Care Home: Anchorstone Services Limited

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What the care home does well The people controlling the home changed in August 2009. Prior to this the former provider changed the category of registration from a care home to a home providing nursing care. The home has worked hard to ensure that there was minimum disruption to resident`s lives during this change. The health care needs of the residents are met with input and support from other health care professionals. The home encourages links with family, friends, and church groups at all times. Much positive feedback was received regarding the new organisation within the home. Several staff commented what a smooth transition it was which had little disruption to the home. Surveys state "the staff are every caring", "we believe the home does everything well", and a resident stated " I love the staff and the staff love me". Staff recruitment procedures ensure appropriate vetting of staff in order to protect residents. The home manages safeguarding referrals well and all the staff have been trained in safeguarding vulnerable adults procedures. What has improved since the last inspection? There were no requirements or recommendations form the last inspection undertaken in March 2008. The replacement of much flooring throughout has created, in parts, a light and airy environment in which to live. Since the last inspection the management structure of the home has changed. This now includes the responsible individual the registered manager, the house manager and the administrator all of whom are working closely to develop the service and improve outcomes for people living there . What the care home could do better: The home must ensure that all its information is up to date in order that prospective residents and their families have access to correct information to help them in their choice of home. Complex mental health needs must be assessed and discussed prior to admission to ensure that the home has the resources to meet these needs. The manager identified the shortfalls associated with the current care planning system and stated that a more person centred plan would benefit residents with dementia. This would also include the management guidance for staff caring for residents with challenging behaviours. Medication administration procedures need to be reviewed to ensure that residents take their prescribed medication and this is recorded as been given. Activities in place do not meet the individual needs of all residents and the manager stated that she had advertised for more staff to undertake activities. Residents were enjoying the aromatherapy session taking place during the afternoon. A review of mealtimes must be undertaken to ensure that residents have a choice of food, receive the support they require as outlined in care plans and are provided with the suitable eating aids to maintain independence. Staffing levels must be reviewed and action taken to ensure that there is always sufficient numbers of skilled staff on duty to meet the assessed needs of residents. Staff must be provided with more training in dementia care and mental health needs to ensure that they are updated in good practice in working with people who have dementia and mental health needs. Staff must be supervised in their daily shifts to ensure best practice and residents wellbeing. Key inspection report Care homes for older people Name: Address: Anchorstone Services Limited 8 & 10a Searle Road Farnham Surrey GU9 8LJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mary Williamson     Date: 1 8 0 1 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 32 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 32 Information about the care home Name of care home: Address: Anchorstone Services Limited 8 & 10a Searle Road Farnham Surrey GU9 8LJ 01252727378 01252710373 anchorstone@woodgatehealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Anchorstone Services Limited Name of registered manager (if applicable) Mrs Christine Ann MacLeod Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia, over 65 years of age (DE(E)). Date of last inspection Brief description of the care home Anchorstone is a care home providing nursing situated on the outskirts of Farnham. People controlling the company have changed since August 2009. The home specialises in providing care for people with dementia. The home provides ample communal facilities including a lounge, dining room, conservatory, and a small quiet lounge where residents may have visitors for a meal. Individual bedrooms all Care Homes for Older People Page 4 of 32 Over 65 0 40 40 0 Brief description of the care home have en-suite facilities. There are also two double rooms available. There is a wellmaintained garden to the rear of the property, which is overlooked from the conservatory. There is ample parking space at the front of the home. Fees range from £630.00 - £850.00 per week. This fee does not include hairdressing, chiropody, newspapers/magazines and toiletries. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Th quality rating for this service is ONE STAR. This means that people who use the service experience ADEQUATE quality outcomes. The information contained in this report has been comprised from an unannounced inspection undertaken over seven hours from 10:00am to 5.pm, and information gathered about the home. The inspection was facilitated by the registered manager Mrs Christine MacLeod, and Mr Aman Badiani (Responsible Individual) was also present for part of this inspection and involved in the feedback of outcomes from this inspection. The inspection was undertaken by two Regulation Inspectors Mary Williamson and Jane Jewell. This was the homes first inspection since the people controlling the company have changed. The focus of the inspection was to look at the experiences of life at the home Care Homes for Older People Page 6 of 32 for people living there. This involved observing residents and their interactions with staff during the morning, lunch time and early afternoon period. Signs of residents well-being/ill-being were observed in order to make judgements about their experiences and wellbeing. The inspectors were shown the communal areas of the home and some residents invited the inspectors to view their bedrooms. Records relating to the care of the residents and the management of the home were examined. These include care plans, risk assessments, medication recording charts, staff duty rotas, and staff employment files. Prior to the inspection the home was asked to complete an Annual Quality Assurance Assessment. This provided a good standard of information about the home and which was used as part of this inspection process. However the information in the AQAA did not always reflect the actual practices in the home. Nine relative/resident survey forms were returned to The Care Quality Commission providing us with views and experiences about the home that have been included in this report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The home must ensure that all its information is up to date in order that prospective residents and their families have access to correct information to help them in their choice of home. Complex mental health needs must be assessed and discussed prior to admission to ensure that the home has the resources to meet these needs. The manager identified the shortfalls associated with the current care planning system and stated that a more person centred plan would benefit residents with dementia. This would also include the management guidance for staff caring for residents with challenging behaviours. Medication administration procedures need to be reviewed to ensure that residents take their prescribed medication and this is recorded as been given. Activities in place do not meet the individual needs of all residents and the manager stated that she had advertised for more staff to undertake activities. Residents were enjoying the aromatherapy session taking place during the afternoon. Care Homes for Older People Page 8 of 32 A review of mealtimes must be undertaken to ensure that residents have a choice of food, receive the support they require as outlined in care plans and are provided with the suitable eating aids to maintain independence. Staffing levels must be reviewed and action taken to ensure that there is always sufficient numbers of skilled staff on duty to meet the assessed needs of residents. Staff must be provided with more training in dementia care and mental health needs to ensure that they are updated in good practice in working with people who have dementia and mental health needs. Staff must be supervised in their daily shifts to ensure best practice and residents wellbeing. 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 32 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 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Currently prospective residents and their relatives do not have access to appropriate and sufficient information to help them make an informed choice about living in the home. Individual contracts must be revised to ensure that all the residents in the home have a contract of occupancy. All residents have a pre admission needs assessment in place. However these must include a more detailed mental health assessment to ensure that care needs will be met. Evidence: There is a statement of purpose and resident information pack in place, however these are out of date. These documents need to be updated setting out the aims and objectives, philosophy of care, and a brief description of the service and support available. This will enable prospective residents and their relatives to make an informed choice about living in the home. Currently prospective residents are only Care Homes for Older People Page 11 of 32 Evidence: offered a single page brouchure with hand written telephone details. The manager stated that new documents were being compiled at head office. Contracts of occupancy are in place for residents who are privately funded. These outline the type of accommodation offered, the support provided, and fees payable and the method and frequency of these fees. Residents who are funded by the local authority do not have these contracts, only an agreement between the authorities and the home. A discussion took place between the manager, the provider and the inspectors regarding the introduction of individual contracts which would outline conditions of occupancy and any additional charges. Prospective residents have a needs assessment undertaken by the manager prior to being admitted to the home. Assessments are discussed with the senior care team prior to a placement being offered to ensure that individual care needs can be met. Since the home changed the category of registration people with complex behaviour needs, and advanced stages of dementia are being admitted to the home. When prospective residents present with complex mental health needs careful consideration must be given to resources required to meet assessed needs. Seven needs assessments were seen, and more detailed information was required regarding how the home was going to manage complex hental health issues. The home does not provide intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from a more individualised and comprehensive care planning system that would guide staff in all aspects of the support, and care needs of residents in order to promote individualised consistent care. The health care needs of residents are met and there is regular input from other health care professionals. Shortfalls in some medication practises do not ensure that medication is being accurately administered placing residents at potential risk. Not all the homes practices preserve residents privacy and dignity. Evidence: Care plans are in place for all residents. Seven of these were sampled. These contain variable standards of information about the needs of residents, largely generic and did not reflect the support being undertaken by staff or did not include the range of residents needs. This is with particular reference to providing guidance on managing challenging behaviour, social needs, and eating guidelines. The Standex system is in place. The manager has already identified some of the shortfalls and restrictions the current care planning system presented and spoke of their plans to develop a more Care Homes for Older People Page 13 of 32 Evidence: person centred approach to care planning. The home maintains a daily record for each resident, however an example was noted which showed that staff had not recorded or reported significant changes to a residents hand over at least two days. The nurse in charge on the day of the inspection had subsequently noticed the changes and completed an accident/incident form. The manager felt that staff usually do report promptly any changes but agreed to ensure that staff were reminded. Individual risk assessments are in place, which covered some basic risks including falls, manual handling, and eating. However the risks faced and posed by residents who were described as presenting with challenging behaviour were not assessed or provided staff with the guidance they needed manage or minimise risk. All the residents were physically well cared for and comments received in feedback surveys included they are very caring, and we believe the home does everything extremely well. The nurse in charge on the day of the inspection spoke knowledgeably about skin care, tissue viability, and good practice in the prevention of skin breakdown. Arrangements are in place to meet the health care needs of the residents. All residents are registered with a local GP and the manager stated that she had introduces a GP clinic on a weekly basis and all the residents are well supported. A resident stated that if they felt unwell the staff would call a doctor who would visit straight away. The chiropodist, dentist and optician visit the home on a regular basis. Specialist input is available on referral by the GP. The Community Psychiatric Nurse provides input and support in the management of residents suffering with dementia. The home has a medication policy in place. The administration of medication was observed in the dining room during lunch. The medication recording charts were sampled and two gaps in the recording of medication were noted for 15/01/2010. There was no explanation for this error. Two tablets were also seen on the dining room floor later in the afternoon having been spat out by a resident. Medication is supplied to the home by a local chemist, some in blister pack format. The chemist also undertakes audits of medication. None of the residents living in the home have been assessed as safe to administer their own medication. Medication was stored appropriately including controlled medication. Staff have the opportunity to update their medication knowledge periodically. There is a policy in place regarding privacy and dignity. Staff consulted showed an understanding of good practice in preserving residents rights to privacy and dignity. Staff were able to give examples of how to promote these rights in their every day care practices. However not all of the homes practices observed confirmed this. This relates to poor standard of curtaining across the home, visible naming of slippers, and a resident left sitting on a commode in their bedroom with the door open while the Care Homes for Older People Page 14 of 32 Evidence: nurse went to fetch something outside. Bedroom doors do not have suitable locks fitted which would enable residents to safely lock their doors but which could be over ridden by staff in the event of an emergency. A resident spoke of how frightened they sometimes got when another resident entered their room at night and that they would like to be able to lock their bedroom door. Care Homes for Older People Page 15 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all of the homes practices promote choice or treat residents as individuals, this is in reference to meals, daily routines, and activities. Resident lives are enriched when opportunities are provided for occupation and stimulation, however any opportunities need to be based upon residents individual social needs to ensure that all residents have the same level of opportunity. Residents lives are enriched by the strong links with families and churches, which is valued and supported by the home. Residents receive largely a poor meal time experience which did not promote choice, provide adequate supervision or quality food. Evidence: There are various arrangements in place for residents to access a range of organised activities. The home employs an activity coordinator, an aromatherapist, and a paid visitor. Residents spoke of particularly enjoying the visiting entertainers. A paid visitor spoke of playing dominos and having an individual chat with a resident during their visit on the day of the inspection. During the afternoon several residents were observed receiving one to one engagement with the aroma therapist which they clearly enjoyed. One resident was able to share with staff their preference to help with the cleaning and this was encouraged and promoted by the domestic on duty. The Care Homes for Older People Page 16 of 32 Evidence: resident spoke of feeling valued and important as they were able to help staff. However for the vast majority of the residents not able to share their interests, their care plans did not identify the individual social needs and preferences in order that suitable opportunities could be arranged. The manager had identified the need to increase the level of opportunities for occupation and stimulation and was in the process of providing additional hours. There are strong links with local churches with regular visitors and ecumenical services held in the home. A resident commented on how important it was to maintain their faith through receiving visitors from their church. A resident spoke of how their visitors are always made to feel welcomed and how they could visit at any reasonable time. A feedback survey confirmed relatives are well supported. Not all of the routines of daily living promoted choice and individuality. There was evidence that for residents who needed full assistance to get out of bed and eat their breakfast this was largely determined by the staffing levels and breakfast timings. A staff member feedback upon how early in the morning sometimes residents are assisted in order to be able to get everyone ready for breakfast on time. This was further evident with the number of these residents who were asleep and showing signs of being disengaged during the morning period. At lunch time there was no obvious choice of main meal with all the residents having the same dish. Records showed that no alternative had been provided over the previous weeks. Some variations were however provided for example additional vegetables, large or pureed meals, or additional gravy. There were no menus available to inform residents of what was being served or if they could ask for an alternative. It was feedback that menus had recently been removed as they were looking worn. The manager agreed to look at ways of making the menus accessible to all residents including the use of pictures in order to help promote choice. When observing the meal time good practises were noted with residents being actively supported and assisted to sit in the dining room to eat their meal, which helped to aid their orientation. However this was poorly organised which meant that for some residents they remained seated up to 45 minutes before their meal was served and due to lack of staffing availability to oversee those residents already seated they began to show signs of challenging behaviour. This in turn caused other residents to become anxious. A resident commented sometimes it is quite frightening all this shouting, There were many poor practices noted during the course of the meal, which largely related to the poor deployment and supervision of staff, which caused the meal to be served 35 minutes later than usual, inconsistent support for those residents requiring assistance to eat, poor quality food, limited resident supervision, lack of Care Homes for Older People Page 17 of 32 Evidence: choice and social interaction. However, one staff member who had been assigned to assist two residents was providing sensitive consistent support in a dignified manner. Verbal feedback was received regarding the meal being served which included that it was cold, very nice, but consistent feedback was given regarding the unedible nature of part of the dish, which was evident by the number of residents who did not eat it. The manager confirmed that the menus are in the process of being changed and which have been based on the likes and dislikes of current residents. The manager spoke of their interest in developing a greater understanding of catering for people who have dementia including how food is presented. It is recommended that the chef also undertakes training in catering for people who have dementia. No specialist equipment was noted to help residents independence when eating, which several examples noted of how the use of such equipment might further enhance residents independence and promote their eating. The manager agreed to look into this as a matter of priority. In order to review the number of poor practices the manager has been required to review the meal time arrangements to ensure that the residents are provided with a choice and are properly supervised and supported and have access to any specialist equipment. In addition to main meals hot drinks and snacks are available including a fresh fruit bowl in the corner of the lounge. A kitchenette in the dining room is used for making hot drinks. The kitchen is domestic in nature and holds little equipment. The providers have already identified the restrictions of this limited space and are developing plans to increase its size. The chef reported that at the last environmental health visit there was no recommendations made. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is not up to date and should include the correct information in order for any complaints to be processed and managed efficiently. The safeguarding procedures in place are robust and ensure the safety and protection of residents. Evidence: The home has a complaints procedure in place that forms part of the residents information pack. This now needs to be updated with the new providers details, as the previous provider is the identified contact throughout this procedure. The new contact details for The Care Quality Commission also need to be included. The manager stated that this document was at head office being reviewed. The AQAA states We are sure that complainants have confidence that their complaints will be addressed accordingly, and without fear of reprisal. We also welcome constructive criticism from residents, their family and advocates. One formal complaint was received since the last Annual Quality Assurance Assessment and the family were satisfied with the outcome. The home has a safeguarding vulnerable adults procedure in place. Staff are made aware of this procedure during their induction training. Staff training files indicated that some staff had received formal training and that others were waiting to complete this training. Although not all staff consulted with had undergone training in safeguarding adults they demonstrated an understanding of what they should do if they were unhappy with the conduct of practices at the home. There have been four Care Homes for Older People Page 19 of 32 Evidence: safeguarding investigations undertaken within the last year, all of which were investigated by the local authority, and reported on in a transparent and open manner. The registered manager and the manager both have attended local authority training in safeguarding procedures. Care Homes for Older People Page 20 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely environment, however there are variable standards of decor and maintenance which must be addressed to ensure a pleasant safe environment throughout. The management of mal odour needs to improve to ensure a pleasant environment in which to live, visit, and work. Evidence: The home is a large detached domestic property which has been extended over the years for its current use. The standard of decor varies throughout the home, with some parts decorated to a good standard and others in urgent need of repair and upgrade. The provider is aware of this and has a refurbishment plan in place to enhance the physical layout of the home. Flooring has been replaced with vinyl in some bedrooms and communal areas creating a bright and airy atmosphere, while other areas need attention as carpets are worn and torn and a potential trip hazard. Communal space is spacious with an open plan lounge and dining area, and conservatory that overlooks a well furnished garden. Much effort is made to create a homely feel with the lounge providing various seating options including sofas to enable friends to sit together and to promote social interaction. However not all of this furniture enabled residents to use them independently with several residents observed struggling to stand. A resident commented on how low the chair was they were sitting in, and how they had to wait for staff to help them stand. There is a small dining area, which staff reported can be used as a quiet area or for visitors to dine with residents. Care Homes for Older People Page 21 of 32 Evidence: This room is largely uninviting and needs to be refurbished. Residents said that their bedrooms provided what they needed and that they were encouraged to bring in personal items to help personalised their rooms. A resident commented I really like my bedroom as I can see the garden. A survey stated mum is very comfortable in her room. Some of the furniture in residents bedrooms was noted to be of poor quality or in a poor state of repair. This had been noted by the provider. The laundry has been upgraded and fitted with new equipment to meet the requirements of the home. Systems are in place for the control of infection with staff reporting that they had undertaken hygiene and cross infection training. Staff were observed to be working in ways that minimised the risk of infection, by using appropriative protective clothing when required. The inspection was undertaken on Monday and mal odour was noted in some areas of the home. It was feedback that there is no domestic staff on duty during the weekend instead care staff undertake this as part of their role. The manager agreed to review this situation. Portable call bell systems were missing from some rooms on the ground floor. The manager stated that she had met with a new call bell supplier a month ago with a view to reviewing the system as these have been lost. Both the manager and provider confirmed that they would take immediate action to ensure residents safety and in the meantime while replacements have been sought. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and skill mix of staff are not sufficient to meet the current residents assessed needs. Some staff do not the have competence and knowledge to care for people with dementia in accordance with good practice guidance. Robust recruitment practices ensures that staff are suitably vetted. Evidence: The duty rotas were examined and indicated there are an average of six care staff on duty throughout the day. Consistent feedback was received from staff and residents that there was not always sufficient staff on duty to be able to provide the support residents needed when they wanted it. Staff stated more staff would enable more quality time to be spent with residents and not having to rush all the time and cut corners. Another staff member said what we do best is provide the best care we can, but with more staff we could provide even better care. During the morning care staff were focused on completing tasks, collecting laundry, and washing cups while the vast majority of residents in the lounge were unengaged, asleep or displaying challenging behaviour. Care staff deployment and supervision over the morning and lunch time period did not enable residents to receive individual quality support. Staff were observed working in ways which did not always promote good moving and handling practices or an understanding of people who have dementia. However some Care Homes for Older People Page 23 of 32 Evidence: positive interactions were noted with residents observed to recognise some staff voices by smiling and showing affection. A survey form states the staff show great feeling for all the residents. Staff training profiles are in place. All staff undertake induction training. Mandatory training is also organised and updated when required. This includes moving and handling but staff did not always demonstrate good practice in moving and handling procedures during the inspection. Staff also have undertaken two hours training in dementia awareness and certificates are retained in individual files. However staff lack the understanding and awareness of good practice in caring for people with dementia. The provider and manager agreed to review this and provide staff with the training and guidance required to meet the current residents needs. National Vocational Qualification is ongoing with some staff having achieved NVQ level 2 and level 3, while other staff are undertaking this training. The home operates a staff recruitment procedure. Four staff employment records were randomly sampled. Three files contained all the required employment information including an application form, two written references, an employment history and a CRB (Criminal Records Bureau) disclosure. The fourth staff employment file was not available and the administrator explained that their file was in her home as she was working on updating the information. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is managed by a person fit to be in charge. The newly formed management team are working to improving standards within the home. Systems are in place to monitor quality assurance and safeguard residents finances. Shortfalls in the daily supervision of staff do not promote best practice. Evidence: The home is managed by the registered manager who has been in post for eighteen months and registered with The Care Quality Commission since June 2009. She is a qualified Mental Health Nurse and has also achieved Her Registered Managers Award (RMA). She has the support of the house manager who has been employed in the home for thirteen years, she also has an NVQ level 4 in management. An experienced administrator and the responsible individual all form part of the management structure of the home. Comments from residents and staff include Lovely people very smooth transition, very friendly do their best, and change in ownership has been very positive. Care Homes for Older People Page 25 of 32 Evidence: Most staff consulted with feedback that they received some level of formal supervision. Evidence of this was seen in staff files. However closer supervision of staff on a daily basis must be undertaken to ensure that the poor practices noted at meal times, manual handling techniques, and shortfalls in privacy and dignity issues are improved. The AQAA outlined the systems in place to monitor quality assurance. Monthly Regulation 26 visits are undertaken by the providers to monitor the homes progress, and resident/relative questionnaires are distributed and feedback acted upon. Relative/resident meetings are facilitated and suggestions implemented. The administrator gave an account of how residents finances are managed. Residents are encouraged to retain control of their own finances for as long as possible. The home will hold small amounts of money for individual residents to pay for hairdressing, toiletries and sundries. Records are kept of any financial transactions and receipts retained for information. The home has a wide range of health and safety policies and procedures in place. All staff undertake training regarding these policies during their induction training. Use of portable radiators had been used to boost the heating in remote parts of the building during some bad weather. Their use had not been supported by a risk assessment to ensure that they were safe, with evidence noted that they were not. The manager agreed to remove these immediately and therefore no requirement was made on this occasion. The AQAA confirms that all the required safety certificates are in place. It also indicates that all fire safety procedures are adhered to and that staff have regular fire safety awareness training. Most accidents and incidents are recorded and reported in accordance with Regulation 37 notifications, however old bruising was observrd on a residents hand which had not been recorded or reported. Care Homes for Older People Page 26 of 32 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 32 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 1 1 4 The registered person must 20/03/2010 ensure that sufficient information, as per Schedule 1 in the form of a statement of purpose and service user guide is available in the home. To enable prospective residents and their relatives have access to sufficient information to enable them to make a choice about living in the home. 2 7 14 The registered person must 20/03/2010 ensure that care plans provide clear guidance for all staff on all aspects of health, personal, social care needs, privacy and dignity which make explicit the actions needed to meet these needs, and that include personal risk assessmnets for all residents, which are reviewed regularly. Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that staff have guidance thay need to be able to meet residents needs. 3 9 13 That the registered person 20/03/2010 shall make arrangements for the recording, safekeeping, and handling of medication. To ensure that residents receive their prescribed medication to promote health, and wellbeing. 4 12 16 The registered person must 20/03/2010 ensure that residents social needs and preferences are identified and recorded on individual care plans and opportunities for social engagement and meaningful activities be provided based on these identified needs. To help further enrich residents lives through providing opportunities for them to participate in activities based around their personal preferences. 5 14 12 The registered person must ensure that care practices are conducted so as to enable residents to make decisions in respect of their care they are to receive, with particular reference to 20/03/2010 Care Homes for Older People Page 29 of 32 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 daily routines being flexible and varied to suit residents individual preferences and needs. To help ensure that residents are able to have some control over their lives and are treated as individuals. 6 27 18 The registered person must 20/03/2010 ensure that the staffing levels are reviewed including the deployment of staff to ensure that all times there are sufficient numbers of staff as is appropriate for the health safety and welfare of service users. To ensure that service users needs can be addressed in a consistent and safe manner. 7 30 18 The registered person must ensure that staff receive specialist dementia training in accordance with the needs of the residents accommodated, in order that they can peovide the appropriate support to people with dementia, challenging behaviour and mental health needs. To ensure that the staff have the range of skills and 20/03/2010 Care Homes for Older People Page 30 of 32 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 knowledge to be able to support residnets safely and in accordance with good practice guidance. 8 36 18 The registered person must ensure that all persons working in the home are appropriately supervised at all times by management and nursing staff. To ensure that residnets are safe and their wellbeing is promoted. 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 20/03/2010 1 15 That meal times are reviewed to ensure that residents are provided with a choice and are properly supervised and supported to have access to specialist equipment. That the chef undertakes training in catering for people who have dementia. Care Homes for Older People Page 31 of 32 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. 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