Care Home: Alexander Care Centre

What the care home does well The home is bright and well decorated and provides a homely and friendly atmosphere for residents. Eight residents who took part in this inspection process said they are happy with their rooms and with the home and that staff and the manager are very friendly and helpful. The registered manager is at the home each day and residents say they can speak with her whenever they want to and that she is quick to help to sort out any problems they have. Management work well with the Commission and all nine requirements made at the last inspection were dealt with. There is a stable staff team in post who know the residents well and the use of agency staff is currently kept to a minimum. Residents are relaxed and comfortable and in their interactions with staff and relatives and residents say that staff are very kind and caring and they feel that they can ask the for anything they need. Residents know the manager and said they would speak to her if they had any concerns. Good food and beverages are available and residents consistently said that the food is good and they can ask for food they like. Residents religious needs are being catered for and all residents I spoke with and those who responded to the inspection surveys said that they are happy at the home and that the staff are helpful. What has improved since the last inspection? There is now clear written information provided for residents about the fees and charges so that they understand the rights and obligations of the home and the service to be provided. Moving and handling practices are now good with regular monitoring of staff practice and review of risk assessments. Residents I spoke to generally said they are asked about their care needs regularly. Medication management is now good with very consistent recording and closer checks being done by the manager. There have been many improvements made to the decoration and upkeep of the home. Communal areas have had new furniture and new curtains and have been repainted. Many bedrooms have had new curtains and equipment is now clean and well maintained. The home now ensures that new staff do not work directly with residents until they have a full Criminal Records Bureau check and are safe to work with residents. This helps to better protect residents. What the care home could do better: The information in the Statement of Purpose should be updated to include the fact that privately funded residents fees are higher than those of publicly funded residents. The staff would benefit from having brief written guidance available in relevant residents bathrooms or bedrooms showing moving and handling guidance for residents who have high support needs in this area. This should include some clarity as to what each resident can independently do for themselves so that they wont be disempowered. The level of exercise activities offered must be increased so that residents who need or want to can join in exercise routines a number of times a week. The home should always discuss any safeguarding concerns with the local authority when any resident has an unexplained injury in addition to speaking with the social services team who placed the resident. Key inspection report Care homes for older people Name: Address: Alexander Care Centre 21 Rushey Mead Lewisham London SE4 1JJ     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: Sean Healy     Date: 2 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Alexander Care Centre 21 Rushey Mead Lewisham London SE4 1JJ 02083145600 02086906100 alexandercare@mchealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Haiqin Li Type of registration: Number of places registered: care home 78 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 20 patients, frail, elderly persons aged 60 years and above (female) and 65 years and above (male) 28 residents, elderly persons and persons aged 55 years and above with physical dependency Date of last inspection Brief description of the care home The Alexander Care Centre is a modern, purpose built care home for Older People: Southern Cross Healthcare Services Ltd is the registered provider. The home provides for a maximum of 78 people with dementia care needs, residential care needs, and nursing care needs. Care Homes for Older People Page 4 of 31 2 8 0 4 2 0 0 9 78 0 78 Over 65 0 78 0 Brief description of the care home The home has 68 single rooms and five shared rooms, each with en-suite facilities. Adequate communal space and bathing facilities are provided. The home is situated in its own grounds in a cul-de-sac in a residential estate. It is close to local shops and public transport. There is car parking at the front of the building and two gardens to the side and the rear. Care Homes for Older People Page 5 of 31 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 Rating for this service is 2 Star. This means that the people who use this service experience Good quality outcomes. This rating has improved since the last key inspection. The inspection was unannounced and took place as a visit to the home on the 21st April 2010. The home provided an Annual Quality Audit Assessment AQAA which was also used to inform the inspection. The registered care manager facilitated the visit. Two care staff completed inspection surveys about their employment and understanding of their job. Four staff employment files were examined to check that they had been properly recruited trained and supervised. I spoke with five staff including a senior nurse the activities coordinator two care staff and the registered manager. I had a discussion also with the area manager and with a social worker from the older persona safeguarding team. Care Homes for Older People Page 6 of 31 Two relatives of residents contributed their views of the home when speaking to me. Five residents discussed their views on the home with me and three other residents responded to inspection surveys. Seven residents files were examined including assessments and care plans. The inspection involved a tour of the premises and examination of a range of management documentation. The home currently has five residents vacancies. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The information in the Statement of Purpose should be updated to include the fact that privately funded residents fees are higher than those of publicly funded residents. The staff would benefit from having brief written guidance available in relevant residents bathrooms or bedrooms showing moving and handling guidance for residents Care Homes for Older People Page 8 of 31 who have high support needs in this area. This should include some clarity as to what each resident can independently do for themselves so that they wont be disempowered. The level of exercise activities offered must be increased so that residents who need or want to can join in exercise routines a number of times a week. The home should always discuss any safeguarding concerns with the local authority when any resident has an unexplained injury in addition to speaking with the social services team who placed the resident. 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 31 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 31 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a Contract or Statement of Terms and Conditions and an assessment of need completed prior to admission. Residents have received confirmation that based on assessment the service was suited to meeting their needs. Intermediate care is not provided. Evidence: There was a requirement made at the last inspection for the home to update the statement of terms and conditions to include fees and to ensure that each resident is given up to date copies of the homes Statement of Purpose and Service Users Guide. I found that both of these requirements are now met. A recommendation asking the home to include all aspects of health and social care Care Homes for Older People Page 11 of 31 Evidence: needs in the pre admission assessments was also met. There is an up to date Statement of Purpose and Statement of Terms and Conditions for living at the home and the five residents I met and spoke with said that they had received a copy of these. The home charges substantially more to privately funded nursing care residents than is charged on an individual basis for local authority funded placements. The range varies from 698 pounds per week to 925 pounds per week. While these fees are now fully included in the individual residents contracts they are not mentioned in the Statement of Purpose. It is recommended that this be included in the next review of the Statement of Purpose in order to allow prospective residents to fully understand financial implications prior to coming to live at the home. (Refer to Recommendation OP1) All residents have full and detailed assessments of need on file. I examined seven residents files and all had a detailed assessment of their health and social care needs. The residents at the home have been placed by seven London borough local authorities with Lewisham as the main contracting agent. 12 residents are privately funded. Core care assessments have been provided by these local authorities and these show the primary care needs of the residents to be associated with ageing needs with secondary care needs such as dementia and mental health support being prominent. 20 of the 78 residents have nursing care needs and a further 26 have various levels of dementia care support needs. Care assessments clearly show the care and support required for each individual and this now includes a clear mention of social care and activities. All residents files I examined showed that they had a contract in place which included the fees paid for their care and showed the service they can expect from the home and their rights and responsibilities. I spoke to five residents about the choice they were given in living at the home and whether they were aware of the Service Users Guide and their fees rights and obligations. Those who were able to discuss this with me said that they were aware and were given an opportunity to visit the home before moving in. All said they were very happy living at the home. Care Homes for Older People Page 12 of 31 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 using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Health and personal care needs are well set out in care plans and care plans and risk assessments are now consistently reviewed each month. Health care needs are being met and medication is well managed Evidence: I found the requirements made at the last inspection to be now met. These concerned making improvements to care plans so that personal physical and emotional care needs are met and improving risk assessments and ensuring medication records are up to date and improving the storage and recording of medication. The manager was able to clearly show that the written records and staff practices in these areas had now improved and were being now checked weekly by the manager and supervisors. Dementia care needs of relevant residents are described in their care plans and exercise and mentally stimulating activities have improved. Five residents I spoke with Care Homes for Older People Page 13 of 31 Evidence: confirmed this and said puzzles and exercise activities are now happening a number of times a week. Care plans for residents who have high personal care supports needs have written guidance for staff to follow to protect residents from risk and to also enable them to do things for themselves. Care plans and risk assessments are being reviewed each month and residents are being asked about important areas so that they can have an effect on the care given. I examined care plans for seven residents and found that all had a care plan based on their assessment of health and social care needs. All were comprehensive and were reviewed on a monthly basis. Many included high levels of personal care support needs where areas of risk are assessed especially regarding moving and handling. The care plans also showed residents food preferences preferred activities health care needs and emotional support needs. Risk assessments included falls medication tissue viability weight loss bruising use of equipment and bedrails. All of these had been approved and signed by the manager and were being reviewed monthly. Some of the handwriting in one care plans was difficult to read but the manager was in the process of improving this. It was agreed that it would be beneficial for the home to provide some written bullet pointed guidance for staff in some residents bedrooms or bathrooms regarding moving and handling for residents who have high support needs in this area and who also cannot communicate their needs verbally. (Refer to Recommendation OP7) The majority of residents have support needs in bathing dressing and a number need support with mental health and the care of dementia. Continence care and physical support are also provided for other residents. I found these areas to be included clearly in care plans. Two visiting relatives said that she felt that the homes management and staff understand how to provide the care residents needs and are very helpful and courteous. The home provides nursing care for 20 residents based on one floor and there are 26 residents with dementia support needs based on a separate floor. 32 other residents have general support needs due to ageing and are based on a separate residential floor. Nine nurses are employed by the home and at least two nurses are available during the day and at night to provide any necessary nursing advice and support. GP visits happen weekly at the home or more often by request. The residents and the manager said that the GP is quick to come out when needed. Other health care professionals attending the home include the Chiropodist the Oral Hygienist the Dentist Nutrition nurse and dietician. The Care Home Support Team also have involvement in advising in care of nursing care residents. None of the residents currently have tissue viability issues as this is very well managed by the home. Care Homes for Older People Page 14 of 31 Evidence: Medication is now well managed by the home and none of the current residents manage their own medication. The medication policy is up to date and was reviewed by the provider in 2010. The home carries out an assessment of the residents wishes and abilities to self medicate as part of the referral and moving in process. All residents spoken to said they are very happy for the home to look after their medication. Storage facilities are adequate and temperatures of the storage cupboard are checked maintained at a safe temperature. Medication labelling and storage is generally good with consistent checks now being done by management. Care Homes for Older People Page 15 of 31 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 using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents are satisfied with their lifestyle and more stimulating in house activities are now being provided. They are supported to maintain contact with family and friends. Residents are involved with making decisions about their life and are given a choice of good and wholesome food. Evidence: Residents care plans include a list of activities offered which are recorded as part of the daily handover system. Activities included are a cinema hairdressing quiz evenings and exercise sessions and reminiscence sessions. Residents said that they are supported to go to see church ministers who come to the home. There is now a full time activities co-ordinator employed by the home showing an improvement in commitment to activities provision since the last inspection. A number of residents said that the activities person is very good and that he asks about their interests and regularly comes around to do activities such as games and short exercise sessions involving ballgames. Many of the residents are very physically Care Homes for Older People Page 16 of 31 Evidence: disabled and said it is very important that the in house activities provided are interesting and regular. However the exercise offered to residents could be improved somewhat. Some exercise activity happens about once a week on the residential and nursing unit and the EMI unit does not have regular routine exercise for these residents. This area needs to be improved so that structured exercise is offered a number of time a week to all residents by staff who have some training in doing this with disabled residents and residents with dementia. The registered provider must increase the exercise based activities available especially on the EMI unit. (Refer to Requirement OP12) All the residents I spoke to said they had family who visit and also who take them out on a regular basis. They are able to entertain visitors in their room but mainly prefer to use the communal areas or visitors room to be with their family. One visitor I spoke with said that they always receive a welcome when they visit the home and they feel that they can visit at any time. Five residents I spoke to confirmed that family and friends are welcomed into the home. Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. The support needed is included in their care plans. Currently none of the residents finances are managed by the home. After examining the records of food given and speaking with five residents I have determined that the home does now provide a choice of good healthy food for residents. The home provides a wholesome and nutritious diet for residents and offers a choice of food on a daily basis. Five residents whom I spoke with said that the food is good and they are offered a choice every day. The homes menus reflect residents preferred meals and a varied menu is on offer. The kitchen was clean and tidy. I looked at records of food provided and sampled a meal and found that the food was wholesome and well presented. Good records of food eaten are maintained as part of the homes system for monitoring healthy diets. Care Homes for Older People Page 17 of 31 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 using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Satisfactory systems are in place to manage complaints and the protection of vulnerable adults. Evidence: The homes complaints policy was last reviewed in 2010. This policy adequately shows how complaints are to be managed and residents have been given a copy. Five residents confirmed this. The registered manager is at the home on a daily basis and residents commented that they are available to speak with them whenever they need to. There have been four complaints made since last inspection and there were records to show that these had been investigated and managed well within appropriate timescales. One of these concerned a resident being made to get out of bed a member of staff. This was handled under the safeguarding policy and appropriate action was taken against the staff concerned. The Statement of Purpose includes a summary of complaints policy and all of staff had received training in how to deal with complaints. There has been one allegation of abuse made since the last inspection as discussed above which was investigated appropriately. The home has a written policy and procedure in relation to Adult Protection which was last reviewed in 2009. The procedure states that all suspicions or allegations of abuse must be referred to the Care Homes for Older People Page 18 of 31 Evidence: local authority for investigation under their procedures. A copy of the local authoritys Adult Protection procedures is available to staff in the home in addition to the homes own policy. The Adult Protection policy shows clearly how to report suspicion of allegations of abuse. All four staff training files I examined showed that all had received adequate training in adult protection and safeguarding procedures. The staff I interviewed showed that they understood the need to report any suspicions or allegations of abuse to the homes management immediately. During the course of the inspection the issue of an unexplained minor injury to a resident was raised and I discussed this with some staff and with the manager of the home. The manager was able to show that she had asked some staff about how this could have happened and had made some notes about what she had done. After discussion it was agreed that given this injury was sustained by a resident who was unable to say what had happened herself and that the injury was not consistent with any usual pattern of behaviour for this person it merited a discussion with the Lewisham safeguarding team. The manager discussed this with senior management and reported it to social services. This does not reflect any question about the management commitment to protecting residents and staff I interviewed strongly felt that the homes management does always show commitment to protecting residents and providing a good quality of care. However it is recommended that the home always consider the need to have a discussion about such matters proactively with the local authority safeguarding team. (Refer to Recommendation OP18) Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People live in a comfortable safe and generally well maintained environment. Evidence: Four requirements were made at the last inspection concerning making improvements to the fabric of the home and equipment maintenance. I found that all of these requirements are now met. The home is modern and well lit with spacious hallways and rooms suitable for wheelchair use. The home is fully wheelchair accessible with a lift used for people who need it to travel between floors. The fire officer from the LFEPA visited in 2009 and his report showed no concerns raised. There is a fire risk assessment in place and a full range of fire equipmentin use to protect residents. Residents rooms are clean and personalised and hospital beds and wheelchairs and hoists are available and used for all who need this support. I saw that wheelchairs and trolleys are now clean and well maintained. Suitable arrangements are in place for the disposal of sharps and soiled waste and medication for disposal under contract. All bathrooms and communal areas have been retiled or repainted since the last Care Homes for Older People Page 20 of 31 Evidence: inspection with a variety of curtains and flooring having been replaced. 24 new lounge chairs have been provided and 20 new dining chairs. The home is now of a very good standard of maintenance and decoration and is clean and safe. The manager stated that there are no known concerns about the fabric of the building or the equipment used. Care Homes for Older People Page 21 of 31 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. People using the 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 numbers and skill mix of the staff meets residents needs and they are in safe hands at all times. Residents are now protected by the homes recruitment and induction practices. Staff are trained and competent to do their jobs. Evidence: The home is divided into three sections. These are the nursing floor the EMI unit and the residential floor. Each section has a dedicated staff team with one nurse and three care staff working on the nursing floor supporting 20 residents during the daytime. The EMI unit which supports residents with dementia care needs has one nurse and and between four and five carers available during the day. The residential unit has one senior carer and between three to four carers available during the day. Night support after 8pm reduces to one nurse or senior carer and two care staff on each unit until 8am. These staffing levels are adequate and there have been no concerns raised regarding the number of staff providing support. Residents and relatives I spoke with said the staff are quick to respond whenever they call them. There was a requirement made at the last inspection for the home to ensure that supervisory arrangements are in place for staff who start work on a POVA First check Care Homes for Older People Page 22 of 31 Evidence: to ensure that they do not work alone with residents and a second requirement was made to ensure that all staff pre employment checks are done before new staff commence employment. Having inspected four staff employment files and spoken with four staff and the management of the home I found that these requirements have now been met. Residents are supported by qualified and experienced staff who have a good induction at the start of their employment and who have appropriate ingoing training available to them throughout their employment. New staff do not work one to one with residents until the home has received a fully enhanced satisfactory CRB check. The manager said the practice now is only to commence staff employment after receiving a fully enhanced CRB except in exceptional circumstances. The home had adopted this practice to overcome delays experienced in having CRB checks completed which sometimes ran on for a number of months. The manager accepted that this practice would only be used in exceptional cases and that the norm is now to wait for a full CRB check to be completed before allowing any new staff to commence providing care. The staff team is made up of a registered manager who is an experienced manager and is a registered nurse and 9 qualified nursing staff employed on full time contracts. There are 34 care staff employed and separate ancillary staff providing in house maintenance housekeeping kitchen and laundry support. A written staff roster is kept to show which staff were on duty at any time. There is a full time activities coordinator also available and he collects information about residents activities and social needs when they move in to the home. Suitable activities are provided and the attitude and approach of the coordinator is enthusiastic and committed. I have made separate comments under Standard 12 of this report regarding the need to increase the level of exercise routines available at the home. The staff ratios are very reasonable ensuring that residents have adequate support available and all of the five residents and two visitors said that they felt staff were always available and quickly answered the call bell consistently. The use of agency staff used has also been reduced since the last inspection with now no use of agency staff. Additional support is provided by the current staff team who are paid additional pay for doing extra time. This is a good achievement and helps maintain a consistent service. The cultural backgrounds of residents are also reflected in the experience and training of staff and residents commented that their cultural needs are understood and are Care Homes for Older People Page 23 of 31 Evidence: being met by staff. Residents and relatives said that they felt there were adequate numbers of staff on duty and that all were quick to provide help when needed. The manager is qualified to NVQ level 4 and 70 of care staff had achieved NVQ level 2 or 3 which a good level for this home. Recruitment policies and procedures are in place. Four employee personnel files were viewed. These were generally very well kept and included all of the information required by regulation. There is an induction schedule in place for new staff which is largely in line with the Skills for Care requirements. The four staff files examined showed that they had received a detailed induction. Inspection of staff files showed that generally training needs are now being well planned. The home has a training schedule which includes equal opportunities diversity health and safety fire safety moving and handling infection control medication and food hygiene. Staff files I examined showed that a good level of training is being planned for and attended by staff. All important features of the care needs of residents are fully reflected in the homes training plan for care staff. Feedback I received from some staff suggested that there is a need for the homes management to survey staff satisfaction about whether the management fully include all staff in opportunities to avail of additional hours and promotional opportunities. The comments I received were not from a broad range of staff and therefore I did not reach a final conclusion regarding these suggestions. Having discussed the issues with the homes management and with the area manager I felt confident that these issues would be explored more formally across the whole team. The management agreed to inform the Care Quality Commission of their findings and recommendations when known. (Refer to Recommendation OP27) Care Homes for Older People Page 24 of 31 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 using the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has an experienced manager and can show that it is run in the best interests of residents. Residents financial interests are safeguarded appropriately. The health safety and welfare of staff and residents are promoted and protected. Evidence: The homes manager is registered with the Care Quality Commission and has the experience and qualifications needed to manage the service. The manager is a registered nurse and has achieved NVQ 4 qualification in care and management. There is a deputy manager who is a qualified nurse and who is studying for the NVQ level 4 award in leadership and management in care. There is an administrator who is very experienced and provides good support for the management in all aspects of paperwork and administration. She is also studying for NVQ level 4 in leadership and management. Care Homes for Older People Page 25 of 31 Evidence: Five residents I spoke with and three others who completed inspection surveys said they were happy with how the home was run. Visitors commented that they were very happy with the homes management and that they were always made to feel very welcome. They felt that the manager and staff were very open and responsive to residents care needs. All residents I spoke with said they were very happy living there. They said they were fully consulted about the move to the home and are confident that they can speak with the manager when they need to. Three residents responded to the inspection surveys and these also showed confidence in the homes management. At the last inspection there was a requirement for the home to ensure that risk assessments regarding moving and handling for residents are up to date and are adhered to by staff. I examined four residents risk assessments and moving and handling and observed three residents being supported in transfers by care staff and found that there are now good plans and practices in place which are reviewed and monitored by the manager. A range of important management activities in the home are now being consistently implemented. These include monthly review of residents care plans carrying out appropriate CRB checks on staff and planning and recording of staff induction and training. The owner and registered manager of the home carries out formal monthly monitoring inspections of the care provided including care plan reviews the management of staff and of the repairs renewals and refurbishments needed. This ensures that the quality of the care and the home are now maintained to a good level. The home has a system for carrying out resident and relatives satisfaction surveys a number of times a year. The last of these was done in February and March 2010. Results showed that more than 60 of residents were happy with all aspects of the service and the majority of others were generally happy with the care and support received. Results of these are sent to the area manager for consideration and results are included in quarterly residents meetings. The manager does monthly monitoring checks and does a written report showing improvements needed. The homes Annual Quality Assurance Audit system includes a 6 monthly audit being done by the providers internal auditors which results in a written report and development plan for improvement. This reflects a committed approach by the home and provider to Quality Assurance. Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. All of the residents or their family are responsible for their bank accounts and DSS benefits. The home keeps very good records and Care Homes for Older People Page 26 of 31 Evidence: receipts for small amounts of money left in their care for day to day spending. An audit of these funds are carried out regularly by the provider. All four staff files examined showed supervision to be consistently happening. Care staff files showed evidence of reflective practice and personal development taking place. The manager keeps a good record of planned supervision for all staff and includes monitoring of when supervision is cancelled and rescheduled. This has improved the level and consistency of supervision. All health and safety and fire safety documentation was checked and found to be up to date and in order. Improvements have been made in reviewing residents moving and handling risk assessments and in checking staff practice in this area of support. Care Homes for Older People Page 27 of 31 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 28 of 31 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 12 12 The registered provider and must increase the exercise based activities offered to residents especially to those on the EMI unit. This is in order to promote healthy living opportunities for residents at the home 30/09/2010 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 registered provider and manager should include comments regarding the difference in fees charged to privately funded residents with some explaination as to the reasons for these fees being higher in the next review of the Statement of Purpose in order to allow prospective residents to fully understand financial implications prior to coming to live at the home. As discussed in this report the registered provider and manager should consider providing some written bullet pointed guidance for staff in some residents bedrooms or bathrooms regarding moving and handling for residents who have high support needs in this area and who also cannot communicate their needs verbally. Page 29 of 31 2 7 Care Homes for Older People 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 3 18 The registered manager should always consider the need to have a discussion proactively with the local authority safeguarding team when any unexplained injury to vulnerable residents occurs as discussed in this report. The registered provider and manager should formally explore with the whole staff team concerns which were raised by some staff about the homes management and provide the CQC with an outcome of their findings when known. 4 27 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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