Care Home: Alpine Care Home

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What the care home does well Service users are valued, treated with respect and their dignity is upheld. Staff are motivated, enthusiastic and committed. Service users are supported to participate in activities, and are consulted about their hobbies and interests. Service users told us they are supported well by staff, and like living at the home. Relatives are happy with the service their loved ones receive. They find the home and the staff welcoming and supportive. What has improved since the last inspection? The home was last inspected in September 2007 where it was identified improvements were required to the decor of the home, and refurbishment of a bathroom. This was done. Staff training was also identified as an area where improvments were required, particularly in terms of first aid, food hygiene and health and safety training. We can see from the training matrix that a number of staff received food hygiene training following the inspection. However, just three staff have received health and safety training. What the care home could do better: Shortfalls identified at this inspection must be addressed to ensure the health, safety and welfare of service users in met. The registered person needs to ensure there are robust systems in place when assessing prospective service users, and that their assessed needs are fully recorded. More detail of support needs is required in care plans and risk assessments, and the home must demonstrate they have consulted service users about their care and about their wishes and preferences. In order to ensure service users health care needs are met, the registered person must ensure protocols are in place with regard to incidents and accidents, and that service users receive treatment without delay when injured. The registered person must also ensure the Commission is informed of significant events in the home. Staff training is inadequate. Efforts must be made to ensure staff are competently trained. Shortfalls noted in the environment mean the home is hazardous for service users. The registered person must ensure that the home and garden are safe without delay. Key inspection report Care homes for older people Name: Address: Alpine Care Home Alpine Care Home 10 Bradbourne Park Road Sevenoaks Kent TN13 3LH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Montgomery     Date: 2 3 0 6 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 33 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 33 Information about the care home Name of care home: Address: Alpine Care Home Alpine Care Home 10 Bradbourne Park Road Sevenoaks Kent TN13 3LH 01732455537 01732455537 manageralpine@regalcarehome.com www.regalcarehomes.com Mr Kanagaratnam Kernal Rajamogan,Anne Crousse Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Mary Barth Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 36. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Dementia (DE) Date of last inspection Brief description of the care home Alpine Rest Home is a care home providing personal care and accommodation for thirty older people. Mr. and Mrs. Rajamogan own the home, which is situated in a residential area of Sevenoaks. The town centre, with the usual amenities, is a bus ride from the Care Homes for Older People Page 4 of 33 Over 65 0 30 30 0 Brief description of the care home home. There is a main line railway station half a mile away. The house is a large detached property with parking to the front and a garden to the rear. Accommodation for residents is over two floors accessed by a lift. There are eighteen single and six shared rooms. One of the shared rooms has an en-suite bathroom. There are two large lounges, a dining room and a visitors room. There are bathrooms and toilets on the first and second floors. Please contact the manager of the home for information regarding the current fee structure. Alpine Rest Home employs care staff, working a roster, which gives 24-hour cover. Ancillary staff includes two cooks, a kitchen assistant and domestic staff. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was conducted by compliance inspectors Sarah Montgomery and Tawa Dowling. They were in Alpine Care home from 10am until 5pm. During the inspection they spoke with representatives from the home including the registered manager, the quality assurance manager, the marketing manager, members of the care staff, a relative and service users. Several records including care plans, assessment documentation, and staff records were assessed. All communal areas and a number of bedrooms were also inspected. Time was also spent observing working practice. The Commission received an annual quality assurance assessment from the home. Information from this document was used to inform the inspection process. The quality rating for this service is one star adequate. This means that people who live at Alpine Care home experience adequate quality outcomes. Care Homes for Older People Page 6 of 33 Care Homes for Older People Page 7 of 33 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 following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 33 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 33 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 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The statement of purpose does not accurately describe services and facilities at the home. Current information provided to prospective service users is misleading. Prospective service users are not competently assessed prior to admission, and their support needs are not recorded. Evidence: Standards 1, 3, 4 and 6 were assessed. To assess these standards we looked at records which told us how prospective service users are supported in their choice of home. These records included the statement of purpose, service user guide and pre admission assessments. We spoke with members of the management team about these processes and documents, and spoke with some residents about their experiences of moving into the home. We also looked at information sent to us from the home in their annual quality assurance assessment. Standard 6 does not apply as the home does not offer intermediate care. Care Homes for Older People Page 11 of 33 Evidence: The homes statement of purpose and service user guide were inspected. They were then cross referenced with all evidence gathered throughout the inspection. This is because the statement of purpose and service user guide tells prospective and current service users, and their representatives what services are provided at the home. It is important that these documents are up to date and relevant as they serve as a benchmark for all service provision. The statement of purpose tells service users that prior to admission a full needs assessment is carried out which is based on person centred care. The annual quality assurance assessment (AQAA) under our evidence to show that we do it well states; completed pre admission assessments. Our assessment of three pre admission assessments and our assessment of the homes statement of purpose does not correspond with statements made by the home in the AQAA or statement of purpose. We found pre admssion assessent of prospective service users to be poor. Two of the forms were not signed or dated. None of them contained any assessment of support needs. On all forms, many areas had been left blank. On one form under the question general state of health, the answer medium is ticked. There is no explaination as to what medium means. This same form had indicated the prospective service user required the support of one carer for washing, bathing and dressing, but no information was recorded regarding what support was required. Possible risks were stated at falls and UTIs. Under prevention of risks, nothing is written. Another pre admission form stated under reason for admission: needing more care. No support needs were recorded or identified on the admission assessment. None of the pre assessment documents assessed indicated that the service user had been consulted or spoken to regarding their assessment of support needs, or that their personal wishes and preferences had been sought or recorded. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users cannot be confident their health and personal care needs will be met. Evidence: Standards 7, 8, 9 and 10 were assessed. To assess these standards we looked at records which told us how the care home meets the health and personal care needs of service users. These records included care plans, risk assessments, daily notes, and medication records. We spoke to members of staff about how these records are used, and asked staff about how they used care plans in their day to day work with individuals. We wanted to see how the home ensures service users are treated with dignity and respect, and spent some time observing working practice. We also looked at information the home had sent to us in their annual quality assurance assessment (AQAA). The statement of purpose tells service users that a personalised and individual care plan is drawn up, reviewed monthly and updated to reflect any changing need. The AQAA tells us that care plans are detailed and specific. Our assessment of care plans (including risk assessment and health care plans) found significant shortfalls, contrary Care Homes for Older People Page 13 of 33 Evidence: to the homes assertions, care plans assessed were not detailed or person centred, and were not reviewed monthly or reviewed and updated when changes occur. Three health and personal care plans were assessed. None of the care plans on personal care contained any information about support needs. One care plan stated enjoys a bath. No further information was recorded. It was not reviewed for four years. In 2008 a review of this care plan stated needs more help. No further information was written. This same service user has specific physical health needs, uses a wheelchair and requires a hoist. there is no mention of a hoist in the personal care support plan. When we looked at risk assessments for this service user we found that many areas of support had not been reviewed. The manual handling risk assessment was dated May 2007, assessment of daily needs was dated April 2008, a pressure area assessment was dated October 2005. We were informed by the manager that this service user is diagnosed and suffers with depression. A mental health assessment was dated June 2005, and no further assessments or reviews have been undertaken. We saw that a service user had their nutritional care plan reviewed in February 2010. The review stated does not always eat a balanced meal. There was no care plan in place to address the review findings. We looked at risk assessments for a service user who the manager stated falls frequently, and has a recent history of a number of falls. Between May 2010 and the date of inspection, this service user had four falls, all resulting in injury. The care plan for mobility and maintaining a safe environment was last updated in February 2010. When we asked the manager why there had not been any review or update to the mobility risk assessment, she told us it is the homes policy not to update the risk assessment until a service user has had three falls. We looked at records of incidents and accidents. Shortfalls were identified in recording and in actions taken following incidents and accidents. We noted that some forms were not completed, and had not been signed or dated by either the staff member or the manager. Of concern is that following accidents in which service user have received injuries including bruises and abrasions, cuts and scratches, and have injuries to their heads, no medical attention was sought. Out of the 5 accident records we looked at, just one received medical attention from a health care professional. When questioned, the manager told us there are no formal protocols in place at the home for staff to refer to if service users have accidents. We looked at medication protocols in the home. A recent audit had been undertaken Care Homes for Older People Page 14 of 33 Evidence: by Boots Pharmacy on June 17th 2010. The audit was very positive and found good practices in medication storage and administration by the home. We looked at medication storage, medication administration records, the controlled drugs register, and the controlled drugs storage. Our findings concurred with Boots, in that medication protocols in the home are good, and comply with Regulation. Care Homes for Older People Page 15 of 33 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. Service users benefit from the activities provided at the home. Service users would benefit from robust nutritional screening. Evidence: Standards 12, 13 and 15 were assessed. To assess these standards we looked at records which told us how the home ensures service users are given social opportunities, and can make choices and decisions about their lives. We also looked at how the home supports service users to maintain contact with family and friends, and looked at records which told us how the home ensures service users receive a wholesome and nutritious diet. We spent time talking with service users about their life at the home, and talked to staff about how they support service users with their lifestyle choices. We referred to the homes annual quality assurance assessment (AQAA) and cross referenced this with evidence gathered. The statement of purpose tells prospective service users that a range of activities will be on offer at the home. The AQAA states that choice regarding activities is promoted and identified in care plans. Our inspection evidenced that hobbies and interests are identified in the care plan file (although it would be beneficial if these documents were dated, as individuals interests may change). Care Homes for Older People Page 16 of 33 Evidence: The home has an activity coordinator who works from 2pm until 5pm Monday to Friday. We spoke with her about her role. She explained there is an activities board in the corridor by the lounge. This details what activities are offered on a daily basis. Activities are based on the preferences of service users, and these preferences are recorded within individuals files. Although activities are planned ahead and are written on the board, service users are consulted on a day to day basis, and activities will change to suit the preferences of the group. Participation in activities is recorded in the activities folder. This also serves as a record for those service users who consistently do not want to participate, and time is set aside to spend one to one time with these residents. We spent some time in the lounge and dining area speaking with service users about their experiences of living in the home. Most service users spoke enthusiastically about the home and told us staff are marvellous, foods not bad either, and the girls are very nice. Other service users told us I get fed up with playing the same games every day, and not many people talk to me. The majority of service users choose to sit together in the lounge. It is comfortable, friendly and relaxed. Staff were observed taking time to speak with service users, and during the afternoon the activities coordinator supported some service users in a game of indoor bowls, while other service users were enjoying a world cup football match on television. We found that staff interacted well with service users, and spoke to them respectfully. The home has an open door policy. Visitors and family and friends of service users are made very welcome in the home. During the inspection we spoke with a relative. He told us he finds the home absolutely smashing, and added there is a nice atmosphere in the home, things are going on in the afternoon, mum really enjoys the singing and the quiz. Everyone is so kind. They look after mum so well. The care is really good, and that means more than decor. We saw that information is recorded on individuals files about important people in their lives. This information includes guidance about when to contact relatives (for example, phone anytime, or dont call after 10pm at night). In discussion with the home manager she told us that she keeps relatives up to date with regard to any changes or accidents. This is usually done by telephone. We looked at records which told us how the home meets the nutritional needs of the service users. We found some shortfalls. For example: where a need had been Care Homes for Older People Page 17 of 33 Evidence: identified, doesnt always eat a balanced meal, there was no accompanying care plan, risk assessment or weight chart. Service users told us that they enjoy the food at the home. We observed lunch, and noted that the food was presented well, and service users were served and (when necessary) supported to eat in a sensitive manner by staff. Menus were assessed. They demonstrated that choices were offered, and meals were balanced and nutritious. The kitchen had been inspected on the 9th of October 2009 by the local council, and was awarded a hygiene score of four stars. Care Homes for Older People Page 18 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are listened to but would benefit from more robust recording of complaints. Service users cannot be confident they will be protected from harm. Evidence: Standards 16 and 18 were assessed. To assess these standards we looked records which told us how the home ensures service users are protected from harm and abuse, and records which demonstrated that the home listens and responds to service users concerns or complaints. We spoke with service users about how they make a complaint, and talked with staff about how they respond to complaints and protection. We also looked at information provided in the statement of purpose, and information told to us by the home in their annual quality assurance assessment (AQAA). The homes statement of purpose gives service users and their representatives a brief outline of how to complain. The home have not developed an accessible complaints procedure for people with dementia, and we noted that in their AQAA, under what we could do better they state: making it alright for clients to complain, helping them to understand this is a way of improving our service. The complaints procedure states that the person making the complaint will be informed of the outcome within 28 days. We looked at the complaints file. We saw one complaint from a relative. There was no record of a written acknowledgement of the complaint, or any record of the outcome recorded. Information in the AQAA records Care Homes for Older People Page 19 of 33 Evidence: that two complaints were received and upheld in the last twelve months. This information was not on the file. We asked the manager about her knowledge and working practice with regard to keeping service users safe from abuse. She spoke competently about safeguarding protocols, and clearly knew her responsibilities in terms of reporting alleged abuse to social services, the Commission, and the police. The AQAA also states there have been seven incidents of restraint in the last twelve months. The Commission has not been notified (as required under Regulation 37) of any incident in which service users were restrained. The staff training matrix demonstrates that out of 25 staff, just 11 have received training in safeguarding. Only three staff have received recent training, with the other 8 having been trained in 2008 (4 staff) and 2009 (4 staff). The registered person must ensure that all staff receive appropriate training in safeguarding as a matter of urgency. Care Homes for Older People Page 20 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users cannot be sure the home they live in is safe. Evidence: Standards 19, 21, 24 and 26 were assessed. To assess these standards we looked the communal areas in the home, and a number of bedrooms. We also looked at records which told us how the home ensures service users are kept safe, for example, certificates of electrical equipment testing. In addition, we looked at systems the home has in place to ensure the home is clean and hygienic, and looked at information supplied in the statement of purpose and annual quality assurance assessment. At the start of the inspection we asked the manager if she was aware of any shortfalls with the environment. She told us it was and old building, but everything was fine. The AQAA states that a handyman is employed to ensure the monitoring and maintaining of the environment. It also states Audits are carried out on the environment and results are given to the manager to improve any areas that need it, and staff are trained in infection control. Evidence gathered tells us that information provided by the manager on the AQAA is misleading and in parts, incorrect. We found many shortfalls with the environment, and when we assessed the staff training matrix we saw that only eight out of twenty five staff had been trained in infection control. Only four of these staff have had recent training (2009). Three members of staff were trained in 2007, and one member of staff in 2008. Seventeen staff have received no Care Homes for Older People Page 21 of 33 Evidence: training in infection control. Information in the AQAA tells us that the homes electrical circuits were last tested in March 2006. The manager showed us around the ground floor of the home. Several shortfalls were found. Most notably: in one bedroom which has a fire escape door to the garden, wires were trailing under the fire escape door. Hot water pipes by the sink were exposed, as were electrical wires in the same area. We saw that window restrictors were not fitted either on the ground or upper floor. We issued an immediate requirement in respect of this. We saw staff bags hung in a communal corridor. On view at the top of one bag was prescription medication. On our request, the manager ensured this was locked away. In two toilets incontinence pads were left out. In one of the toilets there was no soap or paper towels. A cupboard containing cleaning materials was left open in a communal corridor with the padlock hanging beside it. On our request the manager ensured this cupboard was locked. In a bedroom we saw three bins. One bin was being used for soiled pads. This bin does not conform to infection control regulations as it did not have a foot operated pedal. The garden was considered extremely hazardous: it slopes upwards, and there is a five foot drop from a wall over the garden path. There is no fencing around this wall (which is also leaning towards the house), and service users who access that part of the garden would be at risk of falling. The garden backs onto a school. The fencing between the home and the school is broken, and there is a large gap. The garden is not secure. We saw that service users bedrooms were comfortable and homely and contained personal possessions including photographs. The lounge and dining area had appropriate and comfortable furnishings. A number of service users told us they liked their bedrooms, were comfortable sitting in the lounge. Effort had been made in the lower part of the garden to provide a comfortable seating area. It had a water feature, table and chairs, and several plants and flowers. Care Homes for Older People Page 22 of 33 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. Service users benefit from being supported by caring and motivated staff. Service users would benefit if the staff were appropriately trained. Evidence: Standards 27, 28, 29 and 30 were assessed. To assess these standards we looked at records which told us about the skills and competencies of staff. These records included recruitment processes, staff training and the homes rota. We also looked at information provided in the statement of purpose and at what the home has told us about in their annual quality assurance assessment (AQAA). The homes statement of purpose tells prospective service users that there is a well trained team of staff, and goes on to state we insist that all staff training needs and requirments are regularly assessed. The home has told us in the AQAA that staff training is on going. We looked at the homes staff training matrix. This matrix indicates that 6 members of the care staff (out of 16) have achieved national vocational qualifications NVQ). Information from this matrix also tells us there are significant gaps in most areas of mandatory training. Most notable gaps are in first aid, fire awareness, infection control, adult protection, health and safety, and moving and handling. This lack of appropriate and necessary training means that staff may not have the skills to carrry Care Homes for Older People Page 23 of 33 Evidence: out their roles, and this will have a detremental effect on service users. Just ten staff out of sixteen members of care staff have had moving and handling training. This means that staff who have not been trained may be supporting people inappropriately, or using equipment they have not been trained to use (for example, a hoist). These gaps in training must be addressed as a matter of urgency to ensure the care and support needs of service users are met. Three staff files were inspected. Two files contained appropriate documentation, and evidenced a robust recruitment process had been followed. One file contained just one reference, and although there was evidence on file that two references were requested, there was no indication that this had been followed up. Observations during the inspection evidenced staff working well with service users. When spoken with, staff were aware of their roles, and spoke enthusiastically about their work. The rota was assessed. We found that the manager had ensured that staff on duty had an appropriate skill mix. We could see that all shifts were lead by a senior carer. At the beginning of inspection we asked the manager about the staffing structure of the home. She informed us there was no deputy, and told us that the deputy manager had left a year ago, and had not been replaced. When we asked why, she was unsure, and thought that head office would advertise soon. Care Homes for Older People Page 24 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users would benefit from more robust management of the home. Evidence: Standards 31, 32, and 33 were assessed. To assess these standards we looked at information and records which tell us how well the home is run, and records which tells us how the home self-monitors their performance. These records include the experience and qualifications of the manager, the homes annual quality assurance assessment, systems in place for supervising staff, and all records relating to meeting support needs of service users, for example care plans. The registered manager has worked at the home for several years, and is very experienced in providing care to older people with dementia. She has obtained qualifications in management and in care. Records assessed today evidence there are some shortfalls in the overall management of this home. Pre admission assessment is poor, care plans and risk assessments are Care Homes for Older People Page 25 of 33 Evidence: not robust, service users do not always receive appropriate health care treatment following accidents, some areas of the environment are unsafe, and staff have not received regular or sufficient training. We read a recent Regulation 26 report. Many issues highlighted in this inspection report had been highlighted in the regulation 26 report. For example: care plans to include more detail, and a long list of problems identified with the environment. Although the regulation 26 report had actions beside the identified concerns, these actions were not dated, and therefore timescales for compliance are unclear. The manager encourages feedback from visitors and relatives. Satisfaction surveys and results were displayed on the noticeboard in the hall. We could see that overall, relatives are very happy with the home. Care Homes for Older People Page 26 of 33 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 27 of 33 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 1 19 23 The registered person must ensure that all windows in the home are fitted with window restrictors. To ensure the health, safety and welfare of service users is met. 23/06/2010 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 1 4 The registered person must 30/09/2010 produce a statement of purpose and service user guide which tells service users and their representatives about the home. The registered person must ensure that prospective residents and their representatives have correct information about all services and facilities at the home. 2 3 14 In order to meet individuals 27/08/2010 particular support needs, the registered person must ensure that prospective service users are competently and thoroughly Page 28 of 33 Care Homes for Older People 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 assessed prior to admission to the home. This includes demonstrating appropriate consultation with the service user and their representative has taken place. Prospective service users are currently not competently assessed prior to being offered a place at the home; therefore support needs are not being met. 3 7 13 The registered person must 30/09/2010 develop robust risk assessments that support people to have a safe but fulfilling life. Current risk assessments are inadequate and do not safeguard service users. To ensure the health, safety and welfare of service users is met. 4 7 15 The registered person must 30/09/2010 develop comprehensive care plans which detail support needs of individuals. The home must demonstrate they have consulted with service users, and have taken into account their wishes and feeling. Care Homes for Older People Page 29 of 33 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 To ensure the support needs of service users are met. 5 8 12 The registered person must ensure that they respond, without delay, to health concerns, and that service users are given access to health care professionals for medical treatment. To ensure the health, safety and welfare of service users is met. 6 18 13 The registered person must ensure that all staff receive accredited sufficient and effective training in adult protection (recognising and responding to signs of abuse) and that they are competent to use this knowledge. To ensure the health, safety and welfare of service users is met. 7 18 37 The registered person must ensure that they inform the Commission, without delay, of all significant events at the home that are outlined in this regulation. To ensure the health, safety and welfare of service users is met. 20/08/2010 29/10/2010 20/08/2010 Care Homes for Older People Page 30 of 33 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 8 19 23 The registered person must ensure the environment (including the garden) is safe for service users, and that all hazards identified in this report are addressed. To ensure the health, safety and welfare of service users is met. 30/09/2010 9 26 23 The registered person must 30/09/2010 ensure robust systems are put into place to prevent the spread of infection. To ensure the health, safety and welfare of service users is met. 10 27 18 The registered person must 29/10/2010 ensure that the home employs staff who are competent to carry out their duties Staff must be skilled, qualified and competent. This includes achieving 50 of the staff team being NVQ qualified, and includes all staff receiving suitable training. The registered person must supply to the Commission a rolling programme of training which demonstrates accredited training. Care Homes for Older People Page 31 of 33 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 To ensure the health, safety and welfare of service users is met. 11 29 19 The registered person must ensure that they operate a thorough recruitment process ensuring the protection of service users. To ensure the health, safety and welfare of service users is met. 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 27/08/2010 Care Homes for Older People Page 32 of 33 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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