Care Home: Ami Court Care Home

Similar services:

• Conifer Lodge
• Compton House
• Cornford House
• Copperfield House
• Cornfields
• Cornwell House
• Cornerways Rest Home
• Corrina Lodge Nursing Home

What the care home does well There is a homely atmosphere. The Manager consults with people before they move in so that they are confident that their needs can be met. One health care assistant says, `we talk with (the Manager) and with the nurses to find out about someone before they come in so that we can welcome them without having to bother them with too many questions. It`s a big thing moving somewhere new and so people need to be made to feel welcome and they need to be able to settle in and ask questions`. People say that they receive the assistance they need in ways that are right for them. One person says, `the staff are good really and helpful. I don`t have any complaints about them and they help me when I need it`. The Expert by Experience says that nurses and health care assistants are, `polite and considerate to the residents`. People can receive visitors whenever they wish and they can meet with them in private. The Manager keeps in touch with relatives so that they know how things are going. One relative says, `I am kept informed of any problems` and `(I) am able to visit at any time of the day`. People enjoy their meals. One person says, `we have very good meals here and I always have enough. There`s a choice. I`ve no complaints about the food`. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. The accommodation is presented to an excellent standard. There is a good range of special equipment such as hoists to help people who have reduced mobility. The kitchen meets the requirements of the local Department of Environmental Health. Security checks are completed on new nurses and health care assistants. Nurses and health care assistants are receiving regular training in a number of relevant subjects. What has improved since the last inspection? A number of improvements have been made since the Service opened. The range of social activities that people can do has been extended. The amount of choice provided by the menu has been increased. The timing of some meals has been changed to better fit in with people`s wishes. There are new safeguards to help make sure that a full assessment is completed before someone`s freedom is restricted. Training has been arranged for nurses and health care assistants to help them to use the new arrangements. All of these things contribute to the Service being better able to care for people in ways that are right for them. What the care home could do better: Although the overall system used to manage medicines is reliable, some further improvements are necessary. Some nurses and health care assistants need to receive extra training and guidance about how best to respond to situations where someone might need to have parts of their freedom temporarily restricted. The arrangement of preparing most foods in the next door service and taking meals between the two buildings on covered trays has not been notified to the local Department of Environmental Health for review. The practice may result in food becoming too cool. Also, it may not be consistent with achieving good standards of food hygiene. The system used to retain small amounts of money on behalf of people who live in the Service is not well recorded. This makes it difficult for the Registered Provider to demonstrate that the system is working in a reliable way. Most members of staff are not receiving fire safety training in the way considered necessary by the Registered Provider. This might compromise the level of fire safety protection provided in the Service. One immediate requirement and two requirements have been made as a result of this inspection. Key inspection report Care homes for older people Name: Address: Ami Court Care Home Ami Court Care Home 198 Dover Road Walmer Deal Kent CT14 7NB     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: Mark Hemmings     Date: 0 8 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Ami Court Care Home Ami Court Care Home 198 Dover Road Walmer Deal Kent CT14 7NB 00000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Raj and Knoll Ltd Name of registered manager (if applicable) Mrs Amita Patel Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 38 The registered person may provide the following category/ies of service only: Care home with nursing ( N ) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Up to 38 older people who need nursing care or personal care can make their home in AMI Court Care Home (the Service). The property is a three storey detached building. It was purpose built in 2009 and the Service opened last November. There is a passenger lift that gives step-free access around the accommodation. Care Homes for Older People Page 4 of 29 Over 65 38 0 Brief description of the care home All of the bedrooms are single occupancy. They are laid out as self contained bed sitting areas. There is a bed, a comfortable chair, bed side table and a wardrobe. Each has their own bathroom with a special walk in shower. Each bedroom has a television point and a telephone. There is one shared use bathroom. This has got a special rise and fall bath that has easy access. There is also a shared use shower room that has got a walk in shower. There are an adequate number of toilets. There are three lounges. The main one leads out onto the garden by some patio doors. All of the bedrooms, the bathrooms and the toilets are connected to a call bell system. This means that people can summon a member of staff if they need assistance. At the back of the building, there is a small garden area that is laid to lawn. There is a patio area but there is no garden furniture. The Service is set back a little from a busy main road. There is a convenience general store nearby. There is a bus stop nearby and there is some limited off street car parking. The nearest mainline railway is about one mile away. The Service does not have its own vehicle. The Registered Provider is a private limited company that runs a similar residential service next door. One of the Directors of the company is the Registered Manager. The weekly fee for living in AMI Court Care Home runs from £525.00 to £750.00. Please contact the Manager to find out more details about the charges and what they include. 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 who use this Service experience good quality outcomes. This is the maximum rating that the Service can have. This is because new services need to have an established history of excellent performance before they can be considered for a higher star rating. We arrived unannounced at the Service at about half past seven in the morning and we were there for about six and a half hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). We received this on time. Some parts of it are only completed in very brief detail. During the present inspection, we spoke with 10 of the people who currently live in the Service. We spent time in the company of another seven of them while they were in the lounges or resting in their bedrooms. We met with three relatives. We spoke with Care Homes for Older People Page 6 of 29 the Manager and with another Director of the Company. We also spoke with four nurses, three care workers, the chef and the administrator. We looked around parts of the accommodation and the grounds. Also, we looked at a selection of key records and documents. These included things like the individual written plans of care and related documents, the menu, complaints documents, the staff roster, staff training records, financial records and various health and safety certificates. The Registered Provider has asked people who live in the Service to complete questionnaires about their home. Later on in our Report, we will tell you the main things that are being said in these questionnaires. A part of the inspection was completed by a pharmacy inspector. She has a detailed knowledge of how medicines should be ordered, stored, recorded and administered. She checked storage facilities for medicines. Also, she looked at records relating to the receipt, administration and disposal of medicines. She talked with five members of staff and observed medicines being given to one person. She checked some individual plans of nursing and personal care to cross reference her findings. We were joined by an Expert by Experience. She has a thorough knowledge of the special needs of older people. She spent about three hours in the Service. During this time, she observed what was going on in the lounges. She also talked with people who live in the Service and with members of staff. She had a look around the main parts of the accommodation. This included going into some of the bedrooms by invitation. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? A number of improvements have been made since the Service opened. The range of social activities that people can do has been extended. The amount of choice provided by the menu has been increased. The timing of some meals has been changed to better fit in with peoples wishes. Care Homes for Older People Page 8 of 29 There are new safeguards to help make sure that a full assessment is completed before someones freedom is restricted. Training has been arranged for nurses and health care assistants to help them to use the new arrangements. All of these things contribute to the Service being better able to care for people in ways that are right for them. 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. People who are thinking of moving in are asked about what nursing and personal care they need and how they want this to be done. They are encouraged to visit the Service to get a first hand feeling of what it is like. People who want to stay for only a short time are supported to go home again. Evidence: The records show that the people who are thinking of moving in are asked about what nursing and personal care they need and want. They and their relatives are also invited to visit the Service. This is done so that they can be confident that moving in to AMI Court Care Home is the right thing for them. The Manager also talks with people such as doctors and care managers (social workers). All of this helps her to build up a really good picture of how the person can best be supported. People can choose to move in for a trial period first so that they can get a first hand understanding of what living in the Service is like. One person says, I did understand Care Homes for Older People Page 11 of 29 Evidence: that I would stay for a while first before deciding about staying so that I could see if I liked it. You need to stay somewhere before you know what it is like. There is a Service Users Guide. This is a brochure that gives lots of useful information about the facilities and the services that people can expect to have when they move in. There is also a written statement of the terms and conditions of residency. This gives information about things such as the fees payable and what they include. Nurses and health care assistants say that the Manager shares with them the information she has obtained about someone who is due to move in. This is done so that they know what care they need to provide. One health care assistant says, we talk with (the Manager) and with the nurses to find out about someone before they come in so that we can welcome them without having to bother them with too many questions. Its a big thing moving somewhere new and so people need to be made to feel welcome and they need to be able to settle in and ask questions. Most of the people who move in do so with the intention of making AMI Court Care Home their longer term home. However, someone might only need to stay for a shorter time. This might be so that they can recuperate before going back to their own home. The Manager says that she liaises carefully with relatives and health and social care professionals in order to help the person achieve their goal of moving on. 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. There are written individual plans of care that describe the nursing and personal care to be delivered. People are reliably receiving all of the support they need. They are treated with courtesy and respect. People have access to the medical and health care services they need. Overall, there are good facilities and systems for the management of medication. There are limited shortfalls in recording the use of some medicines and in the way that medicines are given out. Evidence: Each person has an individual written plan of care. These describe the nursing and personal care they are to receive. The plans are detailed and are kept up to date with regular reviews. When people use the call bell to ask for assistance it is answered promptly. The records show that people are receiving the medical care they need. This includes seeing professionals such as their doctor as and when they are needed. They also see specialist nurses who give advice to the Service about how best to respond to people Care Homes for Older People Page 13 of 29 Evidence: who have complicated nursing care needs. In their replies to the Registered Providers questionnaire people say that the care they receive is very good. One person says, the staff are good really and helpful. I dont have any complaints about them and they help me when I need it. Someone else says, Ive no complaints about the staff, they come to help me when I need it and theyre kind to me so I dont mind asking for help. The Expert by Experience says members of staff are, polite and considerate to the residents. One relative says, (I am) so pleased with the care my mother has received, particularly with respect to (a particular medical condition) which has been treated and is now looking good. The Service has good facilities to keep medicines safe. Some medicines need to be kept cool. On the day of our inspection visit, the temperature recorded in the medicines refrigerator was too warm. If some medicines are stored at this temperature they may not be at their best. However, the records show that previous to this, the temperatures have been within the required range. There is a recommendation about this matter at the end of this Report. Controlled drugs are medicines that require more secure storage than usual and their use has to be recorded more thoroughly. These medicines are controlled because they are addictive and can be abused. There are several minor recording errors for these medicines which means that complete information about their use is not available. Complete and accurate records are required by the law so that proper audits can be completed and to reduce the risk of abuse. There is a requirement about this matter at the end of this Report. There are several gaps on the charts that should be completed each time a medicine is given. On checking supplies we saw that one medicine was not in stock. In some other instances it was not possible to check the stock level. This means that we cannot be certain that the medicines in question were given. There is a requirement about this matter at the end of this Report. For one antibiotic medicine which was prescribed four times a day, the records showed that it was given only three times a day. An immediate requirement was made during the inspection visit to ensure that the medicine in question is given as prescribed and intended by the doctor. The immediate requirement is confirmed at the end of this Report. For seven people the medicines prescribed for the morning of our inspection visit were not signed as having been given, although the remaining supplies showed that they Care Homes for Older People Page 14 of 29 Evidence: had been dispensed. These seven residents all have their bedrooms on the same floor and have their medication administration record sheets in one file. Each person should be given medication on an individual basis with their personal record then being completed straight away. We were told that the our presence had made the nurse on duty nervous and that this was the reason for the recording errors. However, they do show that on this occasion the medicines were given to a group of people before the nurse had intended to complete the records. This means that they were given in a task centred way rather than by using a person centred approach. There are no individual plans to guide nurses when administering particular medicines that can be taken on a discretionary basis as and when they are needed. This might lead to these medicines being given in an inconsistent manner. 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. People can take part in a limited range of social activities if they want. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: There is someone who comes into the Service twice a week to lead gentle exercises. This used to be once a week but it was increased in line with peoples requests. Someone else comes in weekly to do aromatherapy. There is an entertainer who calls about once a month. Recently some board games have been requested and provided. There is a religious service every three weeks. A hairdresser calls once a week. There have not been any organised trips out since the Service opened. People say different things about the adequacy of the calendar of activities. In their replies to the Registered Providers questionnaires people are positive about the activities they can do. One person says, it can be a long day with just (other people) to watch. You get to rely on family and friends coming in. You have to fill your own time in here. Someone else says, I like being here in the lounge with people around me. We have the exercises and things to do. Thats enough for me thanks. The Expert by Experience says, residents do not seem concerned that there is a lack of activity. Care Homes for Older People Page 16 of 29 Evidence: Although staff do know individuals well, they cannot come up with any ideas that might stimulate them. However, the home has not been open many months and I was told that activities are something that they intend for the future. People are free to receive visitors whenever they want. They can speak with them in the privacy of their bedroom if they wish. The Manager says that she keeps in touch with relatives so that they know how things are going. One relative says, I am kept informed of any problems and (I) am able to visit at any time of the day. The Manager says that people are encouraged to make their bedrooms their own private space. They are helped to arrange them as they want them to be. People can use their bedrooms whenever they want. They can choose to have private time on their own or to be in company. The Registered Provider does not get involved in helping people to manage their financial affairs. Most people are helped by their families or by the local authority. The records show that there is a varied menu and that special needs and personal preferences are met. The main meal is lunch and the sorts of dishes served are things like lamb hotpot, salmon fillet, shepherds pie and cheese flan. There is sometimes a cooked option for tea and people can have a cooked breakfast if they want. There are drinks and biscuits served mid morning, mid afternoon and later in the evening. People can dine in their bedroom if they wish. Recently the timing of some of the meals has been changed so that they are more convenient for people. Also, the menu has been revised in response to peoples suggestions. One person says, we have very good meals here and I always have enough. Theres a choice. Ive no complaints about the food. Someone else says, (the meals) are normally okay and I certainly have enough. The Expert by Experience says, food is served individually to those in their rooms and is hot and on time. Residents in the lounge eat with a table by their chair. There is no dining area set up so there is little need for people to be mobile but every one seemed happy. 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. There is a complaints procedure. There are systems in place that are designed to keep people safe. Extra training is needed to support nurses and health care assistants when using some of these systems. People are protected from prejudice and discrimination. Parts of the arrangements used to retain someones money needs to be strengthened. Evidence: There is a complaints procedure that explains how someone can raise concerns in relation to the Service. The procedure says that, (we) welcome complaints and look upon them as opportunities to learn, adapt, improve and provide better services. All complaints will be dealt with properly and taken seriously. Since opening the Registered Provider has received six relatively minor complaints. The records show that these have been properly investigated and resolved. People who live in the Service are confident that they are safe and that their wellbeing will be promoted. One health care assistant says, all of the residents get treated really well. They get kindness and attention like everyone wants and should have. I have never seen any unkindness here and Im sure that (the Manager) wouldnt stand for it. Kent County Council is currently investigating several concerns that peoples wellbeing may have become compromised. We understand that the Registered Provider is Care Homes for Older People Page 18 of 29 Evidence: cooperating fully with the enquiry. The Manager says that some recommended improvements have already been made and that others will be implemented as necessary. New safeguards are now required for exceptional circumstances when someone may need to have parts of their liberty limited to promote their best interests. The Manager recognises that nurses and health care assistants need more training about this matter. She has arranged for this to be undertaken in the near future. The Assessment commits the Registered Provider to promoting diversity in the Service. It says, prejudice of any sort is not tolerated. Ageist attitudes within the Service are not tolerated by either staff working within the home or by professionals. This means respecting each person who lives there as an individual. It also means making sure that no one experiences any form of prejudice or discrimination. Nurses and care workers receive training about this subject. This is done both when they start their employment and then on an ongoing basis. The Manager says that this commitment to promoting diversity is also expressed in practical terms. For example, in the way that each person receives individualised care in ways that respect their preferences and wishes. The Registered Provider assists one person to manage small amounts of their personal spending money. This is done so that they have enough to buy things such as toiletries and to pay for things such as hairdressing. The system is not well recorded and so it is difficult for the Registered Provider to show us that it working in a reliable way. The Manager says that a more detailed record will be introduced so that there is a clear account of the various transactions involved. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation is presented to a very high standard. There is a modern fire safety system. The kitchen is adequately equipped. The way in which prepared foods are being transported needs to be reviewed. There is enough equipment to help people who have difficulties with their mobility. There is a suitable laundry. Evidence: The building provides a suitable range of facilities for the people who live there. These are in line with what the Registered Provider has committed itself to deliver in its Statement of Purpose. This is a legal document that describes in some detail the facilities and services that are available in AMI Court Care Home. The building is well presented on the outside. The garden area is neat but uninteresting. On the inside, the accommodation is presented to an exceptionally high standard. The Expert by Experience says, all is in excellent order, being a new building. The decoration of Ami Court is bright, well lit and ventilated. The walls in the main corridors have large bright and cheerful pictures hanging and the bedrooms are bright, clean and had items belonging to the individual resident in them. There is a range of equipment to help people who have reduced mobility. There are two mobile hoists that can be used in the lounges and in the bedrooms. These are being used in the correct way. There are other things such as special sheets to help Care Homes for Older People Page 20 of 29 Evidence: people change position in bed. There are sensible things such as frames around toilets and bannister rails in the corridors. There is a modern automatic fire detection system. This has been assessed to make sure that it meets the national standard. People say that the accommodation is always comfortably warm. The radiators are cool touch. This means that their surface does not become hot enough to burn someone. There are large sky lights in the main lounge. These do make the room uncomfortably hot when the sun is out. The Manager says that blinds will now be fitted to reduce this problem. The hot water system is temperature controlled. This has been done so that it does not get hot enough to scald someone. The water pressure on the second floor is quite low. The Manager says that there are plans to address this problem. The kitchen is clean and well equipped. At the moment it is not being used for the main meals. These are prepared in the next door service and brought over on covered trays. There is a heated trolley but this is not being used because the path is not very level. The Registered Provider is going to check with the local Department of Environmental Health to see if this arrangement is acceptable. There is a recommendation about this matter at the end of this Report. The kitchen that is currently used for preparing the main meals is neat and clean. The chef follows good food hygiene practices. The laundry has two commercial grade washing machines. These have special cycles for items that need an extra thorough wash. There are two commercial dryers. There are sluices that are used for cleaning items such as commodes. 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. There are enough nurses and care workers on duty to provide people with the care they need. Nurses and care workers know what they are doing. They are receiving most of the training that the Registered Provider considers them to need. Security checks are completed on new nurses and care workers. Evidence: The records show that there is always a qualified nurse on duty. They are supported by five or six health care assistants. At night time there is a nurse and two health care assistants on waking duty. During the day there are other people who do the housekeeping, the laundry and who work in the kitchen. One nurse says, I think that we have enough staff to ensure that all of the nursing and care tasks are done in the right way. Theres no need for people to rush and Im satisfied that the place it staffed adequately. A health care assistant says, we always have between five or six health care workers on duty and it seems to be enough to get the work done. The records show that the necessary security checks are being completed for new nurses and care workers. These include things such as confirming their identity, taking up references and doing a police check. This is done to make sure that they are trustworthy people to work in the Service. Care Homes for Older People Page 22 of 29 Evidence: The records show that nurses and care workers do introductory training before they join the roster. After their introduction, there is ongoing training in key subjects such as first aid, health and safety and how to promote good hygiene. The records show that most of this training is being completed in an organised way. One health care assistant says, Ive done lots of training about important things such as how to help people transfer, health and safety and other things. There always seems to be another course to attend and in general the training is very helpful for the work that we do. Most members of staff are a little overdue the periodic fire safety training that the Registered Provider considers to be necessary. A minority of them are significantly overdue. The Manager is going to address this oversight by 1 July 2010. A majority of the health care assistants have completed a relevant National Vocational Qualification (NVQ). This Award is designed to further develop their ability to provide people with the assistance they need. 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 Manager is registered with us. There is a quality assurance system. There are reliable health and safety arrangements. Evidence: The Manager is a Registered General Nurse and she has a recognised management qualification. Nurses and health care assistants say that there is good team work in the Service. One nurse says, we work together well as a team of nurses and the health care assistants know what they need to do without too much direction from us. A health care assistant says, in general its a happy place to work and lots of people have worked for (the Manager) for a long time including me which is a good sign isnt it. I wouldnt stay if I wasnt happy. There are handover meetings at the beginning and end of each shift. These are when nurses discuss how things are going so that they can plan what needs to be done. Care Homes for Older People Page 24 of 29 Evidence: They then pass this information on to the health care assistants. There are regular staff meetings. Each nurse and health care assistant meets on a one to one basis with the Manager in order to review their work and to plan their professional development. There are residents meetings when people can comment on the Service. There are also the annual questionnaires to which we have already referred. There is a suggestion box. There is evidence to show that suggested improvements are implemented. There is a health and safety policy. This commits the Registered Provider to maintaining a safe environment in the Service. Fire drills are held regularly. Fire safety equipment is being checked frequently to make sure that it remains in good working order. The chef regularly checks that the refrigerators and freezers are cold enough to store food safely. She also checks that hot foods are cooked through. There is a system to date mark food so that it does not go beyond its use by date. All items of equipment are new and are within their warranty period. The Manager says that when this expires they will be inspected and serviced on a regular basis. The records also show that there have not been many significant accidents in the Service since it opened. The Manager monitors the occurrence of accidents. This is so that she can see if anything needs to be done to help prevent them from happening again. She says that nothing particular needs to be done at the moment. The Records show that the Manager checks to make sure that there are no hazards that might result in someone having an accident. The Manager says that there are no particular hazards that need to be dealt with. We did not notice any either. 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 9 13 The Registered Provider is 09/06/2010 required to dispense fully Medicine 1 to Person A in the manner prescribed by their registered medical practitioner. To ensure that Person As treatment and healthcare needs are met Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The Registered Provider must keep complete and maintain accurate records relating to the storage and use of medicines including controlled drugs. To ensure that there is sufficient information to enable the storage and use of medicines to be checked. 31/07/2010 2 9 13 The Registered Provider 31/07/2010 must ensure that a safe, person centred procedure is used when giving medicines. To ensure that medicines are given in an appropriate individualised way that is Care Homes for Older People Page 27 of 29 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 compliant with the current guidelines from the Royal Pharmaceutical Society of Great Britain. 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 Registered Provider should ensure that the refrigerator used to store some medicines operates reliably within the prescribed temperature range. The Registered Provider should consult with the local Department of Environmental Health to determine the acceptability of the present arrangement of preparing most foods in the next door service and transporting them on covered trays. 2 19 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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!