Care Home: Angel Court

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What the care home does well People told us the staff were kind and considerate and that they are satisfied with the accommodation. People told us `The manager is helpful and approachable`. People visiting the home during the day, stated that they were satisfied with the visiting arrangements and were fully satisfied with the service and care provided. What has improved since the last inspection? This is the first key inspection of the service. What the care home could do better: The care plans should be discussed and agreed with the person whenever possible and/or their representative. The care plans, risk assessments and monitoring tools should be reviewed using a person centred approach. This will ensure that all details of a persons health, personal and social care needs are fully documented. All staff will then have the necessary details to ensure the care is provided in a consistent way and as to the preferences of the person. Amendments are needed to the correct storage of medicines. This will ensure that medications are stored in accordance with the manufacturing instructions. External medicines (creams and ointments) that have short shelf lives upon opening should be dated so the risk is reduced of giving out of date medication. All care staff administering these creams and ointments should be suitably trained to do so. Protocols for all `as required` medications should be available for reference. To ensure people can have their occasional medications as they need them. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. The service should continue to increase the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. Improvements should be made to improving the meal and the mealtime experience to make it a more social and pleasing part of the day. All people living at the home should have their nutritional needs assessed and kept under review. Daily records should be completed of the diet offered and taken, this will ensure that staff have the details to check that the diet is satisfactory for the persons needs. Key inspection report Care homes for older people Name: Address: Angel Court 1 Manor Road Precinct Walsall W Midlands WS2 8RF     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: Joy Hoelzel     Date: 0 5 0 5 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) © 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 32 Information about the care home Name of care home: Address: Angel Court 1 Manor Road Precinct Walsall W Midlands WS2 8RF Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Bimla Purmah Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is 24. The registered person may provide the following category of service only: care home only- code 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- code OP 24; physical disability- code PD 2; sensory impairment- code SI 2; dementia- code DE 16. Date of last inspection 16 0 2 2 Over 65 0 24 0 0 Care Homes for Older People Page 4 of 32 Brief description of the care home Angel Court is a purpose built social care home providing personal care and accommodation for up to twenty four people. The home changed ownership in December 2009 and is privately owned. It is situated within the local community, close to shops and other amenities. There are a selection of communal areas on the ground floor of the building. All bedrooms are single occupancy with en suite facilities. A passenger lift is used to access the first floor bedrooms. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents are available directly from the service. They can be produced in alternative formats upon request. Information on the current level of fees for the service can be obtained directly from the care service. Care Quality Commission reports for this service are available from the provider or can be obtained from www.cqc.org.uk 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: This is the first key inspection since the service opened and was registered in December 2009. The home did not know that we would be visiting to inspect the service. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was Care Homes for Older People Page 6 of 32 posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The provider/manager completed this document in February 2010 and returned it to us. Comments from the AQAA are included within this inspection report. We asked for our Have Your Say, surveys, to be distributed to people living in, working in and visiting the home. Seven were returned from people living in the home (six people had help to complete the form) and nine were completed by members of staff. The responses and comments are 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 care plans should be discussed and agreed with the person whenever possible and/or their representative. The care plans, risk assessments and monitoring tools should be reviewed using a person centred approach. This will ensure that all details of a persons health, personal and social care needs are fully documented. All staff will then have the necessary details to ensure the care is provided in a consistent way and as to the preferences of the person. Amendments are needed to the correct storage of medicines. This will ensure that medications are stored in accordance with the manufacturing instructions. External medicines (creams and ointments) that have short shelf lives upon opening should be dated so the risk is reduced of giving out of date medication. All care staff administering these creams and ointments should be suitably trained to do so. Protocols for all as required medications should be available for reference. To ensure people can have their occasional medications as they need them. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. The service should continue to increase the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. Improvements should be made to improving the meal and the mealtime experience to make it a more social and pleasing part of the day. All people living at the home should have their nutritional needs assessed and kept under review. Daily records should be completed of the diet offered and taken, this will ensure that staff have the details to check that the diet is satisfactory for the persons needs. Care Homes for Older People Page 8 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the care home can support them because assessments of their care needs have been obtained. Evidence: Information on the home is provided in two documents. The statement of purpose, which sets out what the service offers and the service user guide which offers more information when a person decides to move in. Both documents can be available in other formats as required and are available directly from the home. We did not look at the service user guide in great depth on this occasion; however, we did not see any information of the current level of the weekly fees. To give people full information about the service the level of fees should be included in the information documents. The manager, following this inspection, confirmed that information on the level of the weekly fees is now included in the documents. Information recorded in the AQAA described the action taken when a person expresses Care Homes for Older People Page 11 of 32 Evidence: an interest in staying at the home- We have a pre admission assessment. Taking into the registration parameters the assessor decides whether the needs of the prospective service user can be met. We then discuss with the social worker, relative, the staff nurse and the service user so as to ascertain that we could cater for his needs. An admission date is then planned and organised. We looked at the case file of the person who recently moved into the home. The contents in the file confirmed that information had been sought regarding this persons needs prior to them moving in. Information had been recorded on a pre-admission assessment and included a full and comprehensive account of the persons health and social care needs. Other case files looked at included pre-admission assessments by the home in addition to social worker reviews and assessments from other health and social care settings. This gathering of information ensures that the service can be confident of meeting a persons care needs. The home offers short stay respite care to people discharged from hospital for a maximum period of six weeks. During this time assessments of care needs are reviewed with a view to either the person retuning to their own home or a permanent social care placement being offered. 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. The care plan includes basic information necessary to deliver the persons care, there are some gaps in important information and does not consistently reflect the care being delivered. Evidence: The AQAA gives information of how the service meets the health and personal care needs of people - A service user plan of care generated from a comprehensive assessment is drawn up with each service user and provides the basis for the care to be delivered. The service users health, personal and social care needs are set out in an individual plan of care. We found that the information provided in the AQAA is not entirely correct; we found some inconsistencies and omissions when we looked at records. We selected the care records of three people living at the home to look at in depth with another two looked at to follow up observations made during the inspection. Care Homes for Older People Page 13 of 32 Evidence: We did not see any evidence to suggest that the person had been involved with developing and agreeing a plan of care. We did see that on a few documents the next of kin had been involved with agreeing some aspects of the plan. In the pre-admission assessments for one person a potential risk of self harm had been identified. We saw that a risk assessment had been completed for maintaining the safety of this person. There was no specific plan of care giving staff full instructions of the actions they are to take to reduce the risk to this person. However, staff gave a verbal explanation of the regular actions they take. Another person requires the support from the community services each day for a specific medical condition. A member of staff told us of this persons needs and how they are met each day by the community nurse. There was no specific plan of care giving the services care staff the information they may need in the case of an emergency or if anything unusual was noted. This persons care could be compromised because there was no care plan to tell staff of the action they should take if the person became unwell. We spoke with one person who has particular difficulties with eating and drinking. This person was unaware of any care plan or subsequent documentation relating to them whilst they are resident at the home. We saw that the service had received information from the hospital to indicate a high risk of malnutrition due to an underlying medical condition. We saw that the general practitioner had prescribed some food supplements for this person. We looked at the care file for this person it did not include a nutritional risk assessment or a plan of care for supporting them to have sufficient to eat and drink each day. Staff described the difficulties this person has with meals and mealtimes and told us the different ways they help this person. They told us that they record each time supplements are offered and make a record of this in the daily notes. The staff told us that this person had been offered supplements the day before this inspection but they were unable to provide any records or information to support this. Limited records are made of what people are offered for the three meals a day provided. These records are not in sufficient detail to determine whether the daily diet is satisfactory and that people are being offered enough to eat and drink. There was limited information recorded in the care plan and risk assessments for one person who was resident at the home on a short stay basis. This persons care could be compromised because the care plan did not tell staff how to meet their physical and mental health needs and ensure their wellbeing. Care Homes for Older People Page 14 of 32 Evidence: We spoke with several care staff about the care they provide. They told us that generally they do not rely on the care plans to deliver the care to people, but that the information is passed verbally to them at the time of the shift handover. They said that generally they do not refer or look at the plans. However, they described the diverse care needs of the people living at the home and the way they helped and assisted each person with daily life. We discussed the care plans and the lack of relevant information with the manager and deputy manager. Both people acknowledged that the care plans were lacking in content and told us that they had already identified this. The manager produced an alternative format for assessing and recording peoples care needs and confirmed that this will be work in progress. Information in the AQAA for action within the next twelve months records - To update the new care plan so that the record could be easily accessible and more documented. We looked at the systems for administering medication to people, staff explained the procedures and we looked at the medication administration records (MAR) for a selection of people. We saw that some of the MAR had not been fully completed when it was necessary to hand write the charts. We discussed the administration of creams and lotions, the deputy manager explained that the care staff apply and administer these preparations. The MAR is not completed at each application, it was not possible to establish when or if the person is receiving the treatment as required. We spoke with the deputy manager and suggested that a separate record for care staff to sign could be used in conjunction with the MAR. Care staff would need training in the safe administration of creams and lotions to ensure they have sufficient knowledge and are competent to do so. We saw that the preparations that may have short shelf lives upon opening were not being dated so there was a risk that some people may be given out of date medication. We saw that phials of in use insulin were being stored in the medication fridge, this being contrary to the manufacturers instructions. We advised staff to make themselves aware of the correct storage of medications and act accordingly. Some people at the home have been prescribed medications that are to be taken on an as required basis. Staff told us that there are no written protocols or instructions Care Homes for Older People Page 15 of 32 Evidence: for what triggers the medications to be given or for how often it can be given. We advised that protocols for all as required medications should be available for reference. We saw that the MAR is completed when the as required medications are given. Information signs are positioned on toilet and bathroom doors to help people find the facilities. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. Care Homes for Older People Page 16 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. People using the service cannot be assured that the care home will support them to follow personal interests and activities. Evidence: The Statement of purpose includes information of the social and recreational activities that are provided at the home. We have entertainment from agencies that come, sing, dance and entertain the residents every so often. We also play Bingo, cards, dominoes, jigsaws and a variety of games at the Home. The residents listen to music, have sing songs. We also do gentle exercises if they want to join in, all from their chairs. We play catch ball. We often take a few residents for a stroll to the shops in the High Street to do a bit of shopping. We have special activities for persons suffering from Dementia and for those suffering from sensory impairment. Residents are consulted individually in relation to their interests and wishes regarding social activities as part of the Service User Planning process and at regular residents meetings. Through out the day of this inspection we saw very little structured activity being offered to people. During the morning the television was on in the main lounge, some Care Homes for Older People Page 17 of 32 Evidence: people were reading the newspaper, some were knitting and others were either asleep or sitting quietly watching other people. During the afternoon for two short periods staff put on a CD, we saw that people appeared to be enjoying listening and singing a long to the music. Two people told us that they preferred to stay in their rooms but were persuaded to be in the lounge with other people. After lunch they returned to their rooms. Out of the seven people completing our survey three indicated that only sometimes activities are arranged for them to take part in. Two people added additional comments of - It would be useful to have a weekly notice board indicating what is happening and at what time. There seems to be very little diversion it would be of benefit if there were activities and outings organised. The home does not employ a person for arranging and organising social and recreational activities. When time allows the care staff organise bingo and sing-alongs for people to participate in. We saw that the care staff were all very busy attending to the care needs of people and dealing with the laundry. We did not see a social or recreational activity plan of care in any of the case files we looked at. The AQAA tells us of the plans for improvements to this area - Decide upon the feedback received from service users and families and make some changes in the activities. At the admission stage- ask the family and service user more details and decide on the activities that would suit the residents better. To also have group activities among the residents and some sort of workshop among them. People visiting the home during the day, stated that they were satisfied with the visiting arrangements and were fully satisfied with the service and care provided. The main front door is kept locked for security reasons. Staff answer the door and allow access. Inside the home there are number key pads to restrict access to and from, and between the two floors. One person completed out survey and indicated that they Cannot go out, cannot remember the code. Do not know the code. The AQAA tells us - The menu is on the white board in the dining room so that all the residents know what they are expecting for lunch. A choice of meal is provided to them everyday. We have menus available and we cater for the different needs and choices of the service users. Meals are taken in a congenial setting and at regular times. Care Homes for Older People Page 18 of 32 Evidence: Meals are prepared by the catering staff and served by the care staff mainly in the dining area. Some people have their meal served to them in the lounge or their bedroom. The dining area was partially prepared prior to the midday meal being served. There was no table linen, serviettes or condiments available. People appeared to be enjoying the meal but told us that they did not have a choice. One person told us -You get what you are given. We did not see that the menu for the day displayed in the dining room. When the midmorning drinks were being offered one person told the care staff that they were hungry. Staff offered a biscuit. The person could not remember if they had had breakfast but staff confirmed that the person had. We could not determine what the person had been offered for breakfast or the amount that they had taken as no detailed records are completed. A member of staff could not offer an explanation of the way they ensure people have their meals and told us that we just know. Some people have a soft diet due to their specific health conditions, it was not possible to determine what they had been offered at lunch time. The food had all been pureed together; an orange mass of blended food was served to the person in a dish. Staff did not tell the person the content of the food or offer any choice. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Evidence: The AQAA includes the systems in place for when people feel the need to make a complaint- We have a complaints procedure and the policy is provided to anyone at the entrance of the hallway with the signing book. When the service user is admitted the family and the service user are made aware of the complaints procedure which is also clearly included in the statement of purpose. We have a complaints policy updated on regular basis. All the staff are aware of the complaints procedure. The staff have followed the abuse training. We saw the complaints procedure displayed in the hall. All seven people completing our survey indicated that they knew someone they could talk with informally if they were unhappy with any aspect of the service. Only two people indicated that they were unaware of the formal complaint procedure. People told us that they would speak with a family member if they had concerns. One person told us they would have no hesitation but to speak with the manager and they were assured that it would be dealt with. Staff told us the action they would take if they had any concerns or suspicions of any wrong doings and confirmed they had recent training in this area. We discussed the recent safe guarding referrals that have been made in relation to the Care Homes for Older People Page 20 of 32 Evidence: care and safety of people living at the service. The manager explained the processes and the subsequent actions taken to ensure peoples well being. The home offers a facility for residents to deposit personal monies for safekeeping. Information regarding the maximum amounts for which the service will be responsible for is included in the statement of purpose. The manager explained the systems in place for ensuring the safety of the money and accuracy of the accounting records. Care Homes for Older People Page 21 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. The home provides a physical environment that is appropriate for the people who live there but there is room for improvement. Evidence: Angel court is a purpose built social care home and is close to the local shops and amenities. The home has recently changed ownership with the new providers opening the home in December 2009. The home is spacious and people told us they are satisfied with the accommodation. The manager explained that there is an ongoing plan for the redecoration and refurbishment of the property. The environmental health officer visited the home in February 2010, some recommendations were made. The manager confirmed that action has been taken to comply with the recommendations. We looked at areas within the home and saw that in the bathrooms were toiletries that are for communal use. The manager explained the difficulties with some people not having their own toiletries. We discussed the various options with the manager to ensure that the use of communal toiletries ceases. We saw that there are no privacy indicators on the toilet and bathroom doors. There is a potential that someones privacy and dignity could be compromised when using the Care Homes for Older People Page 22 of 32 Evidence: facilities. We saw that the bedrooms have been provided with a locking facility on the door. People told us that they had not been offered a key to their door with one person saying that they would like to have one. We discussed this with the manager who explained the difficulties with some people having a key and potentially losing it. All areas within the home have been provided with hand wash facilities for the prevention of the spread of infections and for general hand hygiene purpose. Staff discussed the way they deal with soiled and infected linen. The manager informed us that all staff have been instructed on the correct and safe way for dealing with such laundry. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have confidence in the staff who care for them. Evidence: People told us the staff are kind and considerate. In our survey three out of the seven people indicated that they received the care and support they needed and at the time that they required the care and support. We observed staff working positively with the people in their care, and although they were very busy they appeared caring and committed to their work. They demonstrated a good understanding of the individual needs of the people living at the home. We looked at the staffing rotas and saw that the staffing levels are maintained with different numbers of staff during the day and night. The manager explained the differing levels and stated that the numbers of staff are sufficient at the moment. The AQAA informs us that of the seventeen permanent care staff, fourteen have been trained at National Vocational Qualification in care at levels 2 and 3. We sampled the files of two staff holding various positions within the home. All files were well presented and contained the information required to safeguard the people living at Angel Court. Care Homes for Older People Page 24 of 32 Evidence: The manager told us the recent purchase of training materials which will be used for staff to receive training in the mandatory and specialist topic areas. All nine staff members completing our survey indicated that they receive training relevant to their role and gives them enough knowledge about health care and medication management. Care Homes for Older People Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the manager has a clear understanding of the key principles and focus of the service and is working to continuously improve services. Evidence: Mrs Bimla Purmah is the current provider/manager for the service. Throughout this inspection Mrs Purmah offered her fullest cooperation and although very busy was able to provide documents and explanations for issues that arose through the day. The provider/manager completed the AQAA in February 2010. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows how they are going to do this. People we spoke with offered positive comments - The manager is helpful and approachable. One person completing our survey made an additional comment of -The manager is always available and has a lovely personality, she is supported by some good staff. Care Homes for Older People Page 26 of 32 Evidence: The provider/manager told us of the quality assurance and monitoring systems that the service has for checking that the home operates as it states it does. They acknowledged that work is needed to improve the service and described the plans for making the improvements. They described the ways and systems used to obtain the views of people with an interest in the service. The responses will be analysed and any suggestions will be considered and acted upon. The home offers a facility for residents to deposit personal monies for safekeeping. Information regarding the maximum amounts for which the service will be responsible for is included in the statement of purpose. The manager explained the systems in place for ensuring the safety of the money and accuracy of the accounting records. Records, documents and certificates are available for inspection to ensure that the weekly, monthly and annual health and safety checks are being carried out. Care Homes for Older People Page 27 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 28 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 7 15 The care plan must set out 09/07/2010 in detail all aspects of a persons health, personal and social care needs. This will ensure that the care is provided in a consistent way and to the preference of the person. 2 8 12 Risk assessments must be completed when a person is identified as at risk of harm. This will ensure that staff have the information of how they can help with reducing the risk to the person. 09/07/2010 3 9 13 Medication must be stored in 09/07/2010 accordance with the manufacturers instructions. This will ensure that people receive medications safely and correctly. 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 4 9 13 Protocols and details of the as required medications must be available for staff reference. This will ensure that people are offered and given medications as they require them. 09/07/2010 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 7 When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. All people living at the home should have their nutritional needs assessed and kept under review. External medications (creams/ointments) that have short shelf lives upon opening should be dated and discarded within the guidelines. Mar charts that are handwritten should be fully completed to include full details of the person and their prescribed medications. The charts should then be checked for accuracy. Amendments should be made to the recording of the administration of external creams and lotions. Staff who are applying such preparations should be suitably trained to do so. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet 2 3 8 9 4 9 5 9 6 10 7 12 Care Homes for Older People Page 30 of 32 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 the needs and personal preferences of all the people living at the home. 8 9 14 15 People should be supported and enabled to make choices and decisions about how they wish to spend their day. Improvements should be made to improving the meals and the mealtime experience to make it a more social and pleasing part of the day. Daily records should be completed of the diet offered and taken, this will ensure that staff have the details to check that the diet is satisfactory for the persons needs. 10 15 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. © 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 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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