Care Home: Amberdene Lodge

Similar services:

• Snydale Care Home
• Abbey The
• Hawkhills
• Larchfield Manor
• Beeches The - North Yorkshire County Council
• Carentan House
• Ravensworth Lodge

What the care home does well The home always ensured that peoples` needs were assessed prior to admission. This enabled staff to be sure the home could meet the persons` needs and gave them direction in how to care for them. Staff were clear about how they promoted peoples` independence and choice and provided care to people in ways that respected privacy and dignity. The staff members knew the residents and their families well and were observed speaking to people in a friendly and respectful way. The home has a low staff turnover, which provides consistency for residents. Amberdene Lodge provided a pleasant and homely environment for people. It was clean, tidy and well presented. The home provided nutritious and well planned meals for people, `the food is lovely`. The home managed complaints well. The home has been awarded parts 1 and 2 of the local authority Quality Development Scheme for ensuring care planning and quality monitoring systems are in place. What has improved since the last inspection? There had been lots of impprovements since the last inspection. The manager is now available in the home on a full time basis and has addressed most of the requirements and recommendations made at the last inspection. Pre-admission assessments are more comprehensive and the manager writes to people following the assessment formally stating the home is able to meet the identified needs. The information gathered enables staff to write a care plan that more fully reflects the persons` needs and the tasks staff have to carry out. Staff also have more time to read the care plans. Recording of risk assessments, monitoring charts and daily living has improved. This makes it easier to ensure care is not missed. There has been some improvements in the way medication is managed, which means it is safer for people. The way staff are recruited has improved and the training they need to support older people with a range of needs has been audited and planned. In most cases mandatory training has been completed. Staff confirmed there has been lots of improvements with training and that all staff had received training in how to protect vulnerable people from abuse. Care staff are now well supervised in their role. They have observations of their practice, one to one discussions with the manager and appraisals to discuss their development.The manager now makes regular checks of the environment to make sure that it is safe and there are no areas that require maintenance. Parts of the home have been redecorated, new commodes purchased and three bedrooms recarpeted. A second floor bathroom has been refurbished. Bathrooms have been decluttered and wardrobes are tidier. People that had bedrails have been reassessed and the decision made that rails are no longer required. Paper hand towels have been provided in all communal toilets to aid infection control. The manager has re-started the quality assurance system to ensure that residents and relatives are consulted about their wishes and how home is managed. The system also makes sure that audits are carried out and any shortfalls highlighted. What the care home could do better: The manager should seek advice from the community psychiatric nurse regarding administration of, `as required` behaviour modifying medication. This will ensure staff have clear guidelines about when to administer it. The manager should liaise with the practice manager at the local GP surgery and the pharmacist to ensure medication is delivered in a timely way. Staff could try to establish if there are any specific activities or occupations people would like to participate in to broaden the activity plan already in place. The provision of a designated activity coordinator would enhance the staff time available to residents. During audits or evaluating surveys, if shortfalls have been highlighted an action plan would focus attention in addressing them and evidence that they have been resolved. The home should continue to work towards the target of 50 percent of care staff trained to NVQ level 2 and 3. Key inspection report Care homes for older people Name: Address: Amberdene Lodge Amberdene Lodge 40-42 Boulevard Hull East Yorkshire HU3 2TA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Beverly Hill     Date: 0 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Amberdene Lodge Amberdene Lodge 40-42 Boulevard Hull East Yorkshire HU3 2TA 01482587774 F/P01482587774 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Graham Abel care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Amberdene is a large care home comprising of two Victorian houses on the Boulevard, off Anlaby Road in the west of Kingston-upon-Hull. Local services on Anlaby Road include a chemist, a GP surgery, taxi office, pubs and the Hull Royal Infirmary. Bus services to the city centre and out of the city are a short walk away. The home provides care and accommodation for a maximum of twenty-five older people, who may have dementia. There are thirteen single bedrooms and six shared on three floors, accessed via a passenger lift or stairs. None of the bedrooms have ensuite and one of the shared bedrooms has single occupancy at present. Communal rooms consist of two lounges, one of which people use if they wish to smoke, and a dining room. The home has three bathrooms and nine WCs. Care Homes for Older People Page 4 of 29 Over 65 25 25 0 0 Brief description of the care home There is a garden to the rear of the house, which is accessible via a concrete ramp. There is parking for two cars at the front of the building and also time-limited on-street parking. According to information received from the home the weekly fees are 359.50 pounds. Additional charges are made for hairdressing, chiropody, clothing and toiletries. Information about the home and services can be located in the statement of purpose and service user guide available in the reception. Copies of the most recent inspection reports are also on display. Care Homes for Older People Page 5 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: The quality rating for this service is 2 star. This means that the people that use this service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 8th July 2008 including information gathered during a site visit to the home, which took approximately eight and a half hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Amberdene Lodge. We also had discussions with the registered manager, staff members and a relative. Information was also obtained from surveys received from residents, relatives, staff members and visiting health and social care professionals. Comments from the surveys and discussions have been used in the report. Care Homes for Older People Page 6 of 29 We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Amberdene Lodge, the staff team and management for their hospitality during the visit, and also thank the people who completed surveys and had discussions with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? There had been lots of impprovements since the last inspection. The manager is now available in the home on a full time basis and has addressed most of the requirements and recommendations made at the last inspection. Pre-admission assessments are more comprehensive and the manager writes to people following the assessment formally stating the home is able to meet the identified needs. The information gathered enables staff to write a care plan that more fully reflects the persons needs and the tasks staff have to carry out. Staff also have more time to read the care plans. Recording of risk assessments, monitoring charts and daily living has improved. This makes it easier to ensure care is not missed. There has been some improvements in the way medication is managed, which means it is safer for people. The way staff are recruited has improved and the training they need to support older people with a range of needs has been audited and planned. In most cases mandatory training has been completed. Staff confirmed there has been lots of improvements with training and that all staff had received training in how to protect vulnerable people from abuse. Care staff are now well supervised in their role. They have observations of their practice, one to one discussions with the manager and appraisals to discuss their development. Care Homes for Older People Page 8 of 29 The manager now makes regular checks of the environment to make sure that it is safe and there are no areas that require maintenance. Parts of the home have been redecorated, new commodes purchased and three bedrooms recarpeted. A second floor bathroom has been refurbished. Bathrooms have been decluttered and wardrobes are tidier. People that had bedrails have been reassessed and the decision made that rails are no longer required. Paper hand towels have been provided in all communal toilets to aid infection control. The manager has re-started the quality assurance system to ensure that residents and relatives are consulted about their wishes and how home is managed. The system also makes sure that audits are carried out and any shortfalls highlighted. 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. 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. The assessment processes used by the home ensures that people are only admitted after their needs have been fully assessed. Evidence: We looked at four care files during the visit, one of which was for a person recently admitted to the home as an emergency for respite care. It was clear that the manager had gathered information during an initial discussion with the local authority and had quickly obtained the assessment and care plan produced by care management staff. This enabled the manager to determine whether the persons needs could be met in the home. The manager completed pre-admission assessments in a more planned way for people not admitted in emergencies. These entailed visits to the persons home or hospital and discussions with them and their relatives. There were improvements noted in the comprehensiveness of the assessments completed since the last inspection. Following Care Homes for Older People Page 11 of 29 Evidence: the assessment the manager writes to the person letting them know the home is able to meet their needs. The assessment documentation covered all aspects of health, personal and social care. 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. The home ensured that peoples health and personal care needs were planned for and met in ways that promoted privacy and dignity. Protocols for the administration of specific medication for one resident would give clear instructions to staff and improvements in stock control would ensure people do not run out of medication. Evidence: There had been improvements noted in care plans since the last inspection. Those examined covered all needs identified at the assessment stage and had clear instructions for staff regarding the tasks required to meet peoples needs. Care plans had been individualised and included likes, dislikes and preferences, for example regarding the clothes they liked to wear, the portion size of their meals and what time they liked to rise and retire. The care plans also included information on what the person was able to do for themselves, which enabled staff to be clear about how to maintain the persons Care Homes for Older People Page 13 of 29 Evidence: independence rather than automatically doing tasks for them. Most care plans had been signed by the resident or their representative and those that hadnt had been picked up in an audit carried out by the manager. Care plans were evaluated monthly and there was evidence of reviews taking place with care management teams and relatives present. One care plan could be improved by including protocols for the administration of a particular medication. The manager completed risk assessments for activities such as moving and handling, smoking, falls, nutrition and pressure area care. These were evaluated and updated when needs changed. There was also evidence that residents had access to a range of health care professionals for advice and treatment. The staff had been monitoring one persons behaviour to inform the community psychiatric nurse of their progress and to enable a change in medication as required. Peoples weight was monitored and recording was generally good for day to day care, monitoring charts and keyworker notes. Staff kept an individual record for each resident of any notable changes regarding health and medication. They contacted emergency care practitioners if any resident had a fall and needed to be checked over by health professionals. People spoken with and surveys received from residents and their relatives told us that they were happy with the care they received and that privacy and dignity was promoted, they do look after you here, the staff are lovely and they keep mam nice and clean, make sure she eats her dinners and look after her very well. Eight of the surveys received from residents stated they received care and support they needed, always and two people said this was, usually. Generally medication was managed well. It was stored appropriately and staff had information to hand about each medication the residents were prescribed. Staff maintained records of when medication was changed by the GP and signed all medication into the home and when administering it to people. It was noted that two residents had painkilling medication prescribed four times a day, however, they frequently declined it. This needs to be discussed with the prescriber to be made, as required. There had also been a stock control issue for two of the residents medication. The manager advised that this was in part because medication was delivered on Thursday ready for start on Friday. However if there were any issues Care Homes for Older People Page 14 of 29 Evidence: it was not possible to get a new prescription for forty-eight hours and because of the weekend this took them to Monday. This potentially left the person without medication for 3-4 days. Another stock issue was that a resident needed fifty-six tablets for a months supply but the prescription was often written for twenty-eight tablets. The home then had difficulty obtaining a repeat prescription mid-month. These two issues need to be addressed with the practice manager at the GP surgery. One resident was prescribed medication, as required to help stabilise their behaviour. Clear protocols for when this medication needs to be given should be in place and advice from a community psychiatric nurse would help staff to develop them. 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. The home provided flexible routines, which enhanced the choices people had about aspects of their lives. Peoples nutritional needs were met by the provision of a well balanced diet. Evidence: Residents told us that their visitors were welcomed at any time and a discussion with a relative confirmed this. In surveys relatives told us that they were kept informed of important events affecting residents. One person said, they always keep us informed and invite us to parties. The home provides some activities for people including films, bingo, skittles, boules, reminiscence, bean bag games and singalongs with dancing. There are also trips to the local shops and outings in a minibus to the coast. Staff told us they organised a trip to Darleys pub for residents about four times a year. Local clergy also visited specific residents for Holy Communion. Staff also told us that some residents liked to set the tables at meal times and fold tea towels. In surveys six residents stated they had activities to participate in, always, Care Homes for Older People Page 16 of 29 Evidence: three said this was, usually and one person said it was, sometimes. In discussions on the day two people felt there could be more activities or occupations to keep people stimulated. Comments were, they need more entertainment - just to sit and chat would be good and I just sit in my chair - there is not much I want to do, if its nice and sunny I will sit outside. Other people stated they were quite happy with the way things were. The manager could check out whether everyone is happy with the stimulation on offer and try to address individual preferences. In discussions with the staff team it was clear they tried to ensure that residents made what choices they could about aspects of their lives, and routines were flexible. Some people chose to continue smoking and facilities were arranged for this, some people managed their own personal allowance and one person managed part of their medication. People had the choice of where to sit and have their meals, the times of rising and retiring and whether they preferred to stay in their bedrooms. In surveys and discussions people told us they liked the meals, the food looks lovely, the foods alright here and what you dont like you dont eat - Ive put a stone on in weight since coming here. The cook told us that menus had recently been broadened to accommodate suggestions from residents. Food request surveys, that residents had completed, highlighted that some people liked black pudding so this has been incorporated into the cooked breakfast provided weekly. Fresh fruit has also been provided on the tea trolleys as an alternative to biscuits and cakes. Menus were on display and although there was only one choice indicated for the main meal people confirmed there were alternatives. The cook advised there were sometimes 4-5 different choices cooked at the main meal. Some residents had input from dietician services that had been referred via the GP. 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. People are protected from abuse by staff training and adherance to polices and procedures. People feel able to make complaints and know what to do, and who to see, if they are unhappy about anything. Evidence: The home has a complaints policy and procedure that is on display and complaints forms for people to complete, should they wish concerns to be investigated by the manager. The complaints records highlighted six minor complaints since the last inspection and all had been resolved. Staff members were aware of what action to take should people raise concerns with them and all stated they would try to sort out complaints quickly. Residents stated in surveys that they knew how to make a complaint and those spoken with during the visit said they felt able to tell staff if they were unhappy. Out of four surveys completed by relatives, three stated they knew how to make a complaint and one person couldnt remember. All stated any concerns raised were dealt with appropriately. The home used the multi-agency policies and procedures to ensure that vulnerable adults were safeguarded from abuse and all but new staff had completed safeguarding Care Homes for Older People Page 18 of 29 Evidence: training. In discussions staff were clear about how they would respond if they witnessed any poor practice or abuse, I would make sure they were safe and report it, we would record everything and tell the manager and we would send an alert to social services. The manager has completed more in depth safeguarding training with the local authority regarding their referral and investigation role. Since the last inspection the local authority received an anonymous complaint regarding two residents being unhappy with the moving and handling techniques used. This was investigated and unsubstantiated. The Commission also received a complaint about staffing and it appeared from rotas we requested that one staff member in particular was working extra night shifts several months ago to cover staff sickness. However, a recruitment drive has ensured that staffing levels have since improved. We have received three notifications regarding one resident that is very independent and who likes to leave the home un-escorted. He is able to make his own choices and the home, in consultation with the local authority, has put in place risk management strategies to support him whilst he is out and about. This tells us that staff ensure that people are able to live as independent a life as possible even when this sometimes involves risks for them, but staff are aware that the risks have to be managed appropriately. Care Homes for Older People Page 19 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. The home provided residents with a clean and safe place to live. Evidence: The home was clean and tidy and free from any malodours. Communal rooms consisted of two lounges, one of which people used if they wished to smoke, and a dining room. The rooms were decorated in a homely way. The dining room had four separate tables and chairs to seat six people at each. This would enable all residents to use the dining room at any one sitting. The manager advised that some people chose to have their meals in their bedroom or in the lounge. People spoken with were happy with the cleanliness of their home, the home is clean and odour-free, staff tidy up and change the beds, its a very nice home - Im happy here and its a nice place here. One health professional stated in a survey, homely, warm environment and all ten surveys received from residents stated the home was clean and fresh either, always or usually. Staff also said that they tried to keep the environment clean and homely for people. The home has an ongoing redecoration plan and since the last inspection the two hallways, both lounges and bedrooms on the top two floors have been redecorated. Three bedrooms have been re-carpeted and ten commodes have been purchased. New bed linen has been ordered. The manager and provider check the environment more Care Homes for Older People Page 20 of 29 Evidence: frequently to enable any minor issues to be resolved quickly. The home had thirteen single bedrooms and six shared rooms over three floors, accessed via a passenger lift or stairs. None of the bedrooms had en-suite facilities. Shared bedrooms had privacy screens and all rooms had a privacy lock for the door. Some of the bedrooms had a lockable facility to store personal items. Staff had tried to make the bedroom of one resident more homely, although this had proved difficult for them as the occupant liked to move objects around. Other bedrooms seen were personalised to varying degrees dependent on the residents choice and taste. Paper hand towels had been installed in communal toilets to assist in infection control. The home had adequate laundry facilities. Care Homes for Older People Page 21 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. The home had sufficient staff to support residents safely and there were systems in place to ensure staff were recruited robustly and had access to appropriate training to equip them with the skills required for their roles. Evidence: The home currently has twenty-two residents, although one person is in hospital. Staff rotas evidenced that there was one senior carer and two carers during the day and two staff at night with an on-call system of the manager and senior carers. The manager was supernumerary and according to staff helped out with personal care tasks at busy times. The manager advised they were currently recruiting more staff to enable an extra carer during the day. This would enable care staff to have more time to sit and talk to residents and participate in activities. However, residents stated they did not feel rushed when supported and some described how the staff enabled them to maintain their independence by ensuring they still did things for themselves, I do lots of things for myself but sometimes the staff shave me. Other comments about the staff were, they are lovely - very kind, the staff are alright, they are taking me into town on Tuesday, I am very happy with the staff, they look after her very well and they keep mam happy and comfortable. Two visiting health professionals described staff as, friendly and always helpful. Care Homes for Older People Page 22 of 29 Evidence: Induction of new staff consisted of an orientation as to how the home worked and covered policies and procedures. However, the manager has obtained skills for care induction information and is to start new staff on this induction process. This means that competence in particular areas will be assessed and signed off by senior staff. The home is fortunate in having a low staff turnover confirmed in discussions with staff. Out of those spoken with on the day, one had worked at the home for fourteen years, two for nine years and two had worked there for two years. The continuity of staff was important for residents. Since the last inspection the manager has completed a full audit of training required by the staff team and a training plan has been produced. There were still some staff to complete food hygiene, health and safety and infection control but the manager was aware and courses were being sourced. All seniors, night staff and some day care staff have completed first aid, all staff have completed fire safety, moving and handling and safeguarding adults from abuse, and seniors have completed deprivation of liberty, mental capacity legislation, diabetes, eating and drinking difficulties and medication. Catering staff and senior carers have completed food hygiene training. Infection control has been arranged for six staff in August. The home is able to access training facilitated by the local authority, and courses in dementia care, dealing with violence and aggression, and mental health awareness have been requested for ten care staff for each course. The manager has also requested four places for senior staff to attend training in mental health and wellbeing in older people. The manager has also started a resource file with information about conditions affecting older people and health and safety. The improvements in the training provided for staff was noticeable and was confirmed in discussions with the staff team, its improved lots this year. The home had also increased the percentage of care staff that had gained a national vocational qualification (NVQ) in care at level 2 and 3 from 37 percent to 38 percent. The target of 50 percent will be exceeded when the nine staff progressing through the course have completed it. Staff prior after Staff recruitment has improved since the last inspection and checks are carried out to the start of employment. There has been a need to employ some care staff a povafirst check but prior to the return of the full criminal record bureau check. worked alongside other more senior members until the final check was returned. Care Homes for Older People Page 23 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. The home was well managed and was a safe place for residents to live in and staff to work in. Evidence: The registered manager has worked in care for eighteen years and has a wealth of experience. She has management qualifications and has completed the Registered Managers Award. Since the last inspection she has kept herself up to date with relevant training such as, mental capacity legislation and deprivation of liberty safeguards, first aid, fire safety, practical moving and handling and a managers course in how to safeguard vulnerable adults from abuse. She is very enthusiastic about her role and knows the people that live at the home very well. Staff spoken with describe the manager and proprietor as very approachable. Comments were, I couldnt wish for a better boss and she is very supportive. One resident commented on the proprietor, I see Graham and he does jobs for me - he made some shelves for my DVDs. Management and staff have been supportive of one Care Homes for Older People Page 24 of 29 Evidence: another through a series of personal bereavements and the manager explained that it has been a difficult year for staff but residents needs have continued to be the focus throughout. The proprietor visited the home most days to complete maintenance tasks, decoration, support the staff team, chat to residents and even to assist with outings. People that lived in the home knew the managers name, which told us she made her presence felt about the home. The home had a quality assurance plan that consisted of audits each month, surveys to people to obtain their views on the services provided, observations of staff practice and consultation meetings. There was an improvement noted in quality monitoring since the last inspection and the audit and survey plan was being followed with shortfalls addressed when highlighted. Some of the surveys, such as resident menu requests, could have an action plan to detail how comments have been addressed. For example, that this information has been passed to catering staff and incorporated into the menu plans. The annual quality assurance assessment (AQAA) requested by the Commission was provided within the timescale and the home had gained both parts of the local authority quality development scheme. Residents finances continued to be managed appropriately. People had individual record sheets and monies deposited were receipted. All monies out were signed for and if staff purchased items on residents behalf they had to obtain a receipt. Monies were securely maintained in the safe with limited access, however residents and their relatives had access to finance records for checking. There were records to evidence that care staff were supervised formally every two months. This included an observation of their practice with a care task. The manager stated she wanted to be sure care staff were supporting people with respect and dignity. Staff also had one to one discussions with their line manager and appraisals, which included a development interview. There was also evidence that the manager had discussions with staff following incidents that occurred in the home. The records maintained for the safe running of the home had improved and were stored securely. Since the last inspection the manager had reviewed the need for bedrails and Care Homes for Older People Page 25 of 29 Evidence: reassessed the residents that had them in place. Following a risk assessment a decision was made to remove the three bedrails and the residents have managed well. Fire alarm checks and drills were completed to ensure staff were aware of evacuation procedures and all had up to date fire safety training. Staff also took part in other mandatory training such as first aid, moving and handling, health and safety, food hygiene and how to safeguard vulnerable adults from abuse. This equipped staff with the knowledge and skills to ensure the home was a safe place for residents. Care Homes for Older People Page 26 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 27 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 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 9 The manager should seek advice from the community psychiatric nurse regarding administration of, as required behaviour modifying medication. This will ensure staff have clear guidelines about when to administer it. The manager should liaise with the practice manager at the local GP surgery and the pharmacist to ensure medication is delivered in a timely way, to prevent medication running out and to ensure people receive medication as prescribed for them. Staff could try to establish if there are any specific activities or occupations people would like to participate it to broaden the activity plan already in place. The provision of a designated activity coordinator would enhance the staff time available to residents. The home should continue to work towards 50 percent of care staff trained to NVQ level 2 and 3 in care. Action plans should be produced which would detail how shortfalls that have been identified in surveys or audits are to be addressed. This would enable a clear audit trail for improvements. Page 28 of 29 2 9 3 12 4 5 27 33 Care Homes for Older People Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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!