Care Home: Anglebury Court

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What the care home does well The home has a warm and friendly atmosphere and was clean and tidy.People are able to visit the home and spend time there before making a decision about residency.People are encouraged to bring their personal belongings in with them and supported to personalise their private room. One resident commented that they were `well looked after and couldn`t wish for more`. People living in the home are supported to maintain their independence as much as possible and there is a good activities programme in place which helps with this. The home provides a nutritious menu that caters for people with specialist dietary needs and people tell us that they are very satisfied with the quality and variety of meals served. One resident told us that there was a `good menu for food and its nicely cooked` . and went on to say that the `cooks always willing to cook anything extra that you want`. Systems are in place to keep people people safe and to make sure they are able to raise any concerns. People who live there told us that they are comfortable in raising any concerns and are confident they will be listened to and taken seriously. Visitors are made welcome and people are encouraged to maintain contact with family and friends. Staff undergo an induction programme to make sure they have the necessary skills and knowledge to meet peoples needs. People who live in the home have confidence in the staff who look after them . One professional commented that the staff were `caring , thoughtful and efficient` and went to say that they thought the care provided was `excellent`. Medicines are stored and given safely to people, and people are encouraged to look after their own medicines if it is safe for them to do so. What has improved since the last inspection? The detail contained in care plans and risk assessments has improved to make sure that all needs are identified and measures put in place to meet them. Professionals commented on the improvements made at the home during recent months and one person said that the home now provides `an excellent service`. The overall management of the home has improved with an improvement in staff morale and confidence. A member of staff commented that they worked as a team now and felt `valued`. Quality assurance systems are in place to find out the views of people who live, work and visit the home to use this information to inform and improve the service provided. What the care home could do better: Polices and procedures need to be reviewed and updated to make sure that they reflect current good practice advice to staff.Records need to be kept in a way that meets the requirements of the Data Protection Act 1998 and preserves peoples right to privacy. Systems must be put in place to make sure that all staff undertake mandatory training and complete refresher courses as necessary to make sure that their qualifications are always up to date. All staff must undertake training in adult protection and this must be updated as necessary to make sure that people who live in the home are safe. Improvements should be made in health and safety matters including , bed rails checks, hot water temperature checks to make sure that people who live and work in the home are safe. There are some improvements that should be made to the way medicines are recorded in the home. Key inspection report Care homes for older people Name: Address: Anglebury Court 21 Bonnets Lane Wareham Dorset BH20 4HB     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: Susan Hale     Date: 1 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Anglebury Court 21 Bonnets Lane Wareham Dorset BH20 4HB 01929552585 01929551984 c.fairlie@dorsetcc.gov.uk www.dorsetforyou.com Dorset County Council care home 36 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 36 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Anglebury Court is a purpose built facility situated within level walking distance of the centre of the small town of Wareham which has shops, a cinema, library, churches etc. Anglebury Court is located next to the local Social Services Offices and a day centre. The home benefits from some of the day centre facilities, particularly transport for social outings. The home accommodates up to 36 older persons including 15 specialist dementia Care Homes for Older People Page 4 of 32 0 6 0 4 2 0 0 9 36 0 Over 65 0 36 Brief description of the care home places, 30 in permanent beds and 2 short term care places. All accommodation is on ground floor level; there are 28 single bedrooms and 4 double bedrooms. All bedrooms have en-suite shower rooms with toilet and washbasin. The home is arranged on a unit basis incorporating 4 bungalows with a central service corridor known as The Street. Each bungalow has 7 single and one double bedroom, one bathroom and a lounge/dining room with kitchenette. There are 2 laundry rooms, each shared by 2 bungalows. Up to date fee information may be obtained from the service. 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: The inspection took place over the course of one day in October 2009.It was conducted by one regulation inspector and the pharmacy inspector. The manager distributed surveys to people who live and work at the home and to social and health care professionals who have contact with Anglebury Court. We received four surveys from staff, eight from professionals and seven from residents. The results of the surveys are incorporated into this report. The inspection involved talking to people who live and work in the home, observation of practice and a tour of the premises. We also looked at relevant records relating to the running of a care home. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Polices and procedures need to be reviewed and updated to make sure that they reflect current good practice advice to staff. Care Homes for Older People Page 7 of 32 Records need to be kept in a way that meets the requirements of the Data Protection Act 1998 and preserves peoples right to privacy. Systems must be put in place to make sure that all staff undertake mandatory training and complete refresher courses as necessary to make sure that their qualifications are always up to date. All staff must undertake training in adult protection and this must be updated as necessary to make sure that people who live in the home are safe. Improvements should be made in health and safety matters including , bed rails checks, hot water temperature checks to make sure that people who live and work in the home are safe. There are some improvements that should be made to the way medicines are recorded in the home. 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 8 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 9 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 do not move into Anglebury Court unless the home is sure that their needs can be met. People are encouraged to visit and spend time at the home before they make a decision about moving in. Evidence: There have been no new admissions to the home since the last inspection. The acting manager told us that nobody would move into the home until their needs have been assessed and the home ensure that they can be met. People are encouraged and supported to visit the home and spend time there before they make a decision about residency. Since the last key inspection, as recommended in the last report, the home now routinely visits residents who have been admitted to hospital and their needs are Care Homes for Older People Page 10 of 32 Evidence: reassessed before they move back into the home to make sure that Anglebury Court can still meet their needs. Care Homes for Older People Page 11 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. All residents have a care plan that is detailed and gives clear guidance for staff on how their needs are to be met. Some improvements are needed in how records are kept. Appropriate risk assessments are in place to keep people safe. People are treated with respect and their right to privacy an integral part of care practice. Medicines are kept and given to people safely, although there are a few improvements to be made to the way medicines are recorded. Evidence: We looked at three care plans in detail. Dorset County Council has a standard assessment, care planning, risk assessment and daily recording system. On the first care file we looked at the person had a care plan that covered all the recommended topics and appropriate risk assessments were in place. They had a fluid Care Homes for Older People Page 12 of 32 Evidence: chart in place to record the amount of fluid they have taken. There was no guidance for staff on the chart as to how much fluid should be encouraged each day and the specific amount of fluid given and taken was not recorded. There was also no record if food or fluid offered had actually been taken by the resident. It was therefore not possible to accurate monitor or evaluate the persons nutritional intake. There was a record of specialist equipment provided such as a pressure mattress and good detail when the person concerned had refused a pressure cushion, records clearly showed that the risks had been clearly explained. The person used bed rails and a risk assessment was in place but these were not checked weekly to make sure they remained in the right position and safe( please refer to outcome group seven) and they were referred to as cot sides. On the second care file we looked at the person had a care plan that covered all the recommended topics and appropriate risk assessments were in place including a specific behaviour risk assessment. On the third plan we looked also contained all the necessary records. It contained a nutritional risk assessment but this also included personal information about other residents in a way that breaches individuals right to privacy of information ( please refer to outcome group seven).The person was at high risks of falls and this had been identified and measures put in place to reduce the risk. Recording in relation to this risk was detailed and up to date. Body maps are now only used on one occasion as recommended in the last inspection report. All residents had generic and individual risk assessments in place with clear information available for staff and measures in place to reduce risk Daily records had been completed on all care files looked at but these were mainly a list of tasks completed and did not give a sense of how the person had spent their time or of their well or ill being. Seven residents completed our survey, five people said that they always received the support they needed and two said that they usually did. Four people said that staff always listened and acted on what they said and one person said that staff usually did. Four staff completed our survey, three said that the way information was shared about residents usually worked well, one said that it sometimes worked well.One person commented that they believed that care assistants should have more input Care Homes for Older People Page 13 of 32 Evidence: into care plans as we are the people who know all the residents needs. It was clear from looking at records that people have access to medical and health care professionals whenever needed and are offered support with this if necessary. Records were kept of peoples contact with such professionals. Six residents completed our survey five of whom said that they always got the medical care they needed and one said that they usually did. Eight health and social care professionals completed our survey. Six said that the residents needs were always or usually monitored and reviewed by the home and one said they sometimes were. Four said that the home always sought and acted on professional advice, two said they usually did and two said that they sometimes did. One professional commented that the home made good use of district nurses but two people commented that the was home are sometimes too quick to call in district nurses for minor things and one person commented that the home would benefit greatly from a trained first aider on their team. One professional commented that Anglebury Court provides a homely setting for people with complex health and social needs whilst another commented that the care given to residents has always been of a high standard. Staff spoken with had a good understanding of recognising people as individuals and respecting their right to privacy and dignity. They were observed knocking on residents doors before entering and offering personal care discreetly and in private. People spoken to talked about staff in very positive terms with one person saying that staff are lovely and so kind and another telling us that staff are very good. Everyone spoken to was satisfied with the service they get at the home. Seven professionals competed our survey, four of whom said that staff always respected peoples privacy and dignity and three said that they usually did. One person commented that staff generally treat their residents with respect and strive to meet their individual needs whilst another said that the home provides safe, caring, pleasant service for residents. We looked at arrangements for storing and giving medicines in the home. We checked the records that are held in the home for medicines given to people, and discussed how medicines are handled with the manager and other staff working in the home. We spoke with someone who looks after some of their own medicines, and watched some other medicines being given to people. Medicines are stored safely for the protection of people in the home. There are suitable arrangements for controlled drugs and any medicines requiring cold-storage. It is recommended to record temazepam in the controlled drugs register, to show that levels are correct. Care Homes for Older People Page 14 of 32 Evidence: Some residents look after and give their own medication. We found risk assessments in peoples care plans, which show that this is safe for them. Records are kept of medicines received into the home, and of any unwanted medicines that are sent for destruction. Records are kept of medicines that are given to people, although we found some gaps in the charts where medication had been given but not signed at the time of giving. It is a requirement to ensure that all medication given is recorded, including external preparations, at the time of giving to people. This is to ensure that the records are accurate, and to show that people receive all the medication they are prescribed. New systems for regular medication audits have been introduced and are resulting in improvements in medication recording. Most medicines charts are printed for the home by the pharmacy that supplies them. Sometimes handwritten entries or amendments are needed. We found one handwritten entry where the name of the medication had been recorded but no dose details were written on the chart. It is recommended to get all handwritten entries checked and signed by a second member of trained staff, to ensure that dose instructions are fully recorded and correct. We watched some of the lunchtime medication round and found that medication is given to people in a safe way. Medication is given by trained staff, and further training has been organised and was taking place on the day of the inspection. Sometimes the morning round takes a long time to complete and there may not be a long interval between this and the lunchtime round, for people who receive their morning medication later. This could lead to a short interval between doses for some medication, although the member of staff doing this round was very aware of peoples medicines, and gave in order to be sure that sufficient dose intervals were maintained. The timings of medication rounds may need to be reviewed if more people are living in the home in the future. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to maintain their independence, contact with their families and friends which enhances their quality of life. Visitors to the home are encouraged and made welcome. Evidence: There was a relaxed and friendly atmosphere throughout the home with staff and residents clearly comfortable in each others company. People are able to choose to continue with religious worship and local clergy visit the home regularly. People told us that the routines of the home are flexible and that they were able to get up and go to bed at times to suit themselves with staff support if necessary. One resident who completed our survey said that one thing the home did well was let us sleep. All the residents spoken to said that they were able to receive visitors at any time and that their visitors were made to feel welcome when they visited. One member of staff Care Homes for Older People Page 16 of 32 Evidence: who completed our survey said that they thought the home was friendly and supportive to family and friends (of residents). This was also confirmed by a visitor spoken to who told us that they had been coming to the home for several years and was always made welcome by all the staff. There is an activities coordinator at the home and a regular programme of social activities is advertised on each unit. On the day of the visit forthcoming events that were advertised included a visit by a symphony orchestra musician and a visit by the local Rotary club. The home also produces a newsletter. The home is able to use accessible transport so that people have the opportunity to go out on trips. One member of staff who completed our survey told us that our activities organiser works hard to arrange activities and entertainment and also commented that staff often came in on their days off to take residents out. Five residents completed our survey four of whom said that there was always activities that they could take part in and one said that there usually was. We observed the lunchtime meal and saw that the atmosphere was relaxed and there was enough staff to serve the meal at a suitable pace. The vegetables and potatoes were presented in serving dishes so that residents could help themselves. Support provided by staff was given discreetly and sensitively. All the residents spoken to were very positive about the quality and variety of food provided. One commented that they thought that the food is very nice, and well presented.Special efforts are made by the home for residents birthdays and they have a cake and a tea party if they want to. Five residents completed our survey all of whom said that they always liked the meals at the home. We noted that at lunchtime some residents remained in their wheelchairs at the table and were not initially offered the opportunity to transfer to an ordinary chair the same as other residents because suitable chairs were not available. Care Homes for Older People Page 17 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. Polices and procedures are in place to make sure that residents and staff can raise any concerns and be confident that they will be listened to and taken seriously. Policies and procedures are in place to make sure that people at the home are safe. Not all staff at the home have undertaken training in adult protection. Evidence: The home has a complaints policy which is on display and included in the service user guide. The complaints policy does not make clear that complainants can contact the Care Quality Commission at any stage of a complaint. A complaints log showed that there had been two complaints since the last inspection. One complaint had been clearly recorded and the correct procedure had and followed. However, in relation to the second complaint there was no written response to the complainant, no detail about the complaint although the acting manager told us that it had been addressed to the complainants for the satisfaction. This was addressed immediately by the acting manager. All residents spoken to were aware that they could raise any concerns or complaints that they had and they had confidence that they would be listened to and taken seriously. Four residents completed our survey four of whom knew who speak to if they had any concerns or wanted to make a complaint. One person did not know who Care Homes for Older People Page 18 of 32 Evidence: to speak to or how to make a complaint. Six professionals completed our survey all of whom said that the home always or usually responded appropriately to concerns raised. All four members of staff who completed our survey said that they knew what to do if someone had any concerns. The home has a whistle blowing policy that was developed in 2004 which includes the contact details of Public Concern at Work but does not include the current contact details of the Care Quality Commission. The home has an adult protection policy and a copy of the Dorset wide multi agency policy to make sure that all staff know what to do should an allegation of abuse be received. The training matrix showed us that the majority of staff have completed training in adult protection. However, eighteen staff have either not completed any training or have undertaken this some years ago. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and furnished so that people are living in a homely, clean and comfortable environment. Infection control measures are in place to reduce the risk of cross infection to staff and residents. Evidence: Anglebury Court is purpose built and entirely on ground level. The home was clean and tidy and free from unpleasant odours on the day of the visit. Five residents completed our survey four of whom told us that the home was always fresh and clean one of whom said it sometimes was. Aids and adaptations are available throughout the home e.g. grab rails, raised toilet seats and specialist bathing facilities. Residents with particular needs have their own personal equipment to assist with them independence. People are encouraged to bring personal possessions with them when they move into the home and this includes furniture within the space constraints of their private room. Pictorial signage on toilets and bathrooms throughout the home helps people to be as Care Homes for Older People Page 20 of 32 Evidence: independent as possible. There was a high standard of cleanliness throughout the home and there was evidence to demonstrate that basic training in infection control procedures are included within the staff induction programme and ongoing training plan. and infection control order to being undertaken in September 2009 in some areas of improvement identified. The sluice facility is within the laundry room. Whilst both areas were clean it is not appropriate to have clean clothing in the same area where sluicing of equipment takes place. Clean laundry were in open baskets but these were due to be replaced by lidded boxes which will be more appropriate. Appropriate handwashing facilities to reduce the risk of cross infection were provided for staff. We noted that while clinical waste bins were foot operated, bins for the disposal of paper towels and gloves were not foot operated to reduce the risk of cross infection. It was positive to see that vinyl gloves are provided to reduce the risk of latex allergies to staff and residents. Care Homes for Older People Page 21 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. There are enough staff to meet current residents needs. Robust recruitment systems are in place to make sure that people who live at the home safe. The majority of staff are qualified to at least N.V.Q level 2 or above although only one person is qualified to N.V.Q. level 3. The training programme does not ensure that all staff have up to date training to make sure that they are able to meet residents needs. All staff complete a recognised induction programme. Evidence: Staff rotas were seen that showed that there were enough staff at all times to meet the needs of people living in the home. In addition to care staff it also included catering, domestic, management and the activities coordinator. The staff rota did not identify the designated first aider on each shift. Seven professionals completed our survey, three of whom said that staff always had the rights skills and experience, two said that they usually did and one said that they sometimes did.One person commented that the staff are knowledgeable and helpful. I have always felt confident my patients are well cared for. However, one person commented that on occasions Care Homes for Older People Page 22 of 32 Evidence: the call bells are not answered quickly and the alert mats by the beds are not being recorded as used. Four members of staff completed our survey, one said that there was always enough staff on duty, two said that there usually was and one said that there sometimes was. One person commented that I would like to see the staff ratio done on the service users needs rather than how many service users we have i.e. service users with complex needs needing more individual time. A robust recruitment system is in place that make sure that all the correct checks undertaken and documents obtained before new members of staff start work. There is a low staff turnover at the home and this means that people are supported by a stable group of staff that they know well. The acting manager told us that further training was planned including medication training for senior staff, recording skills and bereavement and loss. The AQAA told us that all new staff complete the Skills for Care common induction standard training. It also told us that the home employs thirty four care staff of whom eleven are qualified to at least N.V.Q. level 2 or above (32 ).No staff have completed N.V.Q. training since 2008. However, the acting manager told us after the visit that this information was out of date and that nineteen staff were qualifed to N.V.Q level 2.(57 ) The home supplied a training matrix that showed that some staff had undertaken training in dementia care (37 in 2008/2009), nutritional care (17)and adult protection. However, it also showed that some staff had not undertaken training for some years in some topics.Please refer to outcome group seven in relation to mandatory training. The acting manager told us that four staff are qualified to N.V.Q. level 3. Four members of staff completed our survey all of whom said they were offered relevant and up to date training. One person said that they thought that they always had enough support and knowledge to meet peoples needs, two said that they usually did and one said that they sometimes did. Care Homes for Older People Page 23 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. The home is now effectively managed by the acting manager and staff and residents have confidence that the home is run in a way that safeguards their best interests. Quality assurance systems are now in place and used to identify and inform how the service is provided. Policies and procedures are not regularly updated to make sure they reflect current good practice advice and legislation. Health and safety is generally taken seriously to make sure that people who live and work in the home are safe. Not all staff have undertaken mandatory training in fire safety, moving and handling and first aid. Care Homes for Older People Page 24 of 32 Evidence: There were clear lines of accountability in the home, the management team compromises of the acting manager and senior care community services officers. As an acting manager is in place the standards in relation to the registered manager have not been assessed. Since the last key inspection there have been several team meetings. One member of staff spoken to said that they thought everyone is working as a team and that everything is running smoothly.One professional who completed our survey told us that the paperwork all appears to have been recently updated and one person commented that it was not easy to get hold of staff in the afternoon by phone. A residents satisfaction survey had been undertaken and comments received showed a good level of satisfaction with the service provided. A communication survey for staff took place in September 2009 but the results have not been collated and were not available on the day of the inspection. In September 2009 residents were surveyed to find out what they thought about the laundry service. Seven people responded, four of whom said that they had lost or had suffered damaged clothing that had been sent to the laundry. Overall, people were satisfied with the service but the results had been discussed in staff meetings and ways to improve the service identified. Many of the homes policies and procedures have not been updated for several years (in some cases 2003). This means that they do not reflect current good practice advice and guidance may not provide the right information for staff. We looked at staff supervision records and found that all staff have had formal supervision although the frequency varied. The acting manager told us that all members of staff have a personal development plan which they are involved in drawing up. Four staff completed our survey two of whom said they regularly had enough support and two said they they often received the right support. Comments included the staff are more relaxed but working to high standards and best practice. We are gaining in confidence and being heard (by the acting manager). We looked at the accident book and found that all accidents had been recorded and records were well kept. The kitchen was clean and tidy, food stored appropriately and all necessary records were well kept. We looked at the way that residents personal finances are managed by the home. All amounts were found to be correct and most but not all entries were signed by two Care Homes for Older People Page 25 of 32 Evidence: members of staff. Some residents had paid money to the chiropodists but had not been given a receipt. Some hairdressing receipts were not dated and one was missing. Contrary to the homes finance policy there was no evidence that the accounts were checked and audited monthly by the homes manager. The home use a staff communication book. However, this contained personal information about residents which is not good practice and is contrary to the requirements of the Data Protection Act 1998. The way in which information is recorded on some other records such as food and fluid charts and other records is also contrary to good practice and should be reviewed. The AQAA told us that most of the relevant health and safety checks and maintenance were being carried out. Regular checks are made of the temperature in most water outlets but this did not include residents en suites, communal bathrooms or the kitchen. Portable appliances are tested every other year with visual inspections taking place during the year they are not tested by an electrical contractor. Some residents have bed rails in situ but there are no systems in place to make sure that they are checked weekly to make sure they are safe and reduce the risk of entrapment. The homes training programme includes mandatory training, fire safety, first aid, food hygiene and moving and handling. However, the training matrix supplied by the home showed that eleven people had not undertaken any fire safety training, ten staff did not have current moving and handling qualifications, twenty six staff did not have an up to date first aid qualification and nine staff did not have current food hygiene qualifications. 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 9 13 To make sure there is an 29/01/2010 accurate record held of all medication administered, including external preparations, completed at the time of administration to people. This is to show that people receive their medication as their doctor has intended. 2 18 13 The registered person shall make arrangements by training staff to prevent service users being harmed. To ensure the safety of service users. 30/04/2010 3 30 18 The registered person shall 30/04/2010 ensure that persons working at the home receive training appropriate to the work they are to perform. To make sure staff have the necessary skills and knowledge to meet service users Page 28 of 32 Care Homes for Older People 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 needs. 4 38 23 The registered person must make arrangements for persons working at the care home to receive suitable training in fire prevention. To ensure the safety of service users and staff. 5 38 13 The registered person shall 30/03/2010 make suitable arrangements for the training of staff in first aid. To ensure the safety of service users. 6 38 13 The registered person must 30/03/2010 make suitable arrangements to provide a safe system for moving and handling service users. To ensure the safety of service users. 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 10/03/2010 1 7 Daily records should be more person centred and give a sense of peoples well or ill being and how they spent their time. Food and fluid charts should include the recommended amount of fluid to be taken daily. It should also record specific amounts of fluid and food taken. Records should be Page 29 of 32 2 7 Care Homes for Older People 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 collated and evaluated to inform care planning and decision-making. 3 9 It is recommended that temazepam is recorded in the controlled drugs register, to show that balances are correct. It is recommended that all handwritten entries on medicine administration charts are checked and signed by a second member of trained staff. This is to make sure that all dosage instructions are available and correct. This will help to reduce the risks of errors when these medicines are given to people. The complaints policy should make clear that complainants are able to contact the Commission at any stage of the complaint. The whistle blowing policy should include the current contact details of the Care Quality Commission. Serious consideration should be given to providing suitable dining room chairs for people who use wheelchairs or who need support. Serious consideration should be given to providing foot operated bins in all communal toilets, bathrooms and the laundry. Serious consideration should be given to separating the laundry and sluice facilities to reduce the risk of cross infection. Serious consideration should be given to identifying the designated first aider for each shift on the staff rota. Serious consideration should be given to offering staff the opportunity for up to date training in all necesary topics. Policies and procedures should be regularly reviewed and updated to make sure they reflect current good practice advice and legislation. There should always be two staff signatures on all financial transactions. Receipts should always be obtained from the hairdresser and chiropodist. Residents accounts should be checked and audited monthly as per the homes finance policy. Care Homes for Older People Page 30 of 32 4 16 5 6 18 19 7 26 8 26 9 10 11 27 30 33 12 35 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 13 14 36 37 Staff supervision should take place at least six times a year. Serious consideration should be given to maintaining information including food and fluid charts and the staff communication book in a way that complies with the Data Protection Act 1998. Serious consideration should be given to ensuring that all staff handling food have up to date training. Weekly checks should take place on all bed rails to make sure they are safe. Regular water temperature checks should be undertaken for communal bathrooms, kitchen and all en suites. 15 16 17 38 38 38 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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