintained. Bedrooms are all single providing privacy for personal care. Bedroom doors do not have locks however bathrooms and WCs do. At the time of the inspection visit nobody was self administering their medication. The home has a staff office where the medications storage cupboard is located. The inspector viewed this at 2pm and noted that a bottle of liquid medication had been left on top of the cabinet. The Medication administration record for this medication was viewed and stated that it should be given at night. Day staff stated that they thought this must have been left out by the night staff. The staff office is not locked and staff had been using this room throughout the morning of the inspection and none had noted the medication had been left out. The responsible person must ensure that all medication is stored correctly at all times. Remaining medication was stored correctly. Medication administration records were viewed and had been fully completed. Medication administration records are normally pre-printed by the pharmacist. The home has some blank forms for use when necessary. One had been used for the person admitted shortly before the inspection. It is recommended that when care staff add to medication administration records or write in new peoples medication to a blank form that two staff do this and initial these to show who has written or amended the record sheet which is used by staff when administering medication. Care Homes for Older People Page 16 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines for daily living are flexible and varied to suit peoples individual needs. Family and friends are able to visit. People receive a balanced diet in pleasing surroundings at times convenient to them. The home does not provide many activities for people who may therefore lack mental and physical stimulation. Evidence: The inspector spent time talking with people in the homes lounge and observed part of the lunch-time meal. Information about social activities was viewed in care plans and the activities file held in the staff office. Care staff and the cook also discussed activities and meals. Comment cards from service users, staff and external professionals are also considered as is the AQAA completed by the registered provider/manager. The routines for daily living are flexible to suit peoples individual needs. People living in the home are able to spend their time in the home where they wish, people were seen sitting on the pleasant landing window sitting area and in the lounge. People were also seen moving around the home as they wished. The home has a pleasant rear garden which has level access, pathways and siting areas. Care Homes for Older People Page 17 of 33 Evidence: People confirmed to the inspector that they are given choice over what time they get up and go to bed, as well as choice as to how and where they spend their time and what they have for their meals. Care plans and assessments include information about leisure activities, hobbies interests, catering and religious needs. The AQAA stated that activities are made available to service users and include quizzes, arts and crafts, film matine and musical entertainment. There was no evidence to support this statement in surveys received, records viewed or observation during the inspection visit. Service users stated to the inspector and in surveys received that the home does not provide many activities. Additional comments in service user surveys to the question asking what the home could do better included organize social events sometimes, sitting in the lounge or room can be boring and residents need stimulation. Another added to the same question it would enhance my quality of life if there were regular planned activities throughout the year. Service users made similar comments during the inspection visit. Care staff also completed comment cards and also identified that the home could do better if they increased the activities available for people. A relative completed a comment card and this also identified that the home does not provide regular activities. Their additional comment stated activities have always been at best sporadic and at worst absent for months at a time. Not all residents may wish to take part in activities but i believe that there would be enormous benefit for those who choose to. I believe it is essential provide stimulating activities to exercise the mind. This wish has been raised many times with only very limited response. During the inspection visit there were no planned activities for people living at the home. One lady went out to the hairdressers in the morning and in the afternoon one person went to an age concern club. Otherwise people were observed sitting in the lounge or sitting on the landing reading. In the staff room there was an activities book and this evidenced that very few activities are occurring as did individual daily records in care plans. The person in charge stated that the provider is aware of the need to provide activities and had arranged for a staff member returning from leave to undertake some activities hours however the staff member was no longer returning as planned. The responsible person is required to ensure that a range of activities are made available to people. Although there were no visitors during the homes inspection service users confirmed that they can have visitors and that their visitors are made welcome. The home does Care Homes for Older People Page 18 of 33 Evidence: not have a private room for visiting however the dining room did not appear to be used outside of meal times and could provide a private area if required for visitors. The home has a separate dining room. People stated that they generally have their breakfast in their bedrooms and other meals in the dining room. People living at the home informed the inspector that they enjoyed the food at the home. People stated that if they did not like what was available they would say and stated instances when alternatives had been provided. Discussions with staff showed that they had a good understanding of individual peoples preferences and one person confirmed that they received their vegetarian meal. People confirmed that they are provided with fresh fruit and vegetables. Since the new provider has purchased the home there has been one service users meeting held in October 2009. The minutes showed that menus were discussed and service users suggested some things they would like to see incorporated into the menus. The cook was aware of these and stated that they would be offered. The inspector was present for the main lunchtime meal. Drinks and snacks are also available throughout the day with people confirming this as well as the inspector observing people being given morning and afternoon hot drinks and biscuits. Daily records of care provided also showed that hot drinks and snacks are available in the evening or at night if people request this. The need for special diets or supplements is recorded pre-admission. The pre-admission form included information about peoples food likes and dislikes. Discussions with the cook showed that she was aware of the dietary needs of people. Surveys were received from four service users, three stated usually and one always that they liked the food provided at the home. An additional comment being meals are very good. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home were confident that their complaints will be listened to, taken seriously and acted upon however surveys identified that issues had been raised in relation to activities and this had only resulted in a limited response. People are protected from abuse however staff have not received safeguarding and other related training and were not clear about safeguarding reporting procedures. Evidence: The home has a complaints policy and procedure a copy of which is provided on the hall wall beside the pay phone that is available for service user or visitor use. People the inspector spoke with stated that they did not have any concerns or complaints, they stated they would raise any concerns if they had any and were confident that the home would sort out any issues. Discussions with staff confirmed they were aware of what to do if a person or their relative complained or raised an issue and would resolve these if they were able or pass them onto the manager. The registered provider/manager identified in the homes AQAA that the home had received no complaints since the home was purchased in May 2009 by the current owner. A comment card was completed by a relative who stated that they were unaware of the complaints procedure and that they had raised the issue of limited activities many times with only very limited response. The AQAA completed by the registered provider/manager stated that all staff receive Care Homes for Older People Page 20 of 33 Evidence: safeguarding training. The AQAA did not state if staff had attended deprivation of liberties and mental capacity training. Discussions with staff indicated that they would not tolerate abuse of people living at the home however they were unclear about correct safeguarding procedures and did not realize that they were able to report directly to social services safeguarding team if they had concerns or if the homes provider/manager failed to act if concerns were raised. Staff recruitment and training are discussed in the staffing outcome group however not all staff have completed all training including safeguarding and related training which may place people at risk that staff do not recognise abuse and fail to act accordingly to protect people. The systems in place to support people to manager their personal finances should protect people. Care Homes for Older People Page 21 of 33 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 live in a clean, safe, well maintained home that meets their individual and collective needs. Evidence: The inspector viewed the home with a senior staff member and viewed records related to services such as gas and electric and fire safety equipment. The inspector also discussed the homes environment with care staff and people who live at the home. Service user comment cards and the AQAA completed by the registered manager are also considered. A senior staff member showed the inspector round the communal areas of the home towards the start of the unannounced inspection visit. All areas of the home viewed were found to be clean and there were no unpleasant odours. The home has been without a cleaner with care staff doing some additional hours to cover cleaning. The inspector was informed that the home has now recruited a cleaner who is due to commence employment soon after the inspection visit. Care staff also do the laundry and the AQAA stated that there are plans to provide new industrial washing and drying machines. Staff stated that the current the homes laundry facilities are adequate however new larger machines would mean that they had to spend less time in the laundry room. Care Homes for Older People Page 22 of 33 Evidence: The home has a pleasant lounge and separate dining room adjacent to the kitchen. Both have sufficient seating should everyone who lives in the home wish to use the rooms at the same time. The home also has a pleasant seating area on the first floor landing that is popular with the people who live at the home and has large windows overlooking the gardens. People were observed sitting here at various times of the day. The garden has been landscaped and provides safe pathways to pleasant seating areas. The home is registered to provide accommodation for up to twelve people. The home has eleven bedrooms, all of which are used as single. One bedroom has en suite facilities. People confirmed that they were able to bring in personal items when they moved into the home. Bedroom doors did not have locks. The senior stated that a lockable facility could be provided to bedrooms for the storage of valuables if required. Two bedrooms are located on the ground floor and the others on the first floor. The first floor is accessible by stair lifts and the home has a bath hoist. Members of staff spoken with confirmed that they had access to all the necessary equipment to prevent cross infection such as disposable gloves and aprons, supplies of which were seen during the visit to the home. Substances hazardous to health (COSHH) were stored securely. Certificates seen confirmed that the homes services such as gas and electric have been checked and serviced as appropriate. Portable electrical appliances are regularly checked. The records for these checks on the homes fire detection and fighting equipment were viewed and confirmed that the necessary checks are undertaken on all the homes fire equipment. Since the new provider/manager purchased the home additional fire extinguishers have been provided. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides sufficient staff many of whom have completed an NVQ of at least level 2. The home has only employed one new member of staff and records showed that the person commenced working in the home shortly before all pre-employment checks had been completed. Staff have not completed all mandatory or service specific training including yearly updates placing people at risk. Evidence: All comments from people who live at the home were positive about care staff. People stated that there were sufficient staff and that staff are available when they need them. Interactions observed during the inspection were warm and friendly with care staff clearly having a good knowledge of the individual people who live at the home. Additional comments in comment cards from service users included I feel safe and cared for and all the staff are really nice and always helpful. Duty rotas were seen during the visit to the home. Duty rotas stated that two care staff and a senior are provided throughout the morning, during the afternoon and evening one care and one senior and at night one care awake and a senior carer on sleep in are provided. The home also employs a cook and the inspector was informed that a new cleaner has been employed and is due to start soon. During the inspectors visit staff on duty corresponded to those on the duty rota. Care Homes for Older People Page 24 of 33 Evidence: Care staff stated that they have sufficient time to meet peoples needs and throughout the inspection care staff appeared to have time to meet peoples needs. Care staff also stated that they cover additional shifts when required due to other staff holidays or sickness. The list for cover required was seen and most spare shifts had been covered voluntarily. Although staff stated that they had sufficient time to meet peoples care needs they stated that they did not have sufficient time to undertake activities as well as care, cleaning and laundry. Training and qualification information was provided during the inspection and on the homes AQAA. The home employs thirteen care staff of whom eleven have at least an NVQ level 2. Of the three staff on duty one stated they had a level 4 qualification, another a level 3 and the third that she had a level 2 qualification. NVQ certificates were seen in staff files viewed. Care staff stated that they felt they had the necessary skills to meet peoples needs and were not expected to undertake activities for which they had not been trained. This was also the view of staff who completed comment cards. However discussions with staff showed that they had not had all the yearly updates for mandatory training. Care staff stated that some training was booked at the college. The inspector saw a letter from the local social services contracts department listing all the training they expected managers and staff to have undertaken. This was on a notice board in the office beside the homes training matrix. The training matrix showed that staff had not completed all mandatory or service specific training including updates. The training matrix showed that the only mandatory training that all staff are up to date with is infection control. The senior staff member stated that the training matrix was not up to date. The inspector looked at certificates and other evidence of staff training in three staff files. This showed that some training not recorded on the training matrix had occurred however this also evidenced that individual staff have not completed all mandatory or service specific training placing people at risk through staff not having the training to meet their needs. The senior showed the inspector the homes diary that recorded training staff were booked on and some they had attended in September and October 2009 but may not yet have received certificates for. However this still did not evidence that all staff have attended all the necessary training. The inspector asked if there was any other evidence that staff had received training and none was available. Care Homes for Older People Page 25 of 33 Evidence: Following the inspection visit the inspector telephoned the registered provider/manager who stated that she was aware that staff had not completed all mandatory or service specific training. The home is required to ensure that all staff have attended all mandatory and service specific training including updates to ensure that they have the necessary skills to meet peoples needs and service users are not placed at risk. The home should have a system in place to identify training needs of staff and evidence these have been met. The home has only recruited one new staff member since the new provider purchased the home. The recruitment records were checked and the inspector was able to talk to the new staff member. The recruitment records evidenced that while three written references had been obtained and a Criminal records (CRB) check applied for, the person had commenced working in the home four days before the first part of the CRB, the confirmation that the person was not named on the list of people unsuitable to work with vulnerable adults, had been received. The person confirmed that they had also undertaken a shadow induction shift prior to commencing work and confirmed their start date. The home must ensure that new staff do not commence working at the home until all pre-employment checks have been completed with a satisfactory response. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider/manager has the necessary qualifications and is aware of and works to the basic processes set out in the national Minimum standards. Peoples financial interests are safeguarded. Records are well maintained. The health, safety and welfare of people and staff may have been placed at risk and four requirements have been made following this inspection. Evidence: The registered provider/manager was not present on the day of the unannounced inspection visit. The inspector telephoned the registered provider/manager following the inspection to clarify some information and provide some feedback and information. The commissions registration records state that the registered provider/manager has the registered managers award and a BTEC in health and social care. The management section of the AQAA did not state if the registered provider/manager had undertaken any mandatory or service specific training since purchasing the home. The inspector was shown the folder of revised policies and procedures the registered Care Homes for Older People Page 27 of 33 Evidence: provider/manager has completed and new staff handbook. The AQAA stated that the views of the service users are taken into account and service user and relative surveys have been undertaken however there was no information either in the AQAA or in the home during the inspection visit to demonstrate what actions had been taken to change the service as a response to service users or other stakeholders views. Since the service was purchased by the current registered provider/manager there has been one service users meeting which occurred the week before the inspection visit. The minutes were viewed and service users confirmed that a meeting had occurred. The inspector asked about staff meetings and was informed that the new provider has not undertaken any staff meetings. The homes registered provider/manager completed the AQAA. The inspector discussed the AQAA with the registered provider/manager following the inspection and identified areas where additional information should have been provided. People who live at the home either manage their own financial affairs or are supported by relatives or representatives. The home will hold small amounts of personal money for people who live at the home. This is held under secure conditions. The arrangements and records in respect of this were viewed and were well recorded with full information as to what peoples money had been spent on. Various records were viewed during the inspectors visit. All records were appropriately stored with access only available to people who should have access. Records were generally well maintained. Discussions with care staff indicated that they had limited understanding about the Mental Capacity Act 2005 and Deprivation of Liberty safeguards however none had attended training in these subjects. The home is well maintained and clean. The home undertakes weekly checks of the fire detection equipment. Fire drills are also undertaken. The local environmental health department has awarded the home five stars (maximum being five stars) for food hygiene. Cleaning substances are stored safely in the (COSHH) cupboard and COSHH risk assessments have been undertaken. The registered provider/manager stated that the homes boiler had been serviced but confirmed that other gas equipment (within the kitchen) had not been checked and that she would arrange for this to be done. Care Homes for Older People Page 28 of 33 Evidence: People living at the home may have been placed at risk as staff have not received all mandatory and service specific training and full recruitment procedures have not been followed. Most medication was stored securely but one bottle of liquid medication had not been returned to the storage cupboard and was still left out on top of the cupboard in the care staff office at 2pm the following day. Care Homes for Older People Page 29 of 33 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 30 of 33 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 9 13 The responsible person must 01/12/2009 ensure that all medication is correctly stored at all times. So that people are not placed at risk. 2 12 16 The responsible person must 01/12/2009 consult with service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation and stimulation. So that people are happy and mentally stimulated. 3 29 18 The responsible person must 01/12/2009 ensure that staff do not commence working in the home until all preemployment checks have been completed and are satisfactory. So that people are safe. Care Homes for Older People Page 31 of 33 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 4 30 18 The responsible person must 01/02/2010 ensure that all staff have undertaken all mandatory and service specific training including updates. So that people are safe and their needs are fully met. 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 It is recommended that when care staff add to medication administration records or write in new peoples medication to a blank form that two staff do this and initial these to show who has written or amended the record sheet which is used by staff when administering medication. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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