Care Home: Alice Grange Care Home

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What the care home does well The premises are relatively new and the furniture, furnishings and fittings are of a high standard and provide a safe and comfortable environment for residents. The home is well equipped with profiling beds for all rooms, and good facilities for supporting residents in moving, and bathing. The laundry and cleaning systems work very well to maintain the dignity of residents and the cleanliness of their home. Residents and visitors told us that the home provided good care, and the staff were `polite, helpful and showed much patience.` What has improved since the last inspection? Care plans have been improved to cover all the needs of each resident, their preferences and abilities. This includes those residents with dementia whose specialist needs are identified using recognised assessment tools. This enabled a more consistent and complete level of care to be provided. The systems for medication had been made safer with better ordering, and recording of `as necessary` medication, and safer storage of controlled drugs. Staff trained to administer medication are subject to regular competency assessments. This ensures that at all times residents receive their prescribed medication in the prescribed manner. The training of new staff in the essential knowledge and skills required for safe practice has improved with only a few gaps. In particular, moving and handling training has occurred at an early stage in the induction period. This ensures residents are supported by competent staff in a safe manner. An activities coordinator has been appointed who has developed a programme of internal and external activities for residents to choose to take part in. What the care home could do better: Communications between management and staff, and management and relatives should be improved, to benefit the morale of the staff, and to keep relatives properly informed about their family member. Some action has been taken already for example the introduction of regular meetings for the various stakeholders, and the intention to set up individual care plan review meetings with residents and/or relatives. If action from concerns is promised, it should happen or relatives told why not. All provider staff visiting the home must understand the local safeguarding procedures. The turnover of staff, and the use of agency staff, should be monitored, to ensure residents receive consistent support from staff they know. Key inspection report Care homes for older people Name: Address: Alice Grange Care Home St Isidores Way Ropes Drive Kesgrave Ipswich Suffolk IP5 2GA     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: John Goodship     Date: 1 1 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Alice Grange Care Home St Isidores Way Ropes Drive Kesgrave Ipswich Suffolk IP5 2GA 01473611967 01473610519 catherine.condon@barchester.com www.barchester.com Barchester Healthcare Homes Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Wendy Margaret Harvey Type of registration: Number of places registered: care home 84 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: The maximum number of service users who can be accommodated is 84 The registered person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical Disability Code PD Date of last inspection Care Homes for Older People 0 5 1 1 2 0 0 8 84 0 84 Over 65 0 84 0 Page 4 of 31 Brief description of the care home Alice Grange is a purpose built nursing home on three floors, that can accommodate up to 84 people who need nursing or personal care. The home has a 10 bedded unit for younger people with a physical disability, a 19 bedded unit for older people, a 38 bedded unit for dementia care and a 17 bedded assisted living unit for people who are independent but may need occasional support. The home offers respite care and short breaks. Each unit has communal lounge and dining areas and all the bedrooms have an ensuite toilet, basin and shower. Each floor has assisted baths and two floors also have assisted showers. The first and second floors can be accessed by both stairs and a passenger lift. The home is within walking distance of local shops. There are bus stops outside the home and the town of Ipswich is approximately five miles away. The weekly fees at the time of inspection in November 2008 were from £708.30 to £945.00 per week. Charges for personal care were dependent on the needs of the individual resident. There were additional charges for hairdressing, chiropody, toiletries and newspapers (although the home ordered two daily newspapers for each floor). 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: We carried out this key inspection on a weekday. The visit lasted 8.75 hours. We focussed on the outcomes for the people using the service, assessed against the Care Homes Regulations and the national minimum standards. The acting manager, Bernard Boyd, was present throughout our visit, together with the providers Head of Regulation. We toured the building, speaking to residents and staff. We spoke in detail to two residents, and three staff members, a nurse, a carer and the activities coordinator. We examined the records and care plans for four residents in different parts of the home, examined two staff recruitment and training records, and inspected health and safety records and quality assurance records. Prior to our visit, we asked the manager to distribute questionnaire surveys to residents, staff and visitors. We received completed forms back from five residents, Care Homes for Older People Page 6 of 31 seven visitors and six staff. We also required the manager to complete an Annual Quality Assurance Assessment (AQAA) which gave them the opportunity to tell us what the home did well and what plans there were for improvements. We have used information from all these sources in the appropriate sections of this report. 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: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 31 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. Prospective residents can be assured that they will receive sufficient information and opportunity to decide if the home is suitable for them. Evidence: All the residents who replied to our survey told us that they had been given enough information about the home to help them decide to live there. We saw the information pack given to prospective residents and their families. As well as giving information about the home, it included two checklists of questions for people to consider and ask about when choosing a home. One list was for people needing care because of their dementia, the other for those needing support through frailty and physical needs. The areas covered included first impressions, atmosphere, care, staff, activities and equipment. We saw copies of the Statement of Purpose and Service Users Guide on display in the entrance hallway. These had been updated in October 2009. The AQAA told us that all Care Homes for Older People Page 11 of 31 Evidence: new residents received a copy of the Guide and a welcome pack which were placed in their rooms, together with welcome flowers and a card. We saw examples of the pre-admission assessments carried out by senior staff prior to people being offered a place in the home. The assessments contained clear information about the persons physical care needs, as well as the needs arising from their dementia, or disabling condition such as multiple sclerosis or Huntingtons disease. The assessments included information from medical staff, hospitals and social workers. The AQAA told us that a trial period of four weeks was offered before residents made a final decision about living permanently in 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. Residents can expect their needs to be identified, monitored and kept up to date. They are protected by the homes medication policy and procedures. Evidence: The previous inspection report in 2008 identified that care plans were of a variable standard and some had minimal detail about individual care needs. This would have made it difficult for staff to provide a consistent plan of care for residents. The action plan sent to us by the manager in December 2008 told us that staff training in the completion and review of care plans was to take place in January 2009, and that the providers clinical development nurse would be monitoring the standard of care documentation. We noted the replies from residents to our survey. All of them told us that they always or usually received the care and support they needed. A resident who we spoke to said: I am well looked after. A relative told us: The home fulfilled all Xs needs. I could not have wished for better care for them. The AQAA told us that residents and Care Homes for Older People Page 13 of 31 Evidence: their family if appropriate were included in the original assessment of needs, and were invited to care reviews. To assess if care planning had improved, we case-tracked four residents with different needs, including dementia, Parkinsons disease, multiple sclerosis, and one requiring twenty-four hour bedfast nursing. We studied the care plans, and, where possible, spoke to the resident concerned or observed them and the way staff were supporting them. The four care plans we examined were all fully completed and covered a full range of care needs with appropriate risk assessments. All contained plans for a range of physical needs such as personal hygiene, continence (using the providers own assessment form), mobility, tissue viability, nutrition (using the MUST assessment tool), medication, and moving and handling. Plans for mental health needs were now based on a recognised assessment tool, which monitored, for example, changes in condition or challenging behaviour. One of the people we tracked had initially presented with behaviour that was considered to be challenging. The care plan described the progress they had made in reducing this behaviour over a period of four months. This resident was reading the paper when we spoke to them. They told us about their contentment with the care they received. We saw risk assessments for mobility, continence, falls, pressure areas, weight loss, all reviewed monthly or more frequently if needs were changing, for example after medical treatment or a change of medication. The plans explained how staff should support residents in all these areas. These included how to encourage independence and mobility, what support was needed at mealtimes, and how the resident wished to be helped with personal hygiene. Importantly, the guidance told staff that residents with certain physical conditions needed to be given time to respond when they were talking to them. The care plan records held information about the resident and their background, although not a complete life story, which the AQAA told us was a planned development for the coming year. For residents with dementia, this would assist staff to understand some residents actions and reactions, and promote fruitful reminiscence. In some cases, information was held about who held power of attorney, and any expressed end of life wishes. There were records of all medical and related health visits and appointments, with for example opticians, chiropodists, complementary therapist, specialist nurses and GPs. The AQAA told us that eight GP practices were happy to visit Alice Grange. This meant that many residents were able to keep to the practice they were already registered with. Records held information on any changes made to residents care and treatment after these visits. All the residents who answered the question in our survey:does the home make sure you get the medical care you need? ticked Always. Care Homes for Older People Page 14 of 31 Evidence: We examined the medication records for the four residents we were case-tracking and observed the medication being administered in some cases. None of the residents were able to take their own medication and had consented to staff assisting them. We checked the medication administration record(MAR) sheets which showed that residents were being given the medication prescribed for them. We particularly noted that where medication was prescribed to be taken PRN (as necessary), the times and reasons for the administration of this medication were noted on the back of the MAR sheet. Equally reasons why a particular medication had not been given was recorded. We checked the Controlled Drug(CD) record in one area. The stock for each resident tallied with the amount delivered by the pharmacy and with the doses given recorded in the CD book. Entries were signed by two staff. The cabinet where these drugs were stored conformed to the current standard. There was a daily record of the temperature of the drug fridge in the store. We observed that the correct procedure was followed when medication was being given, with the staff member wearing gloves and a red tabard. This tabard was to identify to visitors that the person should not be interrupted unless it was urgent,to prevent errors or omissions. We saw examples of staff respecting the privacy of residents by knocking before entering their rooms, and asking their permission to take an inspector into their room. We saw a member of staff treating a resident who became agitated with respect by using calming actions and a patient and caring attitude. 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. Residents can expect to be offered a choice of activities suited to their preferences. They can expect a nutritious diet suited to their health needs. Evidence: All the residents who replied to our survey told us that the home always or usually arranged activities that they could take part in if they wanted. Two relatives thought there should be more activities offered, and more residents encouraged to go into the garden during nice weather. We met the full-time activities coordinator. She had achieved an NVQ in dementia run by the Alzheimers Society, as well as following an NVQ equivalent course run by the National Association of Providers of Activities for older people. She attended meetings of activity coordinators organised by the provider. She, along with two other staff, was trained to drive a wheelchair-accessible vehicle under the national MIDAS scheme, and was trained in using SONAS Improving Communication Techniques using exercises, music and quizzes. She described the range of activities which were offered to residents according to their abilities. There was a session of music and dance during the morning of our visit, which highlighted the power of music to awaken memories and encourage movement. The coordinator had been in touch with a music therapist Care Homes for Older People Page 16 of 31 Evidence: whom she hoped would start visiting the home in January to increase the benefits to residents. We noted from a notice board that during the week of our visit, there was a meeting of the knitting club, bingo, a cake competition and a coffee morning. Groups of residents had been out for the day to Felixstowe during the summer. One group had visited a local vineyard. A church service was held once a month, with other faiths and organisations such as the Salvation Army regular visitors. The WRVS Library service came monthly, there had been skittles outside in the summer, walks to the park, and tea in the garden. A Christmas fair was due to be held in December. Some residents visited the nearby pub monthly for fish and chips. One of the residents could go out on their own and this was recorded in their care plan. As it was Remembrance Day when we visited, we saw a group of residents, staff and the manager in one of the lounges watching the service and observing the two minute silence. Residents were then served with a glass of sherry. The residents in the Memory Lane unit(the first floor) each had a diary which staff completed to record activities, as well as visits from friends and family, to help with communication and for reviews. We visited each dining area in the home and observed the serving of lunch. All of the residents who completed our survey told us that they usually liked the meals at the home. However one person wrote: The meals are of varying quality and not always ideal for those who find eating a challenge. Another wrote:Sometimes the food is almost cold when served. A staff member wrote in their survey that the food has really improved. The lunch menu on the day of our visit was: Soup or Florida cocktail, gammon and parsley sauce with potatoes and vegetables, or curry and rice. Dessert was banana and butterscotch ice cream, or spotted dick. When it was served from the heated trolley, it looked and smelled appetising. We asked a resident who usually ate in their room about the food, and they said that it was usually hot enough for them. We noted that the supper menu was minted pea soup, turkey hash, or pork pie and pickles, and profiteroles. Staff told us that residents can choose their preference the day before, or on the day. The residents we spoke to on the first floor could not remember what was on the menu. However, staff were aware of their likes and dislikes and were able to offer them the choice while it was being served. We saw staff supporting several residents to eat, in an unhurried and dignified way, encouraging people to use the cutlery as far as they were able. Some were on special or soft diets. We saw a staff member trying to persuade a resident to eat. They offered alternatives and eventually went to the kitchen and brought an omelette which the resident ate. Each wing of the home had its own kitchen area which enabled staff to prepare food Care Homes for Older People Page 17 of 31 Evidence: outside the main meal times. We saw two residents come out of their rooms in mid morning having just got up. They were offered breakfast which they chose, and the staff prepared it for them. Residents were weighed monthly,if appropriate using a hoist with built-in scales and the weight recorded in their care plans. Their nutritional state was measured using the MUST(Malnutrition Universal Screening Tool) assessment tool. The care plan indicated where concern about a residents weight had led the home to call in the dietitian for advice. Care Homes for Older People Page 18 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. Residents can be confident that their concerns will be promptly addressed, and that they will be protected from abuse. Evidence: The home had a complaints procedure which was included in the statement of purpose and was also on display in the entrance hall. Replies to the question in our survey Do you know how to make a formal complaint? were mixed. Half the residents and relatives told us that they did not know how to complain. However one resident who we spoke to during our visit said they did know how to complain but had never needed to. The AQAA told us that in the previous twelve months the home had dealt with eight complaints. We examined the complaints register which detailed each complaint and the action taken after investigation. Replies to complainants were made in writing within the homes policy timetable of twenty eight days. One relative told us that management fail to act upon concerns raised and do not appear to follow through actions/plans they say they will put in place. The providers Head of Regulation acknowledged there had been a lapse of follow up action in some cases. The provider was now aware of these shortcomings and had taken action at management level to improve communication and to improve confidence in the complaints process. The home had a policy for the reporting of incidents which affected the safeguarding Care Homes for Older People Page 19 of 31 Evidence: of vulnerable adults. The home had referred three incidents to the local authority safeguarding team during the year. In all cases the home had been asked to undertake the investigations as no police involvement was appropriate. One case was still being investigated by the home. The correct reporting procedures had been followed by the homes management. Unfortunately in one case a regional specialist from the provider had not followed the Suffolk procedure. The provider acknowledged this and undertook to ensure all visiting specialist staff were aware of local procedures. The staff we spoke to confirmed that they had received training in safeguarding during their induction, and in their NVQ studies. Care Homes for Older People Page 20 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. Residents can expect to live in an attractive and well-maintained environment, that is clean and hygienic. Evidence: A resident told us that the accommodation is extremely good, clean, new, fresh and bright. The atmosphere is friendly, positive and upbeat. All the residents who replied to our survey told us that the home was always fresh and clean. As the home was only opened in May 2008, it was to be expected that the furniture and fittings were in good condition and of a high standard. Each unit had a communal lounge and dining areas, and all the bedrooms had an en-suite toilet, basin and shower. At the ends of corridors there were small areas of bay windows where residents could sit to see what was going on in the street, or to use as a quiet place to read the paper, as we saw. Each floor had assisted bathrooms and two floors also had assisted showers. The bathrooms were brightly decorated, with colourful pictures on the walls. The door had a picture of a bath on it for easier recognition by those with confusion. The lights came on automatically on entering the room. We noted that there were records in the room to show that water temperatures were monitored, to minimise the risk of scalding of residents. Care Homes for Older People Page 21 of 31 Evidence: The doors to bedrooms were designed to look like front doors of houses, with a letterbox and door knocker. The rooms on the top floor were designed as bed-sitting rooms including a kitchenette, for those with greater independence. There was an enclosed garden for those with dementia. The AQAA told us that the main garden was due to be re-designed to incorporate more mature planting, a shed and a greenhouse. Raised flower beds for residents were also planned, which some residents could upkeep themselves. The AQAA told us that additional garden furniture had been bought for the garden in the last twelve months. The home employed a gardener and a maintenance person. We spoke to one of the domestic staff. They had a special cleaning trolley to keep their supplies safe. They told us that there was always sufficient materials and equipment for them to keep areas clean and odour free. We noted that aprons and gloves were readily available for staff to use to prevent cross-infection. Yellow clinical waste bags were in use, and there were also colour coded bags for dirty laundry. The laundry room was large and well organised with separate dirty and clean areas. Two staff worked in the laundry, both had done training in infection control and were due for an update the week after our visit. One relative put in their survey that the laundry service is excellent. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for by enough competent staff to meet their needs, although there is a lack of consistency due to high staff turnover and a regular use of agency staff. Evidence: On the day of our visit, there were, on the ground floor, 12 residents in the physical disability wing and 12 in the elderly frail wing. On the first floor were 26 residents with varying degrees of dementia. On the top floor, there were 10 residents whose care needs required less support from staff and who were more independent than those on the ground floor. To cover these residents, there were six staff on each of the first two floors including a qualified nurse on each floor, with two staff on the top floor, also including a qualified nurse. These staff levels were rostered from 08:00 to 20:00 each day. Of the six staff who completed our survey, the answers to the question: Are there enough staff to meet the individual needs of all the people who use the service?, varied. Two replied usually, two sometimes, and two never. However several of these staff also said how good the home was, for example care is next to none, great place to work but not always enough people. One said:Too many agency staff. On one of the floors, there were three staff off sick at short notice, leaving one nurse and two carers. No emergency cover had been provided, according to the staff member we spoke to, until the afternoon. One result of this shortage was that a Care Homes for Older People Page 23 of 31 Evidence: resident had waited until 15:00 to be washed. Two carers working on the ground floor had differing views of the staffing arrangements. One was positive. I love working here and havent yet come across a problem that hasnt been solved. The other was critical of the staffing levels: We are always rushing around to get everything done. No time to have a conversation with residents. The AQAA reported that in the previous three months the home had used agency staff on an average of 4.7 shifts a week. The AQAA also reported that 52 out of a total of 62 care staff had left their employment at the home over the previous twelve months. These factors mean that residents do not benefit from a continuity of staff who they can get to know, and who can get to know them and their needs. The acting manager told us that he had just recruited seven more bank carers. When these people had been cleared to work in the home, that would reduce the use of agency staff significantly and provide better cover for sickness. Those residents who completed our survey commented that: Several of the carers are exceptional in their care, very polite and helpful, show much patience in looking after dementia clients. Generally the nursing and care staff work hard and do their best. Staff are polite, friendly, caring and encouraging. We examined the recruitment files for two recently appointed staff. Both contained evidence that proper and safe recruitment procedures had been followed prior to staff commencing employment, with references taken up, identification documents filed and Criminal Record Bureau checks undertaken, in both cases the certificates received before the person started work. The files also held copies of training certificates and certificates of attendance at all the mandatory course such as moving and handling, fire procedures, infection control, food hygiene, and the protection of vulnerable adults. We also saw the training record for all staff which showed a continuous programme of training sessions over a twelve month period. A nurse who had recently started told us that they were not allowed to administer medication until they had passed a drug assessment, which was booked for later in the month. Some staff said that they were sometimes working with residents whose conditions they had not been trained to care for. But others said that the home was always putting on training. If we get a new condition in, they train us. A sample of supervision records showed that training was discussed at these sessions and action to meet training needs promised. The acting manager told us that a review of training had highlighted that some staff had not yet had the full range of training to enable them to work with all residents. Care Homes for Older People Page 24 of 31 Evidence: For example he had arranged dementia care training in conjunction with the Alzheimers Society during the current month. Training would also be arranged on The Mental Capacity Act and the Deprivation of Liberty Safeguards to ensure that the home met the requirements of these legislative provisions for the protection of residents. The deputy manager had been trained as the in-house trainer for these areas. At the time of our visit, fourteen care staff were qualified to NVQ Level 2 and above, and four staff were studying for Level 2 and 3. Care Homes for Older People Page 25 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. Residents can expect that the home will be well managed and that any shortfalls in the management of the home or the staff are being addressed. Evidence: Following a safeguarding referral by the provider concerning the registered manager, the provider had brought in an acting manager. He was on site during our visit, together with the providers Head of Regulation. The latter had investigated the safeguarding referral with the agreement of the local authority and had produced a report and an action plan which we had been sent. A key action point was the improvement of relations between management and staff. Adverse comments about this had been put on some of the staff surveys we had sent out. Some of the communication issues had also been highlighted in our last report. A review of training had been undertaken and plans made to bring all staff up to date on their training needs. Daily heads of department meetings had been introduced to Care Homes for Older People Page 26 of 31 Evidence: ensure information was cascaded to the staff teams in order to aid the daily running of the home. The staffing structure of the home consisted of the manager, the deputy manager, a senior sister on the ground floor and the first floor, nurses, senior carers, carers together with an activities coordinator, catering staff, maintenance and gardening staff, two full time domestic staff, laundry staff and two administrative staff. The current policy was to expect all staff to work on all floors. However the acting manager told us that he was surveying staff to test their views on more specialisation and what their preferred location would be if this happened. The provider had a comprehensive quality assurance programme. Satisfaction surveys were sent to residents and relatives. The latest one had revealed that some residents did not fully understand what their care plan was for. The manager had arranged individual review meetings with residents and their families to discuss and update care plans to ensure that care was being delivered as per the residents wishes. Residents meetings were held monthly and relatives meetings two monthly. We saw the notices for the next of these on the noticeboards. The AQAA told us of some changes that had been made as a result of these meetings. These included: reviewing the evening menu choices, moving the evening meal from 6pm to 5pm, placing more benches in the garden. The home had a monthly programme of audits covering different aspects of the home such as health and safety, nutrition, infection control (twice), and medication administration(twice). In addition, regional managers audited health and safety and fire procedures, recruitment and finance, and housekeeping. We saw that the homes fire risk assessment had been reviewed and noted a list of the actions taken. The manager told us that the clinical development nurse would undertake an audit by the end of the year into how residents with dementia spent their day. The home did not hold any personal money for residents. They either kept money in a lockable drawer in their room, or families would be invoiced over and above the fees for such items as hairdressing and chiropody. The programme for the regular recorded supervision of staff had fallen behind schedule. This had led some staff to feel unsupported and unable to specify their training needs or discuss aspects of care practice. The acting manager explained that he had re-started the programme, beginning with the qualified nurses who all had a supervision session over a three week period in October. Other staff would be completed by February 2010. No residents had been identified by the home as requiring referral to the local Care Homes for Older People Page 27 of 31 Evidence: authority on the basis of the Deprivation of Liberty Safeguards. Care Homes for Older People Page 28 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 29 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 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 16 If action is promised in response to a complaint, this should be recorded and tracked , to ensure confidence in the homes willingness to take complaints seriously. Training in the local safeguarding procedures should be given to all of the providers staff who visit the home to ensure that residents are properly protected. Staffing levels should be regularly monitored to ensure that the appropriate numbers of competent staff are on duty to meet the needs of the residents. 2 18 3 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. 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