Care Home: Adderley Care Home

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What the care home does well People live in a clean and homely environment and are satisfied with the cleanliness and comfort the home provides. Staff are committed to providing a good standard of care to people the service supports. People described staff as "pleasant" and available when they needed them and also felt they received medical attention when they needed it. Relatives felt staff kept them well informed and we saw there was a good rapport between people who live in the home, staff and relatives. A relative said of staff "they treat people as people not as kids". People made positive comments about the meals provided and told us they liked them and have a choice. They majority of people told us they knew how to make a complaint and felt staff generally listened and acted on what they said. What has improved since the last inspection? The majority of the matters we raised at the last key inspection have been addressed and we saw progress has been made to those that have not yet been fully completed, for example care plans are in the process of being reviewed so that they contain more person centred information. Staff have had more training. This has included updated training about moving and handling people and additional equipment has been obtained to make sure moving and handling can be carried out safely. Staffing has improved and the acting manager confirmed that since the site visit they have recruited to the vacant activities coordinator post and an administrator has been appointed, both who are due to start work in July 2010. There have been improvements made to the kitchen in order to address matters raised during an environmental health kitchen safety inspection. A comment from a staff member about the home was that it was "running a lot better and improving slowly under the new manager" and comments from people who live in the home indicated they felt able to raise any problems. What the care home could do better: We made some requirements at this inspection. These are things that they must do to meet standards. We said everyone living at the home must have a care plan that clearly identifies all of their individual needs and wishes. This is so that staff are clear about the help and support people need. We also said that they needed a clearer system in place to record the care given so that they can better demonstrate how people are supported and cared for and people can feel confident staff know their needs. We said they needed better systems in place to make sure any maintenance matters reported received prompt attention to promote peoples safety and welfare. We said they need to make sure that the social, leisure and recreational activities meet the individual needs of all people within the home. We said staff must be appropriately supervised in order to monitor their work performance and personal development on a regular basis.We also made some recommendations. We recommended care plans should be reviewed so that they show clearly consideration has been given to peoples capacity to make decisions and choices and how their rights and best interests are protected. We also said they should review the information they have telling people about the service, so it accurately reflects the management arrangements and any terms used fully respect people`s dignity. We recommended any questionnaires used with people to obtain their views about the quality of the service should be dated so they can demonstrated there are effective systems in place monitor the quality of the service. People told us that an area where they felt the service could improve was to provide better facilities for people who smoke. One person said "The only thing I think they could do better is make sure the people who smoke and there are a few, get a place where they can go in the winter". Key inspection report Care homes for older people Name: Address: Adderley Care Home 23 London Road Adderley House Long Sutton Lincs PE12 9EA     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: Sue Hayward     Date: 2 4 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Adderley Care Home 23 London Road Adderley House Long Sutton Lincs PE12 9EA 01406364309 01406364938 star.gate@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Adderley House Ltd Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 72 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 people who can be accommodated is: 72 The registered person may provide the following category of service only: Care Home with Nursing - Code N to people 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 Date of last inspection Brief description of the care home Adderley Care Home provides nursing and personal care for up to 72 people. The home is situated in the small market town of Long Sutton and is part of a complex, which includes a separately registered home providing personal care with some self contained flats in the same grounds. The home is close to shops, banks, post office Care Homes for Older People Page 4 of 28 Over 65 0 72 72 0 Brief description of the care home and other facilities. Accommodation is purpose built with single and double bedrooms on the ground and first floors. There are 66 single bedrooms, 26 which are en-suite with showers and 3 double bedrooms. The first floor is served by stairs and a shaft lift. There are accessible gardens and car parking is available at the front of the home. The philosophy of the home includes encouraging people to exercise their rights to the full, to treat each person as an individual and to respect privacy at all times with the aim to create a warm, caring and friendly atmosphere. The fees confirmed by the acting manager range from £360.00 to £488.62 each week. Hairdressing, chiropody, toiletries, personal newspapers and magazines are additional costs to the fees. Information telling people about the home can be obtained from the acting manager. Some information is also on display in the entrance hall of the home. Care Homes for Older People Page 5 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: 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 an unannounced inspection which focused on those standards considered to be key in terms of the health, welfare and safety of the people the service supports. It lasted approximately 8 hours. We followed the care of four people who use the service with a range of needs through checking their care records. We had discussions with service users, 3 sets of visitors and five staff who were on duty. In addition we saw the bedrooms of people who gave us permission to do so as well as checking some of the communal areas in the home such as lounges, dining areas, bathrooms and toilets. Prior to the visit we sent out surveys to people who use the service and included one for them to give to their friends and relatives if they wished. We also sent surveys to be distributed to a range of staff. The comments we received were used to plan the inspection and produce this report. Care Homes for Older People Page 6 of 28 We also checked the records we have about the service, including any significant events we have been been notified of. We sent out an annual quality assurance questionnaire (AQAA) which the acting manager completed and returned to us. This gave us important information about the services own assessment of how well it is meeting standards and is also used to plan the inspection. We gave some general feedback about outcomes to the acting manager who was present throughout our visit. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: We made some requirements at this inspection. These are things that they must do to meet standards. We said everyone living at the home must have a care plan that clearly identifies all of their individual needs and wishes. This is so that staff are clear about the help and support people need. We also said that they needed a clearer system in place to record the care given so that they can better demonstrate how people are supported and cared for and people can feel confident staff know their needs. We said they needed better systems in place to make sure any maintenance matters reported received prompt attention to promote peoples safety and welfare. We said they need to make sure that the social, leisure and recreational activities meet the individual needs of all people within the home. We said staff must be appropriately supervised in order to monitor their work performance and personal development on a regular basis. Care Homes for Older People Page 8 of 28 We also made some recommendations. We recommended care plans should be reviewed so that they show clearly consideration has been given to peoples capacity to make decisions and choices and how their rights and best interests are protected. We also said they should review the information they have telling people about the service, so it accurately reflects the management arrangements and any terms used fully respect peoples dignity. We recommended any questionnaires used with people to obtain their views about the quality of the service should be dated so they can demonstrated there are effective systems in place monitor the quality of the service. People told us that an area where they felt the service could improve was to provide better facilities for people who smoke. One person said The only thing I think they could do better is make sure the people who smoke and there are a few, get a place where they can go in the winter. 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 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 10 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. There is a satisfactory process in place to assess and introduce people to the service and sufficient information is available so people know what they can expect from the service. Evidence: We checked the records of four people who live in the home with a range of needs and included a person who had been admitted to the home within the past year. We saw a needs assessment had been carried out for each person and included area of risk assessed, such as falling, skin sensitivity and manual handling. We also saw relevant information had been obtained from other professionals such as social services. The acting manager said he generally visits people prior to their admission either in their own home or hospital and showed us letters, which are now being sent to people confirming the outcome of the assessment. This was a matter we said they must address at the last key inspection. Care Homes for Older People Page 11 of 28 Evidence: One person we spoke to who lives at the home could not recall visiting before coming to stay as this had been arranged by social services, but thought information about the home had been given on arrival. We spoke to two sets of relatives, who told us that there were opportunities for them to visit the home as well as their relatives and they received relevant information about the service. One told us they thought their relative had settled in better than where she was previously. Comments we received from surveys people had completed varied although the majority thought they had received sufficient information about the service. The acting manager told us he was aware information contained in the statement of purpose and service user guide needed updating as it still makes reference to the previous manager and does not include information to tell people that there is a no smoking policy within the home. This information is however, contained in the terms and conditions of residency which the acting manager said is given to all people on their admission to the home. The brochure on display contained relevant information about the service although the terminology used in one instance to describe the accommodation for more vulnerable people would benefit from review, to better respect their dignity. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are satisfied with the help and support they receive. Care records have improved but are not being consistently maintained to clearly show peoples individual needs and how they are being met. Evidence: The care records of four people the service supports with a range of needs were checked on this occasion. Care plans were in place for them all and those checked had been reviewed this year. Information in care plans was not always being consistently completed. For example, peoples wishes after death had not been recorded in some but had in others. One persons spiritual needs and how they were to be met had not been recorded as part of their care plan although this need was known and it could be demonstrated was in the process of being addressed. The acting manager confirmed there is still further work to be done on improving care plans and they are in the process of introducing a different way of recording this information. Some care plans contained more person centred information than others although we did not see clear information contained in three of the personal files we checked to show that consideration had been given to peoples capacity to make decisions. This was a Care Homes for Older People Page 13 of 28 Evidence: recommendation we made at the time of the last inspection. However, some training has occurred to inform staff about the law in relation to peoples capacity to make decisions. We also saw records to confirm that staff have had training about record keeping. Daily records referred to care plans numerically but care plans we checked were not numbered in some instances therefore it was difficult to ascertain which of peoples needs were being refereed to as met. We observed staff working with people in two of the lounges. Staff were attentive to peoples needs when assisting them to have their meals. We observed how staff moved and handled people when taking them from the lounge to the dining room. We saw staff explained what they were going to do prior to moving people and used a mobile hoist and sling to transfer people. We saw the people being moved looked comfortable during the manoeuvre. Training records showed most staff have had manual handling training in the past year. Staff told us if they have not had training then they are not able to carry out manual handling procedures. We saw information contained on peoples records to show they can have visits from other medical and health professionals as needed. A member of staff accompanied a service user to a hospital appointment during our visit. A person who lives in the home told us staff arranged for the doctor to visit her when she had told them of her concerns about her health, her records confirmed details about the visit. She said she did not look after her own medication, staff did this but she received it regularly and on time. Staff told us that qualified nurses administer medication although the acting manager has told us it is the intention care staff should also receive training about this. We observed part of the teatime medication round. We saw the nurse dispensed medication to each person and checked it was taken. We saw records of medication administration were well maintained. They use a monitored dosage system and have a contract with a local pharmacist who visits to check procedures in place and offer advice and guidance. People told us they thought staff respected their privacy and dignity and we observed that there was a good rapport between them. Most people who had completed surveys said they received the support and care they needed. Relatives also made positive comments such as They care and look after my mum well. If I have any worries they sort it out for me. Who could ask for more. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals are well balanced and cater for peoples individual preferences. The social, leisure and recreational activities are not consistently meeting peoples needs. Evidence: Some information was available to show the social and leisure opportunities available, although we were told that the activities coordinator who worked for 35 hours a week left in April 2010. Since the site visit we have been informed they have successfully recruited a staff member to this post who is due to start on 07/07/2010. One person told us they had had the opportunity to attend the local village hall to play bingo and that this activity was also carried out in the home. A key worker system has been introduced where named staff have specific responsibilities for specific people who live in the home. One person said her key worker was going to take her out to the local shop. Comments from surveys we received varied about peoples satisfaction with the activities and leisure opportunities. For example a service users relative said about what the home could do better more activities for residents, more time spent with bedridden residents to talk, read etc. A staff member also made the comment allow staff more time to do more activities with residents and a comment from one person who lives in the home about what the home could do better was to Care Homes for Older People Page 15 of 28 Evidence: have more day trips. We saw records of meetings held with people who live in the home to show they are consulted about trips out. We also saw that individual sheets for recording activities were included on peoples files although no entries were made on two of them to show what activities they had participated in. People told us they could have visitors whenever they wished. We spoke to two sets of visitors who said were made to feel welcome and staff were friendly. We saw from the menus we checked there is a variety of meals provided for people. People who live in the home told us they liked the meals and they have choices offered. We spoke to one of the catering staff on duty who was aware of peoples particular food preferences and specific dietary requirements. We saw at tea time, staff assisted more vulnerable people who needed support with their meals appropriately, making sure they received the sandwiches of their choice and checked to make sure they had sufficient to eat. We saw that South Holland District Council Environmental Health department last visited the service on 08/08/2009 and awarded a rating of 2 Tulips/good for the catering provision. 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. People feel confident that any concerns or complaints they have will be dealt with appropriately so they are kept safe. Evidence: People told us they felt comfortable to raise any concerns they may have with staff. Of the comments we received all but one said they knew how to make a complaint and felt staff always or usually listened and acted on what they said. Comments people made about what the home does well included everything. Well maintained records are kept of any complaints or concerns received and of actions taken to resolve them. We saw there was information to show that any concerns raised are acknowledged in writing. Residents meetings minutes we saw held on 02/03/10 showed people had opportunities to raise any concerns they had. They have told us they have relevant policies and procedures in order that people can raise any concerns or complaints they have. We saw for example that they have a copy of the Local Authoritys vulnerable adults procedure which is accessible for staff to refer to if needed. Staff knew of their role to report matters of concern which may indicate someone is at risk of being harmed. Records showed staff have training about safeguarding vulnerable adults. We saw they keep records to show how any concerns or complaints raised have been dealt with and resolved. Records showed four complaints had been made since December 2009. We have not received any complaints about the service directly. Care Homes for Older People Page 17 of 28 Evidence: There have been some matters raised and referred to the Local Authority for investigation under their safe guarding procedures. One matter is still on going. Some recommendations were made as a result of the investigations relating to improving record keeping, appointing key workers and making sure staff follow the proper procedures when moving and handling people. Key workers have been appointed, staff have had moving and handling training. Staff have had training about record keeping and care plans are improving though it was acknowledged by the acting manager further work is needed in this area to make sure they are sufficiently person centred. None of the people we spoke to who live in the home or their relatives had any complaints and people said they could discuss any problems with staff. There is a satisfactory staff recruitment procedure in place which includes obtaining proof of identity, satisfactory references, criminal records bureau (CRB) and Independent Safeguarding Authority (ISA) checks of people employed to work in the home. Care Homes for Older People Page 18 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 adequate 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 comfortable and homely environment suitable to their needs, but the lack of prompt attention to make sure aspects of the environment are well maintained poses a risk to people. Evidence: People we spoke with were satisfied with the cleanliness of the accommodation. The areas we saw included three lounges, two dining areas a sample of bedrooms and the kitchen. They were generally clean and tidy. We checked a sample of bedrooms. We saw that people had been able to make them more homely with their own personal items and effects. Although bedrooms are lockable one person we spoke to said they chose not to do so. A comment made about what the service could do better we received was, Prevent people coming into rooms where people are bedridden and picking up their treasures & personal possessions, even spectacles. The acting manager was made aware of this comment in order to address it. Each bedroom has a call bell system which we heard in working order. Comments from all the surveys we received were that the home was always fresh and clean. We saw records were in place to show when any maintenance issues had been reported. We saw that there had been three request sin total for more desert bowls. We saw for example, they had been requested on 10/03/2010. Staff told us that there Care Homes for Older People Page 19 of 28 Evidence: were insufficient stocks of crockery which resulted in dishes having to be washed and reused at meal times. We were told 42 people were living in the home at the time of the visit. There were 21 dessert bowls available. A lot of the bowls and other crockery we saw were chipped. A staff member also made the comment that it sometimes took a long time before maintenance issues were attended to. Another staff member told us a hoist had been broken and it had also taken a long time before it was repaired. The acting manager has since confirmed further bowls have been attained. Since the last inspection the cook confirmed there has been a new kitchen floor laid, new dishwasher installed and new chopping boards purchased. This addresses the requirements raised in the Environmental Health Officers report of 08/09/09. The cook also said there was a weekly waste disposal contract. We saw there was equipment around the home such as hoists, handrails and raised toilet seats to assist people with specific needs. We have been made aware of some concerns relating to manual handling equipment in the home. Information we have received from the Local Authority Quality monitoring visits indicate slings and hoists are inspected every six months and further slings and hoists have been ordered. They have told us they have relevant policies and procedures about infection control and staff told us they had sufficient supplies of gloves and aprons provided. People told us they were happy about the laundry arrangements. Care Homes for Older People Page 20 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. There are sufficient staff, who are safely recruited to meet the needs of people who live in the home. Evidence: Peoples comments about the staff were positive indicating they were very pleasant and were available when they needed them. Comments from surveys we received from relatives varied, two indicating more staff on duty were needed whilst two others said they keep a constant watch on everyone and they do a good job and I cant fault them. There were care staff on duty on the day of the visit, two qualified nurses, two catering staff and three housekeeping staff. The acting manager was also on duty. He confirmed that there was one nursing staff vacancy currently. We saw staff and people who live in the home and their relatives had a good rapport. We saw there is always a staff member in the lounges to attend to people as needed. We checked staff records of recruitment for three people, all who had commenced employment this year. They showed a thorough recruitment procedure was in operation, which included obtaining proof of identity, satisfactory references, a criminal records bureau and an independent safeguarding authority check as part of the recruitment procedure. Staff told us they followed a training programme which Care Homes for Older People Page 21 of 28 Evidence: included a range of matters some which were updated on a regular basis and other more specific training. Records of training we saw as well as discussions with staff, confirmed new employees follow an induction training programme. Information we received prior to the site visit informed us that twenty-six staff had attained a nationally recognised vocational award in care at level two or above. There has been training for staff about the Mental Capacity Act, moving and handling, record keeping, fire safety and safeguarding vulnerable adults since October 2009. The acting manager also attended dementia care training in April 2010. Care Homes for Older People Page 22 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. Quality monitoring systems are improving and people have opportunities and feel comfortable to make their views known. Evidence: The AQAA we received showed they are aware of areas within the home they need to improve and have put forward ways in which they hope to achieve this. There has been a change to the management arrangements since the last inspection took place. The acting manager who is a registered nurse in mental health and learning disabilities took up this position in September 2009. He had not submitted an application to become registered at the time of the site visit but we have since received confirmation of this. People told us they knew who was in charge and would feel comfortable to raise any problems with staff or the acting manager. We saw that there is a comments and suggestions box in the entrance hall. There has been some progress since the last inspection to address outstanding issues regarding the management standards. For example, we saw reports to show a Care Homes for Older People Page 23 of 28 Evidence: company representative visits and checks aspects of the service, although since December 24th 2009 only two other reports were seen and the law says these should be monthly. We saw records to show a relatives group meeting was held on 05/05/2010 and these occur monthly. We saw records to show when staff meetings had occurred the most recent being 13/01/10. A residents meeting was held on 02/03/10 and records showed people were given opportunities to raise concerns. We saw that questionnaires had been used with visitors to give feedback about the service although these were not dated. There was some evidence of systems in place to monitor staffs performance and development however the manager acknowledged formal staff support and supervision sessions were not being carried out regularly enough. They have told us all policies and procedures were reviewed in September 2009. They have a range of them, which include health and safety matters such as fire safety, health and safety and moving and handling. They have confirmed to us that the maintenance of equipment is carried out regularly. For example, we checked service certificates for hoists which were carried out on 07/12/2009, fire fighting equipment was last checked in January 2010 and this corresponded with the dates shown on the fire equipment seen in the home. Fire audit records were in place and showed the last check of call points was carried out on 19/05/2010 and fire doors were shutting correctly, emergency lighting and fire signage checks had been carried out and no issues were identified. A fire safety risk assessment had been reviewed on 01/03/2010. Staff records and discussion with them confirmed that they have training about health and safety matter such as moving and handling, first aid and fire safety. Comments we received from surveys were generally positive about the quality indicating people were happy and satisfied with the service. No suggestions were made as to how it could be improved. One staff member commented that the home is running a lot better and improving slowly under the new manager. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 (n) Appropriate stimulation must 31/08/2009 be provided to everyone living at the home. This is to ensure that the people that may not be able to participate in the planned activity programme receive meaningful stimulation and comfort. 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 7 15 Care plans and care records must be consistently maintained in sufficient detail to identify peoples individual needs and how they are met. This is to make sure peoples individual needs and wishes are known and being appropriately met by staff. 05/08/2010 2 19 16 There must be sufficient and 05/08/2010 suitable kitchen equipment such as crockery, cutlery and utensils provided, which are in good condition. So that peoples dignity is respected and their health and safety promoted. 3 36 18 Staff must be appropriately supervised on a regular basis. 05/08/2010 Care Homes for Older People Page 26 of 28 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 This is so people who live in the home can feel confident they are being cared for safely. 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 1 Documents such as the statement of purpose and brochure should be reviewed so that people have clear and up to date information about the service, which includes the management and smoking arrangements in the home. Any terms used must fully respect peoples dignity. All care plans should include reference to the Mental Capacity Act 2005 and the effects it has upon peoples lives. This is to ensure that peoples rights and choices are protected. It is recommended any questionnaires used with people to comment on the quality of the service are dated so it can better be demonstrated there is an effective quality monitoring assurance system in place which includes obtaining the views from family, friends, other professionals and people who use the service on a regular basis. 2 7 3 33 Care Homes for Older People Page 27 of 28 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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