Care Home: Alpine Villa

What the care home does well There was a statement of purpose and service user guide and people interested in moving into the home were given a copy. This meant that people had sufficient information to make an informed decision about whether to move into the home. When they moved in each person`s needs were assessed in detail to ensure that their diverse needs would be met. After this people`s personal, social and health care needs were set out in a person centred plan to ensure that their diverse needs were met. Any risks were assessed and action was taken to make sure that people were kept safe. People were generally helped to take their medication in a safe manner. People were treated with respect and their right to privacy was upheld. Activities were provided and people were taken out so that their social and recreational needs were being met. People kept in contact with their families and friends as they wished. People, within their capabilities, could exercise personal autonomy and choice. There was a varied menu and special diets were catered for so that people received a varied and balanced diet in pleasant surroundings. The accommodation was spacious and there were different seating and dining areas so that people had a choice of where to spend their time. People lived in a safe, comfortable, clean and well maintained environment. People had enough shared space and enough toilets and washing facilities to meet their needs. Most of the bedrooms were single and people were able to bring items of furniture if they wished. They had safe comfortable bedrooms with their own possessions around them. There were sufficient numbers of staff on duty at all times to meet people`s needs. People benefited from being cared for by staff who had a range of experience and training to meet their needs. The recruitment practices ensured that people were protected from being cared for by unsuitable staff. The manager had many years of experience of working with people with dementia and the deputy had a management qualification so that people were benefiting from a well run home. People or their families managed their money. There was a quality assurance process and work was taking place to make sure that the home was run in people`s best interests. People were cared for by workers who were well supported by their managers. The environment was generally safe for them and the staff because the managers and workers on the whole carried out good health and safety practices. What has improved since the last inspection? The care plans had been developed further so that people received more individualised care. People had signed their plans to show that they were in agreement with them. The deputy manager had been on a course with Age Concern about person centred care. Following this training the senior carer had developed person centred plans. The managers had sent out complaints procedures to all the relatives so that they would know how to make a complaint.Staff had received training about health and safety so that they knew how to keep people safe. New staff were receiving an induction using the common induction standards so that they could provide the right standard of care for people. Staff members were receiving more regular supervision so that they were well supported to care for people. The manager and deputy had developed the quality assurance system so that the views of relatives contributed to service improvements. What the care home could do better: A procedure should be developed to describe the circumstances in which medication may be given in food. This will help to make sure that medication is only given in a covert way if absolutely necessary. Any hand written additions to the medication administration records should be signed and dated. This will make it possible to tell who made the addition and to cross reference the change with any instructions from the prescribing doctor so that people are given the right medication. A controlled drugs register should be obtained to record the administration of controlled drugs. A cupboard should be provided that meets the current storage regulations for controlled drugs (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007). This will make sure that any controlled drugs prescribed can be stored properly. The manager had identified that they could improve the service by seeking professional advice about activities for people with dementia. An extension was being built to provide five single bedrooms with ensuite toilets and a separate shower. The manager also planned to refurbish the main house once the extension was complete, to improve the overall accommodation provided. The registered person must make sure that all the fire safety checks are carried out at intervals prescribed by the fire authority so that people are protected from the risk of fire. The registered manager should hold a relevant management qualification. All staff should have an annual appraisal. The manager and deputy should receive more in depth training about developing a service for people with dementia to keep their practice up to date. Advice should be sought from a specialist organisation about how to involve people with dementia in assessing quality and developing the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alpine Villa 70 Lowbourne Melksham Wiltshire SN12 7ED     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Barber     Date: 1 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Alpine Villa 70 Lowbourne Melksham Wiltshire SN12 7ED 01225706073 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : lpm1280@yahoo.co.uk Mrs Luzuisminda Mercer care home 15 Number of places (if applicable): Under 65 Over 65 15 15 dementia mental disorder, excluding learning disability or dementia Additional conditions: 0 0 The maximum number of service users who may be accommodated in the home at any one time is 15 Date of last inspection Brief description of the care home Alpine Villa is a private residential care home offering accommodation and personal care to a maximum of 15 people who are over the age of 65 with either dementia and/or mental disorder. The home is a large Victorian house, close to the centre of the market town of Melksham. The accommodation consists of three shared and eight single bedrooms, one of which has en-suite facilities. There are bedrooms on both the ground and first floor. There are stairs to the first floor. The home has a lounge-dining room, a conservatory, an additional lounge and separate dining room. Information about the service is available in a combined statement of purpose and service user guide. Information about the fees is available from the home. Inspection reports are also available from the home and the Commission website, www.cqc.org.uk. Care Homes for Older People Page 4 of 29 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 asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We visited the home on the 12th May 2009. We talked to the registered manager, the deputy and the senior carer. We looked at some of the homes records and talked to two members of staff. We met with three people who lived in the home and asked them about their experience of living in the home. The judgments contained in this report have been made from all the evidence gathered Care Homes for Older People Page 5 of 29 during the inspection, including the visits. The last inspection of the home was on 13th May 2008. What the care home does well: What has improved since the last inspection? The care plans had been developed further so that people received more individualised care. People had signed their plans to show that they were in agreement with them. The deputy manager had been on a course with Age Concern about person centred care. Following this training the senior carer had developed person centred plans. The managers had sent out complaints procedures to all the relatives so that they would know how to make a complaint. Care Homes for Older People Page 7 of 29 Staff had received training about health and safety so that they knew how to keep people safe. New staff were receiving an induction using the common induction standards so that they could provide the right standard of care for people. Staff members were receiving more regular supervision so that they were well supported to care for people. The manager and deputy had developed the quality assurance system so that the views of relatives contributed to service improvements. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 29 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had sufficient information to make an informed decision about whether to move into the home. Each persons needs were assessed in detail to ensure that their diverse needs would be met. Evidence: We saw that there was a combined statement of purpose and service user guide. It contained all of the required information. It included information about the quality assurance process and areas for improvement and a copy of the terms and conditions. We looked at three peoples care records. We saw that two of them had assessments completed by the home. These contained information about their likes and dislikes, needs and preferences, social and health care needs. Each had a personal profile with information about their previous life, personal relationships, family contacts, religion and social activities. There was information about their physical and mental health Care Homes for Older People Page 11 of 29 Evidence: needs, personal risks, moving and handling needs, risk of falls, behaviour, risk of developing pressure sores and nutritional screening. The third person had moved in recently from hospital. They had assessment information from the hospital. The home was in the process of completing an assessment for them. Most of the information had been completed except the risk of falls and pressure sores and nutritional screening. Care Homes for Older People Page 12 of 29 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. Peoples personal, social and health care needs were set out in a person centred plan to ensure that their diverse needs were met. Risks were assessed and action was taken to make sure that people were kept safe. People were generally helped to take their medication in a safe manner. People were treated with respect and their right to privacy was upheld. Evidence: We looked at the care records of three people. Two people had a care plan, which included the outcome that they wished to achieve from their care. The care plans were detailed and covered all aspects of their care. They included information about needs in relation to culture, religion, gender, age and disability. Care plans were reviewed monthly and changes were recorded. The third person had moved in recently and did not yet have a detailed care plan. We recommended at the last inspection that each person, or a representative should sign their care plan to show that they have been involved in developing it and are in agreement with it. Two people had signed their plans to show that they were in agreement with them. Care Homes for Older People Page 13 of 29 Evidence: We made another recommendation that the care plans should be developed further to make them more person centred to ensure that people receive individualised care. We recommended that advice should be sought from a specialist organisation about care planning with people with dementia. The deputy manager told us that she had been on a course with Age Concern about person centred care. She said that she found it very interesting. Following this training the senior carer had developed person centred plans. Each of the three people had a person centred plan. These covered all aspects of their lives including their preferred routine, their likes and dislikes, how they liked to be supported, hobbies and pastimes, conversation points, relationships, personal grooming and behaviours. Risks were identified in the assessment and care plan. Each person also had risk assessments with action taken to reduce risks for example in relation to falls and bathing. At the last inspection we made another recommendation that risk assessments should include all risks to the person and the action and measures required to reduce these risks to ensure that people are kept safe. We saw that each person had risk assessments that included information about risks to the person and any risks they may present to other people. The assessments included the action and measures needed to reduce risks and keep people safe. We noted that information about peoples health care needs were recorded in their assessments and care plans. Peoples contact with health professionals was recorded in their files. These included appointments with the GP, district nurse, community psychiatric nurse, podiatrist, dentist and optician. There was a medication policy. No-one was assessed as being able to manage their own medication. Therefore, all medication was administered to people by staff. Each person had a record of the medicines they took in their personal file. A monitored dosage system was used. The medication was stored in a locked cupboard. There were records of medication received into the home and medication administration record sheets. These were on the whole appropriately recorded. However, some hand written additions had been made to the sheets. These had not been signed or dated so it was not possible to tell who had made the addition and they could not be cross referenced with other records about directions from the prescribing doctor. There was a book to record medication returned to the pharmacist. The pharmacist visited every three months and gave advice about medication. There was a second double locked cupboard for controlled drugs. There was a separate book to record controlled drugs. This was a ruled line book modified for the purpose by the deputy but was not a controlled drugs register. The administration of controlled Care Homes for Older People Page 14 of 29 Evidence: drugs was recorded in this book with two staff signatures. We made a recommendation at the last inspection that a controlled drugs register should be obtained to record the administration of controlled drugs. The manager had not yet obtained one. We also recommended that the registered person should obtain advice from the pharmacist about whether the current controlled drugs cabinet meets the new requirements for the storage of controlled drugs. The deputy told us that the pharmacist had advised that the cupboard was suitable for the needs of the home when they were storing Temazepam. However, they were no longer storing Temazepam. One person was having their medication given to them in their food. This was with agreement from their relatives and the GP. However, there was no procedure for describing which medication can be given with food and under what circumstances. Comments were contained within the homes statement of purpose and service users guide, which confirmed the core values of good practice such as privacy, dignity, choice, independence and fulfilment. The aim of the home was to retain as much privacy as possible for the people who lived there. The issue of respecting peoples privacy was covered during staff induction. Observations and discussions with management and people who lived in the home confirmed that people could choose where to spend their time and who and where to see any visitors. People had access to a phone. People who were able dealt with their own mail. However, the manager dealt with the vast majority of peoples official mail and staff assisted people to understand the contents of any cards and other letters addressed to them. Locks had been fitted to the toilets and bathrooms. The toilet by the main loungedining room had been enlarged and this ensured that peoples privacy was maintained as the door was kept closed when it was used. The manager said that they were building an extension to increase the number of single rooms and ensure privacy. At the time of the inspection most of the shared rooms were being used as single rooms. The manager and deputy said that people had the choice to bathe or shower every day. They also said that they thought it was important to support people to keep clean to maintain their dignity. Care Homes for Older People Page 15 of 29 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. Peoples social and recreational needs were being met. People kept in contact with their families and friends as they wished. People, within their capabilities, could exercise personal autonomy and choice. People received a varied and balanced diet in pleasant surroundings. Evidence: We saw that there was information in the statement of purpose and service user guide about the activities provided in the home. Peoples interests and hobbies were recorded in their care plans. We saw that one persons plan said that they liked to do light household tasks such as drying up and hanging out the washing. The manager told us in the AQAA that they provided a range of daily activities and celebrated festivals such as Christmas and birthdays. They also said that they had introduced a set monthly activities programme. During our visit the manager told us that some residents go out into the community, for example shopping into town and to the park. She said that one person went to the bank. We spoke to one person who said that they could go out independently. They had just been out into town with some relatives. During our visit we saw people talking with staff and looking at magazines. One person was watching the TV in their room. The manager had identified in the Care Homes for Older People Page 16 of 29 Evidence: AQAA that they could improve the service by seeking professional advice about activities for people with dementia. There was information in the statement of purpose and service user guide stating that visitors were welcome in the home at any time. There were records in the personal notes about visits from and to relatives. There was a quiet lounge at the front of the house and a conservatory, which could be used to meet with visitors in private. People could also see visitors in the privacy of their rooms. There was information about maintaining privacy, dignity, choice and independence in the homes statement of purpose and service users guide. People had brought items of furniture and personal possessions to make their bedrooms more homely. They could make their own drinks, choose where to spend their time, where to eat, and what activities to participate in. Staff support was provided to those people who needed help to choose what clothes to wear. One person handled their own finances. Peoples preferred daily routines were recorded in their care plans. People were involved in the daily routines as they chose, for example in meal preparation, hanging out the washing and washing up. The manager had changed the accommodation around to create another lounge dining room. This meant that people had more choice of where to sit and spend time and where to eat their meals. Menus were planned in advance. The deputy manager told us that the senior carer planned the meals and took advice from websites about suitable meals for older people. The menus showed that a variety of meals were served to give a balanced diet. There was a choice of breakfast and tea and a set meal for lunch. Supper was also served and drinks were available throughout the day. Special diets were catered for. Two people had gluten free diets. The menus were adapted to accommodate this. One person chose to have their meals in their room. The manager told us in the AQAA that they were involving people and their relatives in menu planning. The deputy said that they tried new meals and they could tell if people liked them by how much food was wasted. We saw that one persons person centred plan stated that they liked to be involved in preparing vegetables. The manager told us in the AQAA that they tried to have a flexible routine and people could choose when to have their meals. During our visit the deputy told us that some people liked to eat at different times. For example one person liked to have their main meal at night time. Care Homes for Older People Page 17 of 29 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. If people were unhappy with the care home, they or their relatives knew how to complain. Staff had received training about how to recognise abuse and were aware of the procedures so that people were safeguarded from abuse and harm. Evidence: We saw a copy of the complaints procedure within the homes statement of purpose and service users guide. We made a recommendation at the last inspection that relatives should be reminded about how to make a complaint about the service. The manager told us in the AQAA that they had sent out complaints procedures to all the relatives so that they would know how to make a complaint. There was a policy and procedure about responding to suspicion or evidence of abuse and all staff had been given a copy of the shortened version of the Wiltshire and Swindon Vulnerable Adults procedures. Staff who were undertaking National Vocational Qualifications (NVQ) at Level 2 covered protecting from abuse in the NVQ. New staff received an induction using the Skills For Care common induction standards which included abuse awareness. All staff had also received training about abuse and recognising abuse the previous year. One safeguarding issue had been dealt with correctly. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a safe, comfortable, clean and well maintained environment. People had enough shared space and enough toilets and washing facilities to meet their needs. They had safe comfortable bedrooms with their own possessions around them. Evidence: The premises were maintained to a reasonable standard and offered suitable heating, lighting and ventilation. The majority of the decoration in the home was maintained to a good standard. The home provided sufficient communal space consisting of a loungedining room, a conservatory, a separate dining room with a seating area and an additional lounge to the front of the property. These areas were suitably furnished and decorated. The home also provided a small, enclosed rear garden, which was used by some people, particularly those who smoked. The home provided a sufficient number of bath, shower and toilet facilities, which were located close to peoples bedrooms and the communal rooms. The toilet close to the main lounge-dining room on the ground floor had been enlarged to provide more appropriate facilities to meet the needs of people. There were also two very small toilets located on the first floor. The home had three double bedrooms and eight single bedrooms, two of which were Care Homes for Older People Page 19 of 29 Evidence: provided with en-suite facilities. Peoples bedrooms were located on the ground and first floor levels. There was a staircase to the first floor. All rooms were fitted with a call bell system, which people could use to summon staff assistance if required. Peoples bedrooms were adequately furnished and decorated. People had brought items of personal possessions to make their rooms more homely. The manager told us in the AQAA that some parts of the old house required updating and this was an ongoing process. We noted during our visit that some of the flooring in the upstairs bedrooms was worn. The manager told us that she was going to replace the flooring gradually. She said that she planned to refurbish the upstairs bedrooms once the extension was complete. A new extension was in the process of being built. One of the downstairs bedrooms had been removed to make way for the extension. Five single bedrooms with en-suite toilets were being added. There was also a separate shower and toilet. The home was maintained to a reasonable standard and was clean and tidy. The laundry room was located on the ground floor and provided adequate facilities to meet the needs of people who lived in the home. During our visit we observed that peoples clothes were clean and pressed. Peoples clothing was labelled and each person had a named basket in the laundry to store washed clothes. This was to ensure that clothes were returned to the right person. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient numbers of staff on duty at all times to meet peoples needs. People benefited from being cared for by staff who had a range of experience and training to meet their needs. The recruitment practices ensured that people were protected from being cared for by unsuitable staff. Evidence: We looked at the rota and saw that there were usually two staff on duty during the day plus the manager or the deputy. There was one member of waking night staff and one member of sleeping night staff. The deputy told us that there was always two staff on duty during the day and evening and the manager or deputy would be the third member of staff. She said that there was one waking member of night staff and the manager was the sleeping member of night staff. The manager told us in the AQAA that there was a cleaner three days a week. We looked at some of the staffing records. These showed that there were eleven care staff. Four staff had a National Vocational Qualification (NVQ) at level 2 in care and four were working towards NVQ level 2. When these staff have completed NVQ 2 more than 50 of the staff will have a qualification in care. There had been one new member of staff recruited since our last inspection. We Care Homes for Older People Page 21 of 29 Evidence: looked at their recruitment records. They had completed an application form which contained an explanation of gaps in employment. There was a declaration that they had no convictions and a declaration that they were physically and mentally fit. Two written references, a Protection of Vulnerable Adults (POVA) check and Criminal Records Bureau (CRB) check were received before they started work. We looked at the training records. These showed that staff received training about manual handling, first aid, medicine management, food hygiene and dementia awareness. We made a requirement at the last inspection that the registered person must make sure that all staff have received training about health and safety. The deputy told us that all the staff had received health and safety training and we saw certificates to confirm this. In addition the senior carer and three care staff had a level 2 award in health and safety. We made a recommendation at the last inspection that new staff should have an induction using the common induction standards. We saw records that confirmed that the new member of staff had an induction using the Skills for Care common induction standards. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were benefiting from a well run home. People or their families managed their money. There was a quality assurance process and work was taking place to make sure that the home was run in peoples best interests. People were cared for by workers who were well supported by their managers. The environment was generally safe for them and staff because the managers and workers on the whole carried out good health and safety practices although attention was needed to the fire safety checks. Evidence: The manager had many years experience in both management of a relevant care setting and in a supervisory role. She had a nursing qualification but she had not completed a management qualification. We made a recommendation at the last inspection that she should hold a relevant managers qualification. The manager told us that she had almost completed her Registered Managers Award. The manager was supported in the day to day management of the home by her deputy manager who Care Homes for Older People Page 23 of 29 Evidence: had the a National Vocational Qualification (NVQ) Level 4 in care and the Registered Managers Award. She was working towards the NVQ assessors award. The deputy manager had increasingly taken over all aspects of the day to day management of the home and will eventually apply to be the registered manager. The training records showed that the manager and the deputy kept their training about basic care practice up to date. They had received training about dementia awareness. We made another recommendation that the manager and deputy should receive more in depth training about developing a service for people with dementia to keep their practice up to date. The deputy told us that they had not found an appropriate course yet and they were continuing to look for one. One person managed their own money. The manager took one person to collect their pension and they kept their own money. Relatives or solicitors managed the money for other people. The home invoiced the relatives for payments such as for hairdressing and chiropody. The manager had completed an AQAA and sent it to us when we requested it. It was clear and gave us information about what the home does well, what had improved in the last year and what improvements were planned for the next year. We made a requirement at the last inspection that the registered person must establish a system for reviewing and improving the quality of the service based on the views of people who use the service. The manager told us in the AQAA that they had created a new questionnaire for the quality assurance system and were awaiting the replies. When we visited the home we saw a report of the findings from the questionnaires in the statement of purpose and service user guide. This showed that questionnaires were sent to relatives who provided several suggestions for improvements. There was a plan to carry out these improvements including providing name tags for staff, enhancing the garden area and updating the decor once the building work is complete. We made a recommendation at the last inspection that advice should be sought from a specialist organisation about how to involve people with dementia in assessing quality and developing the service. The deputy said that they had not found any suitable advice yet. The deputy had received training about supervision and had introduced supervision contracts and a structured method for recording supervision. We made recommendations at the last inspection that all staff should receive formal one to one supervision at least six times a year and a record should be kept. We looked at the supervision records and saw that most staff had had a supervision meeting with the deputy or senior carer in December 2008 and February 2009 and there were records of these meetings. Each member of staff was due another supervision meeting. We also recommended that each member of staff should have an annual appraisal. Annual Care Homes for Older People Page 24 of 29 Evidence: appraisals had not taken place. The deputy said that the senior carer was planning to do these but was off sick. The deputy had attended a health and safety course, which included risk assessment. Since the last inspection the staff had received training about health and safety. There were certificates to show that the boiler, the hoists, and the electrical wiring were serviced. Portable appliances were tested. The upstairs windows were restricted and the temperature of the hot water was regulated on the tank. Radiators were covered. There was a fire risk assessment dated 2006. This will need to be updated when the building work is complete. There were magnetic hold open devices on all the main fire doors. Examination of the fire log book showed that fire instruction to staff, fire drills and quarterly checks of the alarm system were occurring. However there were no records of the weekly checks of the fire alarm system or checks of the fire fighting equipment and emergency lighting since January 2008. Care Homes for Older People Page 25 of 29 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 26 of 29 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 38 23 The registered person must 11/07/2009 make sure that all the fire safety checks are carried out at intervals prescribed by the fire authority. So that people are protected from the risk of fire. 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 2 9 9 A controlled drugs register should be obtained to record the administration of controlled drugs. A cupboard should be provided that meets the current storage regulations for controlled drugs (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007). This will make sure that any controlled drugs prescribed can be stored properly. A procedure should be developed to describe the circumstances in which medication may be given in food. This will help to make sure that medication is only given in a covert way if absolutely necessary. Any hand written additions to the medication administration records should be signed and dated. This will make it possible to tell who made the addition and to cross Page 27 of 29 3 9 4 9 Care Homes for Older People reference the change with any instructions from the prescribing doctor so that people are given the right medication. 5 6 31 31 The registered manager should hold a relevant managment qualification. The manager and deputy should receive more in depth training about developing a service for people with dementia to keep their practice up to date. Advice should be sought from a specialist organisation about how to involve people with dementia in assessing quality and developing the service. All staff should have an annual appraisal. 7 33 8 35 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!