Care Home: Aldington House

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What the care home does well Prospective residents were given information about the service and could view the home before making a decision to move in. Staff carried out an assement to see what support people would require and if the home would be able to meet the persons needs. Care plans were easy to follow and understand. Staff worked in partnership with other care professionals to promote residents health and wellbeing. Staff were polite and helpful and respected peoples privacy and dignity. People could choose where and how they spent their time. Visiting hours were flexible and relatives could attend social events and meetings. Most relatives were satisfied with the care provided in the home. The complaints procedure was displayed and most people said they knew who to speak to or how to make a complaint, if they had concerns. The home was clean, tidy and welcoming. People could bring their own furniture and possessions into the home and could arrange their room to suit their needs. Staff had access to a varied and relevant programme of training. Regular audits and surveys were carried out to monitor the homes performance and to obtain feedback about the service. There was a regular programme of health and safety and fire safety checks. Equipment was serviced regularly to ensure that it was in working order and was safe to use. What has improved since the last inspection? Care plans and risk assessments were reviewed regularly and were updated when residents needs changed. The home obtained a special cupboard for the safe storage of controlled drugs. Medicines were kept in a locked room. New door signs were introduced to indicate if staff could enter residents rooms. One member of staff was a `dignity champion`. The range and frequency of activities had increased and efforts were being made to provide more opportunities for residents to go out and take part in community events. The chef had developed picture menus and some new snacks such as fruit bowls and cheese and biscuits were introduced. The kitchen was redecorated and new flooring was laid in the storage cupboards.Some new permanent and bank staff were recruited. Staffing levels were satisfactory and residents received good continuity of care. Good records were kept about residents money. Accident records had improved. Clear records were kept about accidents and unexplained injuries. Staff monitored residents health and wellbeing for a period after accidents to see if they had suffered any injuries. Cleaning fluids were stored securely. The front door was locked. Residents were supported to move in a safe manner. The new manager had worked hard to get to know the staff team, residents and relatives and had identified areas for improvement. Staff and relatives told us the new manager listens and tries to put things right. What the care home could do better: Some of the written information that the home provides for residents should be updated. Care plans should be discussed and agreed with the resident or their relatives. Records must show what action staff are taking to protect residents that are assessed to be at risk. Checks that are carried out to identify and address concerns about the balance of some medicines must be effective. Medicine charts should include a photograph of the resident. This will help to identify residents. Staff should receive further training about the homes whistleblowing procedure. References for new staff should be followed up to ensure they are genuine. Confirmation about follow up telephone calls should be recorded in the staff members file. Regular checks should be carried out to identify faulty window restrictors. Some fire drills should occur when the night staff are on duty. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Aldington House 107a Blackheath Park Blackheath London SE3 0EX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Maria Kinson     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Aldington House 107a Blackheath Park Blackheath London SE3 0EX 02084630641 02082978985 Aldingtonhouse@new-meronden.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : New Century Care Limited care home 31 Number of places (if applicable): Under 65 Over 65 31 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Aldington House is a care home registered to provide accommodation and personal care for thirty-one older people. The home is part of a group of care homes managed by New Century Limited. The home is situated in a quiet residential road on a private estate in Blackheath. It is approximately 15 minutes walk to the shops, local facilities and public transport connections in Blackheath Village. Accommodation in the home is provided on three floors. The home has twenty-nine single and one shared bedroom. There are pleasant and well-maintained gardens to Care Homes for Older People Page 4 of 32 Brief description of the care home the front of the home and a small patio area accessible from the lounge on the lower ground floor. There are no parking facilities at the property but you can park in the road subject to parking restrictions. 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 last key inspection on this service was completed on 6th April 2008. This inspection was carried out over two days in April 2009 and was unannounced. We reviewed all of the information that we had received from, and about the service in the period since the last inspection. This included complaints, concerns, notifications and the annual quality assurance assessment form that homes complete and return to the commission once a year. This information was used to decide when we would carry out the inspection and if we needed to focus on any specific issues. We sent surveys to some of the residents and staff and to five health care professionals that were in regular contact with the home. We received seven Care Homes for Older People Page 6 of 32 responses, three from residents, three from staff and one from a health care professional. During the inspection we spoke to three residents, four members of staff and two visitors. We left a supply of surveys next to the visitors book for relatives to complete. One relative completed and returned a survey. The comments that we received from residents, relatives, staff and health care professionals helped us to form a judgement about the home. Some of their comments are included in this report. During the site visit we examined some of the records that were kept in the home and assessed the management of medicines. We observed staff supporting residents to eat and drink, move around the home, undertake activities and take their medicines. We visited all of the communal areas and viewed a selection of bedrooms on each floor. There were twenty four people living in the home and six empty beds at the time of this inspection. The fees charged by the home range from £365.14 to £750 per week. The fees do not include hairdressing, toiletries, activities in the community or newspapers. What the care home does well: What has improved since the last inspection? Care plans and risk assessments were reviewed regularly and were updated when residents needs changed. The home obtained a special cupboard for the safe storage of controlled drugs. Medicines were kept in a locked room. New door signs were introduced to indicate if staff could enter residents rooms. One member of staff was a dignity champion. The range and frequency of activities had increased and efforts were being made to provide more opportunities for residents to go out and take part in community events. The chef had developed picture menus and some new snacks such as fruit bowls and cheese and biscuits were introduced. The kitchen was redecorated and new flooring was laid in the storage cupboards. Care Homes for Older People Page 8 of 32 Some new permanent and bank staff were recruited. Staffing levels were satisfactory and residents received good continuity of care. Good records were kept about residents money. Accident records had improved. Clear records were kept about accidents and unexplained injuries. Staff monitored residents health and wellbeing for a period after accidents to see if they had suffered any injuries. Cleaning fluids were stored securely. The front door was locked. Residents were supported to move in a safe manner. The new manager had worked hard to get to know the staff team, residents and relatives and had identified areas for improvement. Staff and relatives told us the new manager listens and tries to put things right. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 9 of 32 7535. Care Homes for Older People Page 10 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 11 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. The home provides written information for people that expressed an interest in the service and carried out an assessment to establish what help people would require if they moved into the home. People could visit and spend time in the home to see if they liked the service. Evidence: The registration certificate was displayed in the entrance hall. The certificate provides information about the type of service the home provides and the number of beds. Information on the certificate about the person that was managing the service was out of date. We informed the registration team about this issue and they will issue a replacement certificate. The statement of purpose and service user guide provide written information about the Care Homes for Older People Page 12 of 32 Evidence: facilities and services that the home can offer. In the period since the last inspection the statement of purpose was updated to provide accurate information about the number of residents that the home can accommodate and the new managers details. The statement of purpose did not provide any information about the arrangements for admitting people in an emergency or how often peoples care plans would be reviewed. See recommendation 1. The statement of purpose was available in large print if required. The contract includes information about the terms and conditions of occupancy and fees. This document also states what services are included in the fees and what services are not. Although the home does not provide nursing care the contract states the fees include the provision of nursing care. This issue was identified during the previous inspection. See recommendation 2. We looked at three assessments that were completed by staff before people moved into the home. The amount of information that staff obtained about the support that people required varied from person to person. Some of the assessments contained very little information as the person was very independent and had very few care needs. The assessments for residents with more complex needs and medical problems were more detailed. All of the assessments were signed and dated. People were able to visit the home before they decided to move in. During visits people were shown around the home by a staff member and were told about the facilities and services that the home could offer. There was an opportunity to ask questions and spend a longer period in the home if required. We saw people viewing the home for their relatives during the inspection. 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. Records showed what action staff were taking to meet peoples needs and preferences but it was not always clear how they managed risks. Staff took immediate action to put things right when we identified concerns about the balance of some medicines. Residents were treated as individuals and requests for time alone were respected. Evidence: We examined three sets of care records for people who recently moved into the home. Staff completed an assessment on the day the person moved into the home and used this information to develop a plan of care for the individual. Care plans reflected peoples needs and were followed by staff. For instance one resident only liked specific foods and wanted to have these foods at every meal. The chef was aware of the residents preferences and we observed staff following the plan during the lunch period. Another resident had a medical problem that required support from district nurses and regular eye drops. Information about the support the resident required in relation to this issue was recorded in their care plan. The care plan was reviewed and updated Care Homes for Older People Page 14 of 32 Evidence: when hospital staff changed the eye care regime. There were references in the care plans about encouraging residents to choose what they wore and about maintaining peoples privacy and dignity. Some of the plans that we saw were personalised. For example one plan stated what cream the resident wanted staff to apply after their wash. Care plans and risk assessments were reviewed monthly. There was little evidence that the care plan was discussed and agreed with the resident or their representative. One file did include evidence of a discussion with a relative. Staff said relatives could look at their family members care plan if the resident gave their consent. See recommendation 3. We received written feedback from one health care professional who was in regular contact with the home. They said the home provides excellent care and always followed their advice. Residents were satisfied with the support they received from visiting health care professionals. There was information in residents files about hospital appointments and GP and district nurse visits. Care plans included information about medical problems and treatments. Pain assessments and care plans were completed for residents that were known to be in pain or uncomfortable. An assessment was completed to determine if residents were at risk of falling, might become malnourished or were likely to develop pressure sores. Staff did not always develop a strategy to protect residents that were identified to be at risk. See requirement 1. The home has a comprehensive policy and procedure about the use of medicines. The policy was reviewed and updated in June 2008. The medicine room was locked and was maintained at a suitable temperature for the storage of medicines. We looked at the records and supply of medicines for four residents. Staff kept good records about medicines that were bought into the home by residents or were supplied by the pharmacist. Medication charts included information about allergies but there were no photographs on three of the charts that we looked at. See recommendation 4. Records of administration were good but the balance of some medicines in packets, boxes or bottles was incorrect. Prompt action was taken by the manager to address this issue. When we returned to the home on 08/04/09 a new form had been introduced to monitor the balance of medicines and regular checks were taking place to identify and address concerns. The manager discussed our findings with the homes Care Homes for Older People Page 15 of 32 Evidence: pharmacist and arrangements were being made to supply more of the homes medicines in blister packs. See requirement 2. The home had one medicine that has to be stored in a special cupboard. A new cupboard had been purchased for this purpose. The register that was maintained about the supply and use of controlled drugs was up to date. We could not assess the previous requirement about the administration and management of insulin as none of the current residents were receiving this treatment. Residents privacy and dignity was maintained. We saw staff adjusting residents clothing and prompting people to use the toilet. People were encouraged to do things for themselves and make decisions about how and where they spent their time. The manager had developed a sign to hang on each of the bedroom doors. The signs indicated if the resident wanted to be disturbed or was resting. The signs were personalised with the residents name and a picture that reflected their personal interests. A visiting health care professional told us that staff always respect residents privacy. Residents said staff listen and act on what they say. One member of staff was a dignity champion. The staff member was nominated by the manager for this role because of the support she provided for residents that were terminally ill. 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. The home provides a varied and interesting programme of activities. Efforts were being made to increase opportunities for residents to join groups and observe activities in the community. Visiting hours were flexible and relatives told us they were made to feel welcome. Food was well presented and people were given adequate time and support to eat. Most people said they liked the food that was served in the home. Evidence: The monthly activity programme was displayed in the entrance hall and on the residents notice board. The programme includes a varied range of activities and events such as manicures, films, art and crafts, knitting, church services and regular entertainment from visiting artists. The activity coordinator had recently resigned. We were told that the senior carer was responsible for ensuring that the activity programme was maintained until a new activity coordinator was appointed. During the inspection we saw residents knitting, reading newspapers and magazines, listening and singing along to music and making easter bonnets. Visitors told us that they often observed staff playing games, chatting with residents and providing manicures. Care Homes for Older People Page 17 of 32 Evidence: The manager said she wanted to increase the provision of activities and outings in the community for residents and told us about some of the people she had contacted to achieve this goal. The local bowls club had given permission for a group of residents to watch their matches from the veranda, once the season restarts. Some of the residents had started to attend a monthly club at the local church. The club provides an opportunity for residents to meet new people, listen to talks about the local area and historical events and purchase a meal or drink if they want to. Some of the residents had recently enjoyed a trip to the 02 to see a dancing show. Photographs from the trip were displayed in the home. Residents had requested a shop trolley and had told the manager what items they would like to purchase from the trolley. The manager was trying to obtain a wheeled trolley for this purpose. We spoke to two visitors during the inspection and received written feedback from one relative. Relatives told us they could visit the home at any time and were always made to feel welcome. They said the home was always the same, no matter when they visited. There were regular resident and relatives meetings. The minutes from a recent meeting indicated that relatives were pleased about recent changes to the menu and the noticeboard which provides information about activities and events that occur in the home. Residents told us that they were able to make decisions for themselves and were able to choose what they ate and where they spent their time. One resident told us about their illness and said they were more comfortable lying in bed. Staff bought meals and drinks to the residents room. Another resident said they could get up and go to bed when they wanted and often spent their time between their bedroom and the lounge. One resident told us that they could probably go to the shops if they wanted to, but said they had no desire or need to do this because everything we need is here. We saw staff serving two meals during the inspection. Residents were encouraged to eat in the dining area but some people chose to eat in their room or to remain in the lounge. People that we spoke to on the second day of the inspection or who completed a survey said the food provided in the home was usually good. We received mixed feedback about the lunch that was served on the first day of the inspection. Some residents said the food was excellent or very good and other people said the meat was tough and tasteless. The manager should monitor this issue. Meals were nicely presented and people were given time to eat at their own pace. Staff assisted some residents to eat whilst sitting at their side. The chef had introduced picture menus and told us that he was planning to provide a menu on each table once the dining area was redecorated. An alternative light bite menu was being developed for people that did Care Homes for Older People Page 18 of 32 Evidence: not want a full cooked meal. Care Homes for Older People Page 19 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. Information about the homes complaints procedure was displayed and people knew who they should speak to if they had concerns. There were procedures in place to protect people from abuse and to safeguard their interests. Evidence: The complaints procedure was displayed near the visitors book. The procedure advised people how to make a complaint and stated how long it would take staff to investigate their concerns and respond. Residents said they knew who to speak to if they were unhappy or wanted to make a complaint. We received an anonymous letter about the service in May 2008. We had assessed most of the concerns raised in the letter at a recent inspection and asked the manager to supply some additional information about the remaining issue. We have not received any further complaints since this time. The home had not received any complaints in the period since the last inspection. The manager holds a weekly surgery for relatives. This provides an opportunity for relatives to discuss their family members care and any concerns they may have. This is a good initiative. We could not assess the previous requirement about providing complaints training for Care Homes for Older People Page 20 of 32 Evidence: the manager, as the manager that was in post at the time of the last inspection had left. The home had a copy of local authority safeguarding procedures and an abuse procedure. The company procedure indicated that staff must report abuse to senior staff and they must inform social services and CQC about the allegation. Most of the staff that we spoke to had attended a safeguarding training session or studied the topic during NVQ course work. Staff were familiar with the term whistle blowing but did not always recognise that the procedure includes reporting issues other than abuse. See recommendation 5. The local authority were investigating one concern under their safeguarding procedures. This investigation was in progress at the time of the inspection. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was nicely decorated and furnished. People told us that they liked the home because it felt homely and welcoming and was always fresh and clean. Evidence: We viewed all of the communal areas and a selection of bedrooms on each floor. The home was clean and tidy throughout and residents and visitors said the home was always clean and fresh. Hand washing facilities were good and waste was stored in lidded bins. There were a few outstanding maintenance issues. A recent leak in one of the bathrooms had stained some of the ceiling tiles, one of the assisted baths was out of order and the lock was broken on one of the bathroom doors. The manager had taken appropriate action to resolve these issues. Ceiling tiles, a new lock and a part for the assisted bath were on order. The toilets were located near the communal areas and centrally on each floor. All of the rooms were well equipped with assisted baths, call bell and aids such as handrails and raised toilet seats. In the period since the last inspection the home had purchased a standing hoist. Care Homes for Older People Page 22 of 32 Evidence: Residents were able to bring some of their own furniture into the home and could arrange their possessions to suit their needs. One resident enjoyed art and craft work. Their work was displayed in their room and spare materials were stored in boxes and containers at the end of their bed. Residents said their rooms were comfortable and clean. There was a quiet lounge on the second floor, a lounge/dining room on the lower floor and areas along the corridor where residents could sit to chat or watch people go by. The lower floor lounge looked out to a small garden area. Some of the residents used this area to enjoy the early morning sunshine and to read their newspaper. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff had a good understanding of residents needs. The company was committed to the ongoing training and development of the staff team. Recruitment practices had improved but some further checks could be undertaken to protect residents. Evidence: There was one senior carer and four carers on duty when we arrived in the home. The atmosphere was calm and relaxed. Some of the residents were eating their breakfast and one resident told us that she had just got up. Requests for support were responded to promptly and people told us that the call bell was answered fairly quickly. Residents said that staff were usually available when they required assistance. We looked at the duty roster which provides information about the staff that work in the home and the shifts they work. The roster had been redesigned and was clearer and easier to follow. The roster indicated that there were usually five or six care staff on duty on the morning shift, four care staff on the afternoon/evening shift and two waking care staff overnight. All of the shifts were led by a senior carer. The manager works Monday to Friday and carried out some unannounced visits at weekends. Staff told us that they could obtain advice from the on call person, if necessary. Care Homes for Older People Page 24 of 32 Evidence: The manager told us that 79 of care staff had a vocational qualification in care at level two or above. This exceeds the standard set by the Department of Health The company has a dedicated training manager and two NVQ training centres. Staff said they received regular training and said the sessions were relevant and helped them to meet peoples needs. We looked at the recent training matrix to see what training staff had received during the past year. The matrix indicated that some members of staff attended medication, health and safety, COSHH, dementia, palliative care, basic skin care, continence, dignity, choice and equality, effective communication, fire safety and the role of the care worker training sessions. Further sessions were planned to provide information about new legislation such as the mental capacity act and deprivation of liberties. We looked at three recruitment files for staff that were appointed since the last inspection. The most recent file was indexed, making it much easier to locate information. All of the files included essential documents and checks such as an application form, proof of identity, a recent photograph, two written references and an enhanced criminal record disclosure. Some of the references were not followed up with a telephone call to ensure that they were genuine and it was not always clear on the application form how, or in what capacity the applicant knew the referee. This information should be requested so the manager can check that the person the applicant has nominated is the most recent employer and can provide adequate information about their work. See recommendation 6. 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. The new manager has made an excellent start and had already gained the trust and respect of relatives and staff. There were systems in place to safeguard residents money and to monitor and improve the quality of care provided in the home. Health and safety issues were well managed overall. Evidence: A new manager was appointed in March 2009, just prior to this inspection. The manager had worked in registered care homes in the past and told us that she has a National Vocational Qualification in care and management at level 4. The manager had completed the first stage of the registration process and said she would be submitting her application to become the registered manager for the service in the next few weeks. The manager had only been in post for four weeks at the time of this inspection but had already identified areas for improvement and made a number of changes to Care Homes for Older People Page 26 of 32 Evidence: improve outcomes for residents. Staff told us that the new manager took a real interest in residents wellbeing and had made some changes for the benefit of residents. One staff member said the new manager was brilliant but added she does tell us off if we do things wrong. Staff gave examples of how the manager supported them and said she acts very quickly if we tell her something is wrong or needs doing. The manager was knowledgeable about residents needs and had introduced herself to relatives at a meeting. Relatives told us that the the new manager was making a real difference. They said their family member was dressed better, that there were more activities going on and the overall standard of care had improved. The manager informed us about significant events that occurred in the home such as residents becoming unwell, deaths, accidents and equipment failure. There were various systems in place for monitoring the quality of care and services provided in the home and for obtaining feedback from residents and relatives. The area manager visits the home once every month to check that staff are following company procedures and to support the manager. Copies of the reports that were compiled after these visits were viewed during the inspection. Senior staff carried out regular audits. We looked at some of the recent medication, health and safety, management of complaints, staff recruitment and medication audits. Satisfaction surveys were sent to residents and relatives once a year. If concerns were identified during audits or in surveys an action plan was completed to show what action was taken to address the issue. Money records had improved. Records were kept about money that was stored for residents, and information was recorded about how people spent their money. Receipts were kept for purchases that staff made for residents and for services such as hairdressing. The requirement that we made at the last inspection about money records was assessed as met. There was an up to date fire risk assessment, the fire alarm system and fire safety equipment was serviced at regular intervals and there were regular in house checks and fire drills. None of the drills occurred when the night staff were on duty. See recommendation 7. We looked at some of the health and safety records that were kept in the home. This included reports for portable electrical appliances, the mains electricity installation, baths and hoists, water chlorination and hot water temperature checks. The reports showed that measures were in place to keep people safe. Care Homes for Older People Page 27 of 32 Evidence: One of the window restrictors in the first floor lounge was broken. See requirement 3. We looked at some of the recent accident and incident records. The accident folder had been reorganised to comply with data protection guidelines. This made it easier to locate information. We saw reports about some of the recent accidents that had occurred in the home. The folder contained an accident/incident form and a follow up monitoring form. The records provided clear information about the circumstances surrounding the accident, where known or the residents account of what happened. The home had Control of Substances Hazardous to Health (COSHH) assessments but one member of staff did not know where the assessments were kept. It is essential that staff know how they can access information about health and safety issues. Training was planned to address this issue. See recommendation 8. Cleaning substances were stored securely. The front door was locked when we arrived and we saw staff letting people in throughout the day. We observed staff supporting people to move during the inspection. All of the transfers that we saw were carried out in a safe and professional manner. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 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 7 13 Records must show what action staff plan to take to minimise the possibility of the resident being harmed, if the assessment indicates the resident is at risk of developing a pressure/becoming malnourished or falling. To ensure residents receive appropriate and safe care. 13/07/2009 2 9 13 Checks that are carried out to monitor the balance of medicines in boxes and packets must be effective in identifying and addressing the issue identified in this report. To ensure medicines are properly managed and to promote residents health and wellbeing. 10/08/2009 3 38 13 The broken window 10/07/2009 restrictor in the first floor lounge must be repaired and regular checks must be Page 30 of 32 Care Homes for Older People carried out to ensure that restrictors are in place and working properly. To prevent falls from a height and to keep people safe. 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 The Statement of Purpose should be reviewed and updated to include information about emergency admission procedures and care plan reviews. The contract should be reviewed and updated. This will ensure that people have access to accurate information about the service. Care plans should be discussed and agreed with the resident or their representative. Medication charts should include a photograph of the resident. Staff should receive further support/training about the homes whistle blowing procedure. References should be followed up with a telephone call to verify the identity of the referee and to clarify queries. References should be from a manager or personnel officer at the previous place of work, not a colleague. Fire drills should occur at various time of the day, including periods when the night staff are on duty. The induction programme for non care staff should include basic health and safety training, such as COSHH. 2 2 3 4 5 6 7 9 18 29 7 8 38 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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