Care Home: Albany Park Nursing Home

What the care home does well The home make sure that residents have all the information they need to choose to come and live at Albany Park. The statement of purpose and service user guide were found to be up-to-date. The home provides detailed information about the service it provides for residents. Since the last key inspection they are good at improvements to care planning and the assessment of resident medical needs. Residents needs are being supported to maintain their health and well-being. More activities are being offered to residents. This means that they can choose from a range of activities that meet their needs and reflect their personal preferences. Residents confirmed that they could raise complaints and concerns about the home. They felt that these will be responded to appropriately. The home has an open culture that allows people to express their views, and concerns in a safe and understanding environment. Staff training record show that they had received all the staff who require training to make sure they worked with residents safely. What has improved since the last inspection? Since the last inspection the home has improved the ways in which it handles mental capacity and the deprivation of liberty safeguards. Staff understand how the residents who have difficulties in making decisions about how they wish to live. New flooring has been delayed in the hallways on each floor. Residents live in a home that has appropriate flooring to maintain the safety. Staff have received training in food hygiene so that food is handled in a way that maintains residents safety. What the care home could do better: There are five new, and two restated, areas for improvement are identified in this report. Care plans need to contain more information about the personal preferences of residents. Residents shall be confident that they care plans are based on how they wish to live. The home still needs to put in place and redecoration and refurbishment plan so that the home provides an environment that meets the needs of residents. All maintain issues must be addressed to maintain the comfort and safety of residents. Any hazards identified in this report regarding new flooring must be addressed to ensure the safety of residents. staffing level needs to be reviewed to make sure that there are staff available to meet the needs of residents. Training on dementia and end of life care needs to be put in place so that staff have all the skills to meet the needs of residents. Key inspection report Care homes for older people Name: Address: Albany Park Nursing Home 43 St. Stephens Road Enfield Middlesex EN3 5UJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tony Brennan     Date: 1 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Albany Park Nursing Home 43 St. Stephens Road Enfield Middlesex EN3 5UJ 02088041144 02088047733 albany@bmlhealthcare.co.uk www.cravenpark-nh.co.uk GSG Nursing Homes Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Rudo Gillian Chikunguru Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 43 The registered person may provide the following category/ies 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 Date of last inspection Brief description of the care home Albany Park Nursing Home is a purpose built care home registered to provide nursing care for a maximum of forty-three service users. Albany Park is to provide nursing care for older people. It is owned by GSG Nursing Homes Ltd. The home is a detached four-storey building. All bedrooms have en-suite facilities. The home is situated in a residential area. It is close to shops, restaurants and public transport links. Fees are linked to the assessed level of nursing care that servcie users need. These range from Care Homes for Older People Page 4 of 32 Over 65 43 0 2 1 0 5 2 0 0 9 Brief description of the care home #539 to #635 a week. This report is available through the internet. Copies may also be obtained from the provider of this service. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality racing on the service is two star. This means that people who use the service experience good quality outcomes. This unannounced key inspection took place in response to the recent registration of a new manager and provider for this home. There had recently been a number of safeguarding allegations. These raised issues about the care provided to residents. We sought to confirm that the home continues to provide good outcomes for residents. The inspection took place over two days. We were assisted by Rudo Chikunguru, the registered manager, with the inspection. We had received ten surveys from residents. We spoke with five residents and two relatives about the care that the home provides. We observed care practice and interaction between staff and residents. we toured the building and examine a number of records relating to the care, health and safety, and management of the home. At the end of the inspection feedback was given to the Care Homes for Older People Page 6 of 32 registered manager, and areas for improvement were discussed. We would like to thank the residents and staff who assisted us answering questions about the running of the home. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: There are five new, and two restated, areas for improvement are identified in this report. Care plans need to contain more information about the personal preferences of residents. Residents shall be confident that they care plans are based on how they wish to live. The home still needs to put in place and redecoration and refurbishment plan so that the home provides an environment that meets the needs of residents. All maintain issues must be addressed to maintain the comfort and safety of residents. Any hazards identified in this report regarding new flooring must be addressed to ensure the safety of residents. staffing level needs to be reviewed to make sure that there are staff available to meet the needs of residents. Training on dementia and end of life care needs to be put in place so that staff have all the skills to meet the needs of residents. Care Homes for Older People Page 8 of 32 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 32 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 32 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. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide provide residents and their families with up-to-date information about the home. Residents needs are assessed to make sure that they receive the care and support they need. Staff have the skills and understanding of the needs of residents to make sure they receive the care they need. Residents know about their rights and responsibilities because they have a contract that lays this out clearly. National minimum standard number six is not applicable to this service, as the home does not provide intermediate care. Evidence: The statement of purpose clearly set out the aims and objectives of the home. Copies of the statement of purpose were available for residents and relatives to examine. The statement purpose had been updated with the details of the new registered manager and provider. We found that the needs of the residents who we can extract were Care Homes for Older People Page 11 of 32 Evidence: within a range of those specified in the statement of purpose. The statement purpose also identified the skills of staff, and the resources that were available to meet the needs of residents. The home provides statement purpose that is specific to the individual service and that is accessible to residents. The statement purpose stated that staff would support residents to express their religious beliefs And cultural needs. residents told us that they had access to religious services on a regular basis. We found that one of the residents case track attended church regularly. This was recorded in their care plan and daily notes. The resident confirmed that she was supported to attend church when she wished to. Training records showed that staff had training on equality and diversity issues. Residents are supported by the home to maintain their cultural and religious identities. All surveys received from residents confirmed that they had been given information about the home before they decided to come and live there. Residents had a copy of the homes service user guide in their bedrooms. We found that this contained all the required information about the home. It contained pictures of the home showing the daily life residents. A relative said that, they gave me in a copy of the brochure to show my mother. Poeple come in to look at the home have sufficient information about the home, so that they are confident their needs will be met. Recently there have been a number of safeguarding meetings. These raised concerns about the quality of the initial assessments carried out of the needs of new residents. We spoke with the resident manager and explained that she has sought to improve the quality of the information gathered as part of the initial assessment of residents needs. Residents and three relatives spoken to told us they had discuss their needs with the registered manager. We found that by the residents who had recently been admitted to the home had detailed initial assessments. These included information about their health needs. A resident said, I am happy here. The residents case track had both assessments from placing authorities and once carried out by the home. were found to provide detailed information specific needs of residents. For example, a residents who had tissue viability needs have these identified in the initial assessment. As part of the initial assessment process information on these needs had been obtained from the relevant health professionals. This had been used to inform the homes own assessment. Admissions are not made to the home until full needs assessment has been undertaken to ensure the best outcomes for residents. We were able to see examples of residents contracts. The contract had been discussed Care Homes for Older People Page 12 of 32 Evidence: with residents (or their relatives) prior to their admission to the home. We found that the contracts clearly outlined their rights and responsibilities. Relatives and residents confirmed that these had been discussed with them. Contracts had been signed by either the resident or their representatives to show that they were in agreement with them stop people have agreed and understand how the home meet their needs. Staff spoke to were able to explain the individual needs of residents who we had case tracked. A resident told us, the staff tried to help when you need it. We observed the interaction between residents and staff and found this supported the continued well-being of residents. The registered manager explained that she will be the introducing further training to enable staff to meet the needs of residents. This will make sure that staff continued to understand how to meet the needs of residents. Admission is to the home only take place when staff have the necessary skills to meet the assessed needs perspective residents. Care Homes for Older People Page 13 of 32 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. People who use the service experience good outcomes in this area. This judgement has been made using the available evidence including a visit to this service.Care plans provide a clear description of the needs of residents. However, they need to contain more information on how residents wish their needs to be met. Residents medical needs are assessed and planned for to make sure they receive the care they need. Residents are protected by safe procedure is for the handling of medication. Peoples right to privacy is promoted and supported to ensure their well-being. Evidence: We know that the home had improved the quality of its care plans. The care plans for all residents who wed have track that were found to be detailed and clearly identified how their needs will be met. Surveys received from residents confirmed that they felt they got the care and support they needed. However, we found that care plans were not personalised. They did not show how residents of personal preferences regarding care had been integrated into meeting their needs. This was highlighted with the registered manager who agreed to make sure that care plans reflected residents views about how they are cared for. Residents should feel that their care plans are based on Care Homes for Older People Page 14 of 32 Evidence: their personal preferences regarding how they are cared for. Residents told us that staff understood their needs. Their medical and personal care needs were identified in their care plans. Care plans had been reviewed regularly and where necessary updated. We saw examples where staff did relate well with the residents, are examples of the two residents in a way that was appropriate to their age. Residents needs are reviewed regularly to make sure they receive the care and support they need. As part of recent safeguarding allegations meetings it was highlighted that the assessments and treatment plans relating to tissue viability, forms manual handling and nutritional needs were not detailed or in place. We spoke with the registered manager who explained that she has worked with nursing staff to improve the quality of these assessments. We found that all residents Case tracked have detailed nutritional, tissue viability, forms and manual handling assessments. These had been cross-referenced and where necessary care plans have been put in place to make sure these needs were met. For example, a care plan for tissue viability needs provided clear guidance on the care they resident needed in this area. Management of risks makes sure that safety issues are addressed whilst at the same time improving the quality of life residents. Daily notes showed appropriate medical attention and advice had been sought. The notes confirmed that residents who we Case tracked as access to their general practitioner. Surveys from residents confirmed that they get to the medical care they need. A residents said, I see the doctor when I want too. Daily notes showed that residents had been supported to attend regular checkups and hospital visits. Where the general practitioner had recommended specific medical attention please had been followed up. Residents health was promoted to ensure their continued well-being. With the exception of one resident, we found that all medication that had been administered was appropriately recorded. We raise the issue of one day that I resident had not received their medication with registered manager who agreed to investigate the issue. Records of medication received and returned to the pharmacist what will complete. We were able to confirm that generally residents were getting the medication they had been prescribed. We found that the medication of each of the residents case tracked was accurately recorded. Generally, medication records were completed, contained the required entries and had been signed by the appropriate staff to make sure residents were safe. Medicines was stored safely. All medicines are stored at the appropriate temperature, separate records were maintained for controlled drugs. We found that these records corresponded with the medication as it Care Homes for Older People Page 15 of 32 Evidence: had been prescribed an administered. Medicines are administered safely to residents. Trade in had been provided on the safe administration of medicines. Training records confirmed that this training was taking place. We observed staff administering medication, and confirmed that this was done safely. Staff understands how to administer medication safely to residents. Care Homes for Older People Page 16 of 32 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. People who use this service experience good outcomes in this area. This judgement has been made using the available evidence including a visit to the service. Residents are provided with varied activities to meet their needs residents are supported to maintain contact with relatives and other representatives of their choice. A more varied diet needs to be offered to residents that reflects their individual preferences regarding what they would like to eat. Evidence: We spoke with residents who told us that they were provided with regular activities. Residents had confirmed in their surveys that there will always activities arranged for them to participate in. We observed that activities were taking place at various times throughout the day we observed that residents were enjoying painting and Bingo. We saw examples of their Kraftwerk on display in the home. We spoke with the activities organiser who explained that she spent part of her time each day providing one-toone activities for residents who might not be able to take part in group activities. A resident commented, they have spoken to me about what I would like to do. The activities organiser explained that as part of a response to discussions with residents and reflexology group had recently started. The activities coordinator showed us records of the activities that she provides. This showed which residents had been Care Homes for Older People Page 17 of 32 Evidence: involved in these groups. The activities organiser had developed activities planned for each resident that outlined their interests and hobbies. Residents are involved in meaningful activities of their own choice and according to their individual interests and capabilities. We observed that staff spent time talking with residents and listening to what they had to say. Staff spoken to understood the importance of one-to-one contact the residents. We observed that staff spent time talking to residents. Two relatives spoke to told us that they visit when they wished. Daily notes showed that residents had regular access to family members, friends and the wider community. One resident explained that the home support her to attend her church weekly. The home support residents to maintain and develop their family and personal relationships. Meals were balanced and nutritious. Residents dietary needs were recorded as part of their care plans (for example, if they were diabetic or needed a puree meal). We observed that Mills were well presented, in a warm and friendly way. We saw that residents were supported to eat we observed that this was done at the pace of the resident being assisted. Residents are supported to eat at their own pace. The registered manager explained that he had been reviewing the menus with the homes cook. However, residents spoken to were not happy with the evening meals and the quantity of food provided. One resident said, We only have sandwiches at teatime. Another resident commented, When I asked for ham and cucumber sandwiches, or any other filling, of an evening Im told I can only have jam. I do not always want jam. Residents were also concerned about the quantity of food provided at mealtimes. The resident said, You dont get much, just two potatoes. this was discussed with the resident manager who agreed to make sure that more variety and quantity of food is provided for residents. Residents must be offered a variety of meals that reflect their personal preferences and dietary needs. Care Homes for Older People Page 18 of 32 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 who use this service experience good outcomes in this area. This judgement has been made using available evidence included a visit to this service. Residents are confident that their complaints, concerns and allegations will be listened to, taken seriously and acted upon to ensure their safety and well-being. Residents are encouraged to be active citizens. Evidence: Policy provided a clear explanation of how to make a complaint and how it will be dealt with. Residents said in their surveys that they knew how to make a complaint. Copies of the complaints policy were available around the home. This makes the policy accessible residents. All the resident spoken to said they were confident that any complex arrays would be addressed. The resident said, I know if I tell them something they will sort it out. There was a record of complaints, concerns and safeguarding issues in place. This recorded the action taken to investigate and resolve any complaints. There had been one complaint referred by the commission to the home since the last inspection. Records showed that this had been fully investigated and a detailed response had been made to the complainant. The home has an open culture that supports residents to express their views, and concerns in a safe and understanding environment. Since the last key inspection there have been a number of safeguarding issues. These Care Homes for Older People Page 19 of 32 Evidence: concerned the care and staff support provided by the home. The home had alerted the host local authority to these issues. They have been fully co-operative with the investigations. Where necessary protection plan had been put in place for the residents concerned by the home. We spoke to social workers who had recently reviewed two these protection plans. They told us that the home had dealt with these issues well and made sure that the residents concerned were safe. One of the social workers commented, I am satisfied with the protection plan. The home makes sure that safeguarding issues are addressed to keep residents safe. Residents told us that they felt that any concerns they raised would be handled sensitively by the home. We found that staff in the process of undergoing outpatient training regarding safeguarding. This will allow staff to update their knowledge of how to protect residents. All staff spoken to were clear about the signs of abuse. They knew what to do if they suspected that a resident was not safe. A relative observed that, staff or friendly, respectful and attentive to residents. Residents generally feel safe and well protected by the home. Care Homes for Older People Page 20 of 32 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 who use the service experience and look at outcomes in this area. This judgement has been made using available evidence including a visit to the service. The home needs to be appropriately decorated and and furnish so that residents live in a homely environment. The home has the necessary adaptions and equipment to encourage and promote the independents of residents. Residents bedrooms are personalised. The home is clean and hygienic. Evidence: We walked from the home and found that it was accessible to residents. We observed that residents were able to access all areas of the home safely. The home as a necessary adaptions support residents to move around safely. Bathrooms and toilets were fitted with adaptions to meet the needs of residents. These are accessible to residents who have mobility needs. At the last inspection it was found that the carpets in the hallways on all three floors were stained and warned. We found that on the day of the inspection new flooring was being laid. The first floor had already been completed. The registered manager explained that over the coming weeks floors would be replaced. Residents spoken to compensate that the new flooring improved the home. However, on the first floor the join between the bedroom carpets and the hallway flooring was raised. This presented a trip hazard for residents and must be adjusted to ensure their safety. Care Homes for Older People Page 21 of 32 Evidence: At the last key inspection we ask that a redecoration and refurbishment plan put in place for the home. As with paperwork and fixtures and fittings were old or warn. The registered manager explained that a plan still needed to be drawn up and she was in discussions with the company about improving the homes environment. It was agreed that the upgrading of the decorations and fiction from fittings of the home needed to be addressed. This will improve the environment for residents so that they live in a well decorated home. There are a number of outstanding repairs. We spoke with two residents and one of their relatives whose rooms are on the ground floor. They told us that their bedrooms central heating had not worked for some time. The rooms were not always as warm as the residents would like. They did have portable heaters. We also found that one of the lifts had been out of action for two weeks. This meant that residents were not able to access all of the home when they wished to. These issues were discussed with the registered manager who agreed that they needed to be addressed. All maintainance issues need to be addressed to ensure the comfort and safety of residents. We saw that bedrooms were more personalised with items of furniture and pictures belonging to residents. A resident told us, I have my own things in my room. The registered manager encourages and supports residents to personalise their bedrooms. Residents had a lockable space in their rooms to keep personal and valuable items. Residents are in courage to and supported to personalise their bedrooms. All surveys received from residents confirmed that the home was clean. We observed that cleaning of bedrooms and other parts of the home was taking place. Where necessary bedroom carpets were being shampooed. We found a range or appropriate measures are in place to prevent cross infection. Training records confirmed that the majority of staff have received training on infection control measures. Style spoken to understood how to minimise the possibility of cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. Hand gel dispensers were placed in areas where staff might handle infectious materials. Effective infection control measures are in place to make sure that residents safe. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience adequate outcomes in this area.This judgement has been made using the available evidence including a visit to this service. Sufficient staff need to be available all times to meet the needs of residents. Staff do not have all the skills to meet the assessed needs residents. Residents are protected by the homes recruitment procedures. Evidence: As part of recent safeguarding allegation investigations it was highlighted that they needed to review staffing levels. In response to this the home has put one more staff member on duty. At the inspection we examined the road has showed that this increase in staffing had been consistently maintain. Will serve the staff were not always available to meet residents needs. For example, we observed that one residents spent time in her bedroom falling for someone to come and see her and staff were not available to do this. Residents commented in their surveys and those spoken to that staff were not always available to meet their needs. One resident commented in their survey, Staff are not always available in sufficient numbers. staff told us that they felt there were not sufficient carers at all times to carry out all that needed to be done to assist residents. This was discussed with the registered manager and she agreed to carry out a further review of staffing needs of the home based on the dependency levels of residents. Sufficient staff need to be available at all times to meet the needs of residents. Care Homes for Older People Page 23 of 32 Evidence: Staff who have recently started work at the home confirmed they have had a full induction. This was recorded on their files. We were able to confirm by looking at training records and certificates that over 50 of staff have achieved the National vocational qualification in care at level II.By looking at training medical and talking to staff we were able to confirm that since the last inspection staff had completed food hygiene training. We were all so when the firm of staff had completed all the other areas of statutory required training. Discussions with staff showed that they understood the needs of residents. A resident commented that staff, Are friendly, respectful and attentive. Residents are supported by staff who understand how to care for them safely. At the last he inspection it was found that staff at needed training in end of life care. We spoke with the registered manager told us this training still needs to be provided. Residents need to be supported in ways that maintain their well-being at the end of their lives. Although looking at assessments and care plan showed that the primary needs of residents were being need for nursing care a number of residents have dementia as well. Safeguarding meeting had raised issues around the management of behaviour of some residents. We discuss the need for dementia training with the registered manager who agreed to make sure staff received training in this area. Residents need to be supported by staff who understand all their needs. Safeguarding allegation meetings and also highlighted the need for training in customer care and dignity in care. The registered manager was able to show that these courses had already been booked and will be taking place within the next month. After the inspection the registered manager has confirmed that this training had taking place as planned. We looked at four staff files. These contained all the necessary documentation to make sure that these members of staff were safe to work with residents. There employment record has been checked. Two references and a CRB check had been obtained prior to starting work at the home. This showed that the home followed a clear recruitment procedure making sure that residents are safe. We also checked the professional registration of all nurses working at the home. All were found to be a date. All nurses working in the home have the appropriate registration. The staff group reflect the cultural background of residents. Staff spoken to confirmed that they were clear about their roles. They had received a job description and specification. Residents confirmed that they felt staff could be trusted. Robust recruitment Care Homes for Older People Page 24 of 32 Evidence: procedures are followed to ensure the safety and well-being of residents. Care Homes for Older People Page 25 of 32 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. People use the service experience good outcomes in this area this judgement has been made available evidence including a visit to the service. The home is managed to make sure that residents receive the care they need. Clear records and procedures make sure that staff know how to support residents. Residents of financial interests are protected by the homes procedures. Residents and staff are protected by the homes health and safety policies. Evidence: The manager and provider had recently registered with the Commission. The registered managers qualifications had been checked as part of the registration process. It was found that they provided her with the necessary skills to manage a nursing home for older people. The registered manager explained that she has a number of years experience working in with older people and has qualifications in nursing, management and dementia care. Residents and staff told us that the registered manager was approachable. We observed that the registered manager spent time talking to staff and residents to make sure that she knew what was Care Homes for Older People Page 26 of 32 Evidence: happening around the home. Staff told us that the registered manager helped them understand how way can best support the residents. Effective management systems are in place to provide the best outcomes for residents. The home has begun to respond to the Mental Capacity Act. We saw that residents care plans contain information about their capacity to make decisions. The home started to make sure that residents have depravation of liberty assessments when necessary. The registered manager was able to show us that training on the mental capacity act will be provided by the end of January 2010. The home seeks to address issues regarding residents mental capacity. As part of the recent safeguarding investigation it was found that the home easy to develop its quality assurance processes. With all that the home now has a suggestion box for residents and relatives to put their views to the home. The registered manager was able to show us that an independent advocate will be starting to work with residents from January 2010. The home is sent regular regulation 26 reports showing how it has addressed issues and made improvements to the home. A system is in place to monitor the quality of the service provided by the home. The registered manager explained that she has started to monitor quality of care on a regular basis. Residents Waals contained copies of the most recent quality survey. The registered manager was able to show us that suggestions for improvement from this survey had been implemented. We saw minutes of recent resident staff meetings where issues about the improvement of the home had been discussed will stop residents views are sought to provide the basis for improving the quality of the service. The registered manager explained how the homes financial systems contribute to its continued viability will stop the registered manager explained our finances were managed. As part of the registration of a new provider financial viability was checked. There were no issues. The financial procedures in place make sure that the home is resources are used in the best interests of residents. The home has the necessary insurance cover. We saw that there was an up-to-date insurance certificate to confirm this. Financial systems make sure that the homes resources are used appropriately for the benefit of residents. The home does not hold up money for residents. The home invoices their families or relevant social service department for any expenditure made on their behalf stop a system is in place to make sure that receipts are obtained in any expenditure. Residents can have confidence in the homes procedures for handling their money Care Homes for Older People Page 27 of 32 Evidence: safely. We spoke with staff who confirmed that they received regular supervision. This they told us help them to understand and meet the needs of residents. There was a record of recent supervision sessions carried out by the registered manager and senior staff to confirm this. Staff are supported in ways that make sure that they are able to meet the needs of residents. All procedures and policies were found to be in place. The new provider is in the process of updating and introducing new policies. Existing policies had been recently reviewed. The home has the necessary records in place to support and make sure that residents safe stop the registered manager and staff spoken to were able to explain how residents were supported to access their records. The procedures and recording systems of the home make sure that the needs of residents are met. The home is a consistent record of meeting the relevant health and safety requirements and closely monitors its own practice. Five tools had taken place, and the fire alarm was tested regularly. We found that there was a fire risk assessments for the home. The question staffed on fire safety procedures at how well I understood by safety issues. All health and safety policies were available will stop certificates for gas, legionella and electrical testing were in date stop COSHH guidance was in place and chemicals were stored safely. We discuss health and safety issues would staff and they show that they understood the importance of maintaining residents safety. The home as an effective system for monitoring accidents to ensure the safety of residents and staff. The temperatures of fridges and freezers were recorded and were within safe limits. Health and safety checks, procedures and training make sure that residents are safe. Care Homes for Older People Page 28 of 32 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 19 23 The registered persons must 26/02/2010 make sure that there is a detailed redecoration plan for the home to improve the homes environment. Residents need to live in an environment that is suitable for their needs. 2 30 18 The registered persons must 26/02/2010 make sure that staff has the necessary skills to meet the end of life needs of residents. Residents need to be supported in ways that maintain their well being at the end of their lives. Care Homes for Older People Page 29 of 32 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 15 12 The registered persons must 12/02/2010 make sure that residents are offered a varied diet. This must provide residents with a quantity of food they want. Residents must have a variety of meals that reflect their personal preferences and meet their dietary needs. 2 19 23 The registered persons must 29/01/2010 make sure that the trip hazards identified in this report regarding the new flooring is addressed. Residents safety must be maintained at all times. 3 25 23 The register persons must make sure that all areas of maintenance identified in this report are addressed. 29/01/2010 Care Homes for Older People Page 30 of 32 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 All maintainance issues need to be addressed to ensure the comfort and safety of residents. 4 27 18 The registered persons carry 12/02/2010 out a review of staffing level to make sure that there is sufficient staff available to meet the needs of residents given their level of dependency. Sufficient staff need to be available to meet all the needs of residents. 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 7 The registered persons should make sure that residents preferences regarding their care from part of their care plans. Residents should feel that their care plans are based on their personal preferences regarding how they are cared for. The registered persons should make sure that staff have training in dementia care. Staff need to be able to meet all the needs of residents. 2 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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