Care Home: Acton Care Centre

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What the care home does well Prospective residents are fully assessed prior to admission to ensure the home is able to fully meet their needs. Staff care for residents in a gentle and professional manner, and the privacy and dignity of each resident is a high priority at the home. The wishes of residents and their families in respect of end of life care are ascertained and recorded, and the home provides effective end of life care in conjunction with the Palliative Care Team. The home has an open visiting policy and visiting is encouraged. Information regarding advocacy services is available. The food provision is excellent, offering variety and choice to include meeting the religious and cultural dietary needs of residents. The complaints procedure is on display throughout the home and complaints are dealt with appropriately. Safeguarding Adults procedures are in place and are followed. The home is being well maintained, and any redecoration and refurbishment needs are addressed promptly. Procedures for infection control are in place and are followed, thus minimising risks. The home is appropriately staffed to meet the needs of the residents. There is an on going programme of training and the majority of care staff have attained NVQ level 2 or 3 in care. There is an induction programme in place for new staff. Recruitment processes are robust and protect residents. The home is being effectively managed and the management style promotes an atmosphere of openness and good communication. There are clear systems in place for quality assurance and the results of surveys are used to influence changes in the home. Personal monies held on behalf of residents are being well managed and securely stored. Health & safety is being well managed at the home. Comments received included the following: The staff and nurses could not be better. They are always pleasant and helpful. I am very happy. The Manager is very supportive and always willing to help us in any way she can. Everything is very good here. The meals are very nice. Any concerns I have raised have always been promptly investigated and responded to. They manage to maintain a cheerful environment in what are often difficult and demanding times. Their outlook confirms a deep sense of concern for the residents. All staff tend to be dedicated, helpful individuals who seem to get on well with each other and any outside individual who enters the premises. I think that they provide a good service and carers have a good professional relationship with their residents. I have found the nurses to be knowledgeable about the residents condition and care needs. This home consistently has a good atmosphere and all the staff are always veryfriendly and helpful. My relative always looks very well presented and cared for. Its marvellous. What has improved since the last inspection? The completion of service user plan documentation has improved, and this is now more personalised, and completed promptly when a resident is admitted to the home. Wound care needs are assessed prior to admission and documentation was up to date, with evidence of the tissue viability nurse being involved in the residents care. Healthcare assessments are now being well completed. Where a resident is identified as experiencing weight loss, action is taken to refer them to the GP and dietician for intervention. There is now evidence that staff have undertaken moving and handling training. What the care home could do better: Where there is clearly an innaccuracy in a weight record, action should be taken to reweigh the resident without delay. Shortfalls were identified in the medication management for the home and this needs to be addressed as a matter of priority. Although there are activities provided, more work is needed in this area to provide the activity staff with better skills and knowledge to meet the needs of all residents. Comments received included: I am not aware of a lot of activities and outings taking place. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Acton Care Centre 48 Gunnersbury Lane Acton London W3 8EF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Henderson-Roe     Date: 0 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Acton Care Centre 48 Gunnersbury Lane Acton London W3 8EF 02088965600 02089927116 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Vintage Care Ltd. care home 125 Number of places (if applicable): Under 65 Over 65 Additional conditions: 1. The registered person person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places: 54) 2. The maximum number of service users who can be accomodated is: 125 Date of last inspection Brief description of the care home Acton Care Centre was registered in March 2003 to provide nursing care for 125 residents over the age of 65. The home provides 71 beds for general care and 54 beds for dementia care. It is a purpose built home with modern amenities close to Acton High Street set on the site of the old Acton Hospital. The home is able to access other health care professionals to supplement the nursing care already provided. The home has a large car park at its front and landscaped gardens at the rear of the building. At the time of inspection there were 100 residents accommodated at the home. The fees charged range from £628 to £1,200 per week. Care Homes for Older People Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection carried out as part of the regulatory process. A total of 26 hours was spent on the inspection process, and was carried out by 3 Inspectors, one of which was a Pharmacist Inspector. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Residents, staff and visitors on each unit were spoken with as part of the inspection process. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents, staff and health & social care professionls have also been used to inform this report. It must be noted that it is not always possible to ascertain the views of residents living with the experience of dementia. Care Homes for Older People Page 5 of 28 The home has a registered manager and a general manager, and where we have discussed issues with them both we have referred to them as the management. A random inspection was carried out in September 2007 to specifically view the wound care management provided by the home. Requirements made at the last key inspection plus at the random inspection have been reviewed at this inspection. What the care home does well: Prospective residents are fully assessed prior to admission to ensure the home is able to fully meet their needs. Staff care for residents in a gentle and professional manner, and the privacy and dignity of each resident is a high priority at the home. The wishes of residents and their families in respect of end of life care are ascertained and recorded, and the home provides effective end of life care in conjunction with the Palliative Care Team. The home has an open visiting policy and visiting is encouraged. Information regarding advocacy services is available. The food provision is excellent, offering variety and choice to include meeting the religious and cultural dietary needs of residents. The complaints procedure is on display throughout the home and complaints are dealt with appropriately. Safeguarding Adults procedures are in place and are followed. The home is being well maintained, and any redecoration and refurbishment needs are addressed promptly. Procedures for infection control are in place and are followed, thus minimising risks. The home is appropriately staffed to meet the needs of the residents. There is an on going programme of training and the majority of care staff have attained NVQ level 2 or 3 in care. There is an induction programme in place for new staff. Recruitment processes are robust and protect residents. The home is being effectively managed and the management style promotes an atmosphere of openness and good communication. There are clear systems in place for quality assurance and the results of surveys are used to influence changes in the home. Personal monies held on behalf of residents are being well managed and securely stored. Health & safety is being well managed at the home. Comments received included the following: The staff and nurses could not be better. They are always pleasant and helpful. I am very happy. The Manager is very supportive and always willing to help us in any way she can. Everything is very good here. The meals are very nice. Any concerns I have raised have always been promptly investigated and responded to. They manage to maintain a cheerful environment in what are often difficult and demanding times. Their outlook confirms a deep sense of concern for the residents. All staff tend to be dedicated, helpful individuals who seem to get on well with each other and any outside individual who enters the premises. I think that they provide a good service and carers have a good professional relationship with their residents. I have found the nurses to be knowledgeable about the residents condition and care needs. This home consistently has a good atmosphere and all the staff are always very Care Homes for Older People Page 7 of 28 friendly and helpful. My relative always looks very well presented and cared for. Its marvellous. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out 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 8 of 28 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 9 of 28 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. Prospective residents are assessed prior to admission to ensure the home are able to meet their needs. Evidence: The home has a pre-admission assessment document and this is completed by one of the senior nursing staff for each prospective resident. Those viewed had been well completed and in addition copies of the Social Services or Primary Care Trust assessments had also been obtained. Care Homes for Older People Page 10 of 28 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. Overall the service user plans are well completed, thus providing good information of the care needs of each resident and how these are to be met. There is good input from healthcare professionals, thus ensuring residents health needs are being met. Shortfalls identified in medication management could place residents at risk. Staff care for residents in a gentle, caring and professional manner, respecting their privacy, dignity and individuality. End of life care needs are identified, with ongoing work taking place to further improve the gathering and recording of residents wishes, so these can be respected. Evidence: We sampled service user plans on each unit. Overall these had been well completed and identified each persons needs and how these are to be met. There was evidence that where a new need had been identified a care plan had been formulated. On the dementia care units the need to make the care plans more personalised to each resident was discussed. On the general nursing care units care plans had been quite well personalised to reflect individuality. Risk assessments for falls were in place and in Care Homes for Older People Page 11 of 28 Evidence: addition a care plan for falls had been completed where a risk had been identified. Documentation had been updated monthly and whenever there had been a significant change in a residents condition. There was evidence of input from residents and their representatives in the formulation and review of the service user plans. We viewed wound care documentation and this clearly identified each wound, the dressing regime to be followed and the progress of each wound. Pressure ulcer risk assessments had been carried out and accurately identified the condition of the residents skin. Pressure relieving equipment was seen in use throughout the home and the specific equipment in use for each person had been identified in the care plans. Moving and handling assessments had been carried out and moving and handling information identified the actual equipment to be used for each manoevre. Nutritional assessments were in place and care plans for specific nutritional needs were available. Residents are weighed monthly unless a problem is identified, when more frequent weight checks are carried out. In two instances a marked change in weight which had been due to the inaccuracy of the scales and not visible weight loss had not been picked up, and the registered nurse was clear that this should have been addressed. Further weight checks had identified that the residents weight had in fact been stable. Continence assessments were in place and care plans for continence care needs had been completed. The GP practice providing a service to the home visit 3 times a week and there was evidence of input from other healthcare professionals to include tissue viability nurse, optician, chiropodist, physiotherapist, speech and language therapist, reflexologist and audiologist. Overall the comments received from healthcare professionals were very positive and commended the care provided and staff attitude at the home. One concern had been raised and this was discussed with the Management. We inspected the safe handling of medication in four units in the home. We looked at the recording of receipts, administration and disposal and counted several medicines in their original packaging to see if quantities could be reconciled with the signatures for administration. We looked at four care plans and met one resident who was administering her own medication. In two units we were overall satisfied that records and audits provided evidence that medicines were being administered as prescribed. There were two gaps noted on the Medication Administration Records (MAR) for lactulose. A medicine to protect the stomach had been changed by the GP and both were being signed as given. There was no stock of the first one and staff reassured us that it had not been given and signed in error. One resident was prescribed medicines to prevent seizures and we noticed that there was a risk assessment and a seizure chart available so that the residents well-being could be monitored. Recording of administration was poor in one unit in the home. We observed many gaps on the MAR. For two residents, insulin was not recorded as administered on one and three Care Homes for Older People Page 12 of 28 Evidence: occasions respectively. We looked at the blood glucose recording and noticed that it had been carried out and results fluctuated quite significantly. There were signatures missing on these records also so we did not know whether the insulin had been administered. We looked at the care plans to see if there were any specific instructions on administration when blood glucose varied and we did not notice any. One of these residents was also prescribed an antibiotic for an infection and it was not recorded for one day of the course. By counting the tablets we were able to deduce that one tablet was given but not signed and one tablet was missed. We could not audit a reducing dose of a tranquilizer. Three doses one day were not recorded as given. There were gaps on the MAR for pain killers such as codeine phosphate and gabapentin and for an antihistamine we noticed tablets left in the blister but signed as given. A steroid was not stored in the fridge as stated on the label and there was a gap on the MAR and one too many tablets left. A laxative was prescribed three times a day and was recorded as given twice a day. For three days of the medication cycle it was only recorded as given once a day. There were omissions on the MAR for medicines for Parkinsons disease but the tablets were not in Monitored Dosage System MDS so we could assume that they were given but not signed as given. The recording of warfarin was not clear for two residents as a change in dosage/day had not been written for one and the different strengths of tablets recorded for another. Several residents were prescribed feeds to be given via a tube because the resident could not swallow. The protocols were all on the notice board but we did not see the feeds documented on the MAR. One resident was able to self medicate and we were shown risk assessments and their consent to take responsibility. The resident was able to explain to us their medication and how they took it but we noticed that they were not storing it securely in their room. It was difficult to audit medication in one unit because there was a considerable stock and the balances were not carried forward to the new medication cycle. We noticed several times that medicine had not been signed the morning of the inspection but the dose had been removed from the MDS.There were other gaps on the MAR but the medication was not in the MDS. For a liquid diuretic though there were two gaps and we did not know whether it had been given or not. One resident was prescribed medication via a syringe driver and we were able to see the instructions including medication for use both on the MAR and a separate chart written by the palliative care team. This also included contact details for fast tracking anticipatory care and medication. We checked the controlled drugs in the home. There was an excess stock of Temazepam for several residents in one unit and the balance was incorrect by one tablet for one resident. We noticed that one entry for a patch had been made a day after administration as it did not correlate with the date of application on the MAR. Diamorphine was not stored securely in a cupboard meeting the Misuse of Drugs regulations in one unit, and staff moved this at the time of the inspection. Records of balances were otherwise accurate. Care Homes for Older People Page 13 of 28 Evidence: In summary therefore we identified several very good practices in the home but the weak recording in one unit and the inability to audit in another unit means that sometimes we were unable to prove that medication was always given as prescribed. The registered manager and general manager conducted an immediate investigation into the major areas of concern and supplied us with the findings. They confirmed that there were many issues of poor recording but that there was no evidence that the residents had not received their medication. They provided us with an action plan of what they were going to do to ensure that the standard of recording of administration improved in the home so that we could see that the health and welfare of the residents was maintained. Staff were seen caring for residents in a gentle, caring and professional manner, respecting their privacy and dignity. Throughout the home residents were dressed to reflect individuality and were well groomed. Clothing viewed had been appropriately labelled. Residents are able to have individual telephones, either landline or mobile. Residents and visitors spoken with expressed their satisfaction with the care provided at the home. On the dementia care units staff were observed to be managing residents behaviours patiently and effectively, and throughout the home the atmosphere was bright and content, with good teamwork between the staff. The Manager has family matters meetings with each resident and their families, in order to give the opportunity to discuss anything that they wish to in order to discuss and enhance the residents life at the home. The home has documentation on which to record information regarding the wishes of the residents and their families in respect of death and dying. We also saw documentation that evidenced that in some instances, the wishes of residents in the event of deterioration of their health and end of life care had been discussed and recorded. The home is working towards implementing the Gold Standards Framework for care homes, which is a recognised tool for managing residents who are coming to the end of their life, in line with their wishes. We discussed the importance of ascertaining the wishes of the residents and their families in respect of health deterioration, and it is acknowledged that this will be part of the ongoing work done by the home. The home has good links with the Palliative Care Team to include the Macmillan Nursing Team, and several of the staff spoken with confirmed that they had received training in end of life care. Comments received from healthcare professionals in respect of palliative care were very positive and showed that the home do understand the importance of this sensitive area of care. Care Homes for Older People Page 14 of 28 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 activities provision in the home is fair with further work to be carried out to offer specific activities to meet the needs of all the residents. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information about advocacy services is available, thus respecting residents rights to individual representation. The food provision at the home is good, and the processes in place to meet individual needs is commendable, thus ensuring preferences are identified and respected. Evidence: The home has 2 activities co-ordinators and there is a separate monthly programme of activities for the general nursing and the dementia care units. Activities were seen taking place on the units, however we noted that the range of activities was limited and did not always meet the needs of the residents. We discussed the importance of the activities co-ordinators undertaking appropriate training to provide them with the knowledge and skills to introduce activities programmes that are specific to meet the interests and needs of the residents, to include those with dementia care needs. The Management explained that due to the increasing frailty of many of the residents, more one-to-one sessions do take place and these are effective. It was clear that the Care Homes for Older People Page 15 of 28 Evidence: management had already identified the need to broaden the activity provision in the home. Residents did comment that they are offered activities and their choice to join in or not is respected. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home and offered refreshments. Residents can choose where they receive their visitors, either in their own rooms or in a communal area, as they so wish. The home has information on display for advocacy services to include Help The Aged, Alzheimers societies, and the Public Guardian Office. The management explained that advocacy is arranged where a need is identified. The home uses a system of cook chill for the food provision. In addition there are some simple meals provided for the suppertime such as ravioli. We viewed the menus and these offer a good choice of meals, to include liquidized meals, and residents confirmed that they are offered a choice, plus we saw completed records to evidence this. The Catering Manager goes to visit every new resident to discuss their individual preferences, and recognises the importance of identifying something that a resident particularly enjoys to eat, to help them to feel that this is their home. There was evidence that meals to meet religious and cultural preferences are available, and this is easily to address using the current catering system. The home had carried out a survey in respect of meals, to determine when residents would prefer to have their main meal, in line with current research. The outcome was to keep the main meal at lunchtime, however this shows that the home is being proactive and is also willing to be flexible regarding meal provision. We viewed the lunchtime meal and staff were available to assist residents as needed in a gentle and discreet manner. The dining tables are attractively laid up with linen tablecloths and napkins, plus small vases of fresh flowers, providing a restaurant style atmosphere. Residents spoken to said that they enjoy the food and that there is a variety of meals on offer. The home is to be commended on their commitment to make mealtimes an enjoyable experience for the residents. Care Homes for Older People Page 16 of 28 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. The home has clear procedures for managing complaints and for the reporting of any safeguarding issues, and these are followed, thus protecting residents. Evidence: The home has a clear complaints procedure and this is on display in the home. Residents spoken to knew how to raise a complaint, and this was also evident in the comments received on the surveys. We viewed the complaints file and there was evidence that all complaints had been promptly acknowledged, investigated and responded to. The home has a safeguarding adults policy and also follows the Ealing safeguarding adults protocols. Staff spoken to were clear to report any concerns and understood Whistle Blowing procedures. Residents and representatives spoken to also knew to report any concerns. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained, providing a pleasant, clean and homely environment for residents to live in. Infection control procedures are in place and are followed, thus protecting residents, staff and visitors. Evidence: The home was purpose built and all rooms have en suite facilities. We carried out a tour of the home and all areas were being well maintained and are kept clean, tidy and free from hazards. The garden looked well tended and was suitable for use by residents and their visitors. During the year up to March 2008 a full refurbishment and redecoration programme was completed and there is ongoing work to maintain all areas of the home. There is ample parking space available and the grounds are maintained. The home has policies and procedures for infection control and staff spoken with confirmed that they had received training in this subject. This included the domestic staff who had received training in specific topics such as MRSA. The home has a laundry with two industrial washing machines, which have wash programmes to assist with infection control. All personal laundry is done at the home, whilst all linen is commercially laundered. Protective clothing to include gloves and aprons were available. Appropriate plans had been put in place in the light of recent media Care Homes for Older People Page 18 of 28 Evidence: coverage of infection risks. Infection control is being well managed at the home. Care Homes for Older People Page 19 of 28 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 home is appropriately staff to ensure the needs of the residents and home in general can be met. Systems for vetting and recruitment are in place, thus protecting the residents. The staff are appropriately trained, thus they have the skills and knowledge to care for residents effectively. Evidence: The staffing levels for nursing and care staff are based on resident dependency and residents looked well cared for, with staff having time to devote to each person. There are also appropriate numbers of catering, domestic and maintenance staff to meet the needs of the residents and the home in general. The majority of care staff are qualified to NVQ level 2 or 3 in care and several staff are in the process of applying to undertake level 4. Staff spoken with confirmed that they are encouraged to develop their skills and knowledge in topics relevant to the diagnoses of the residents. The domestic and catering staff are also given the opportunity to undertake NVQ training relevant to their roles, and several have completed NVQ level 2. We viewed 3 sets of staff recruitment records. With the exception of the reasons for leaving all previous relevant employment, all information required under Schedule 2 of Care Homes for Older People Page 20 of 28 Evidence: the Care Homes Regulations 2001 was available. The application forms were adapted at the time of inspection to ensure that the reason for leaving previous employments is to now be ascertained. At the previous inspection the home had clear evidence that the induction training programme incorporated the Skills for Care common induction standards. We viewed the induction programme, which although comprehensive, did not contain all the information. The General Manager took action immediately to ensure that all appropriate areas were reintroduced to the programme, and said that any new staff who had not completed the common induction standards would do so as an addendum to the induction training they had already completed. Staff spoken with confirmed that they had received induction training and also that the training provision is good, with frequent training opportunities being offered. Care Homes for Older People Page 21 of 28 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 management arrangements in place for the home are good and ensure that the home is being managed effectively. There are systems in place for quality assurance, and these are followed, providing a process of ongoing review. Monies are well managed on behalf of residents, and securely stored, thus protecting residents interests. There are very good systems in place for the management of health and safety, thus protecting residents, staff and visitors. Evidence: The Registered Manager is a first level registered nurse and also has completed the Registered Managers Award. She has undertaken other training relevant to her role, and since the last inspection this has included end of life care, tracheostomy and ventilators, leadership skills, Mental Capacity, Deprivation of Liberty, emergency planning training. The home also has a General Manager who has responsibility for the business, financial and strategic planning areas of management. Staff spoken to said that the managers are approachable and supportive. Care Homes for Older People Page 22 of 28 Evidence: The home has systems in place for quality assurance. Regular meetings for staff to include heads of department, unit staff, health and safety and all staff groups take place, with minutes being taken. The General Manager has an objectives plan for the financial year and this covers all aspects of the home. In addition the home has to complete a 3 monthly in depth report for those who contract the homes services and this is very comprehensive. Six senior registered nurses have been appointed, and there is a plan in place for each person to be responsible for the auditing of an area of care. With the exception of the medications, it was clear that the monitoring processes in place for quality assurance are effective. We viewed the systems in place for the management of personal monies on behalf of residents. Individual records are maintained for all income and expenditure, and these were up to date with receipts available to view also. We checked the cash amounts for 4 residents and these tallied with the written records. Where the home does not hold monies on behalf of residents, invoices are sent to the responsible person for each resident. Monies are being well managed on behalf of residents. We sampled the maintenance and servicing records, and those viewed were up to date. Since the last inspection the fire drill records include evidence of the staff and visitors in the home at the time of each drill. The maintenance person is in charge of ensuring all staff attend fire drills at the required intervals, and she explained that if staff have not been on duty during the drills, then she carries out individual training sessions to ascertain that they have the knowledge to react appropriately in the case of fire. The fire risk assessment had last been completed in January 2009 and the maintenance person confirmed that the areas identified for action had been completed. Risk assessments had been carried out for equipment and safe working practices, plus individual assessments had been done for pregnant staff and staff using workstations. Accident records had been completed for resident and staff accidents, and Regulation 37 reports had been completed for any notifiable events. During the tour of the home we noted that the home was free of hazards and that equipment was being appropriately stored. The maintenance person is responsible for ensuring health and safety training is carried out for all new staff and is also involved in other areas of training such as end of life care. Training records evidenced that staff undertake training in health and safety topics and staff spoken with confirmed that they do have updates at the required intervals. The records for all aspects of health and safety, which are completed by the maintenance person were comprehensive, up to date and clear, and it was evident that her attention to detail in ensuring all areas of health and safety are kept up to date is excellent. Care Homes for Older People Page 23 of 28 Care Homes for Older People Page 24 of 28 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 25 of 28 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 Controlled drugs must be 15/05/2009 recorded in the register when administered and balances must be correct. Controlled drugs must also be stored securely at all times in a cupboard meeting the requirements of the Misuse of Drugs Act. To ensure medications are being managed safely. 2 9 13 That the home ensures that 15/05/2009 instructions for medicines on the MAR are clear and are the current instructions. Discontinued medicines must be clearly documented. This is to prevent the risk of error. 3 9 13 The home must develop its audits process so that stock of medicines can be reconciled and poor recording identified. 15/05/2009 Care Homes for Older People Page 26 of 28 This is to provide evidence that medication is being handled safely in the home. 4 9 13 That the safe storage of medication when residents administer their own medication is reviewed. This is to ensure all medications are securely stored. 5 9 13 That medication is recorded accurately when administered. When not given the correct endorsements must be used. This is to provide evidence that residents are receiving their medication as prescribed. 15/05/2009 15/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 8 12 Where an inaccurate weight is recorded, prompt action should be taken to repeat the weight check without delay. It is strongly recommended that training specific to the provision of activities is undertaken by staff. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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