Care Home: Anson House

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What the care home does well The management and staff make the people who use the service and their visitors welcome. There are frequent visitors to the home. People spoken with were very positive about the care that they were receiving. The home was clean, warm and comfortable. Staff recruitment records showed us that a good system of recruitment is in place, ensuring the safety of people using the service. The activities organisers post was reviewed and the service increased the hours to provide activities across seven days per week. The service believes that this is a significant improvement since the previous inspection. The service employs two activities coordinators who provide 50 hours in total per week, working with individuals and groups, and organising regular and appropriate activities. What has improved since the last inspection? The Annual Quality Assurance Assessment completed by the care manager told us about the following improvements made since the previous inspection: "We have kept our statement of purpose under review and have developed a service user guide to better inform residents about the services and type of care we offer at Anson House. We now have the statement of purpose in Braille format, audio and large print. We have reviewed how we monitor and record information about each persons care and health needs. This has resulted in documents that are more thorough and consistent. We have an activities organiser who is able to do a wide range of activities with our residents. We also have singers and other entertainers coming in to the home. We have restructured the kitchen and created the position of chef manager to oversee the catering department. We have updated our policies on Complaints and Concerns Procedures. We have reviewed the Residents Finance policy and put in place more safeguards. We have trained staff in safeguarding and behaviour that challenges. We have now completed refurbishment to all communal areas of the home to include Upgraded fire safety to ensure correct fire partitioning and upgrades to the fire alarm system. Upgraded fixed wiring within the home. Upgraded the water safety of the home with correct thermostatic mixer valves. Decorated the external areas of the building to include replacing windows and redecorated woodwork. New lighting in communal areas. Repainted with new carpet and curtains to all communal areas. Resited the laundry to provide a larger area with adequate storage. Refurbished 2 communal bathrooms. Purchased new furniture for communal areas. Replaced the kitchen flooring. We have invested over £300k on this work in the last financial year. Recruited more full time staff to avoid using agency staff. We have reduced the agency use significantly.We developed a better training program to include mandatory topics and more specialist areas. We have a collective training matrix to monitor training. Each staff has an individual training file. We have enrolled some staff onto the NVQ level 3 program Our staff team receives regular supervision sessions. The manager and head of care have recently attended staff appraisal training and we are planning to roll this out to all staff." What the care home could do better: Pre admission documentation should be completed comprehensively, and should contain enough information to enable a decision as to whether the service can meet the persons individual needs. Staff should treat individuals with the respect they deserve, and should ensure that their dignity is promoted. The routines of daily living, particularly during the morning period, should be flexible to suit the persons needs and wishes. People using the service should feel safe, secure and be protected from abuse. Staff on the Chetwynd unit should be in sufficient numbers to safely support the needs of the people using the service. Staff should receive training according to their role and responsibilities. This should include Dementia Care training for the two activities coordinators, Mental Capacity Act 2005 and Deprivation of Liberty training for all staff. The manager should ensure the monitoring of the service, includes regular auditing, and spot checks in regard to staff practice, attitude, and competence. Key inspection report Care homes for older people Name: Address: Anson House Pasturefields Great Haywood Stafford Staffs ST18 0RD     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: Pam Grace     Date: 1 3 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Anson House Pasturefields Great Haywood Stafford Staffs ST18 0RD 01889270565 01889271784 s.flint@abbeyfield.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Abbeyfield Society Name of registered manager (if applicable) Mrs Susan Ann Flint Type of registration: Number of places registered: care home 65 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 65 The registered person may provide the following categories of service,Care Home with Nursing, Code N, 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, Physical Disability, Code PD, Mental Disorder excluding learning disability or dementia, Code MD, Dementia, Code DE Date of last inspection Care Homes for Older People Page 4 of 29 Over 65 0 0 65 0 65 65 0 65 Brief description of the care home Anson house is a 65 bedded Nursing Home situated in Pasture fields, Great Haywood. It comprises of two connecting buildings built between 1991 and 1993. The current owners, The Abbeyfield Society, were registered in April 2009. The home is currently registered to admit 32 Elderly and 33 Elderly Mentally Ill people for nursing or personal care only. Anson House is set in a rural location and consists of 65 single bedrooms all of which have en-suite WC facilities. There are five lounges, each having satellite and wide screen televisions. One lounge also has a dining area, and there are two more separate dining rooms. The lounge on Chetwyn unit has been fitted with air conditioning to assist the individuals comfort. Other facilities at the home include a hairdressing salon and a therapeutic sensory room. The home has an enclosed garden with a suitable patio area. All areas of the home have access via the stairs and or passenger lifts. There is ample car parking space. Contact with the community is encouraged and visiting is allowed at any reasonable time of the day or by arrangement with the management. A full administration team assists in the smooth running of the home. The reader may wish to enquire directly with the service in regard to the current fees, these were not available at the time of this report. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 key unannounced inspection was carried out over one day, by one inspector. The inspection had been planned using information gathered from the Care Quality Commission (CQC) database, the Annual Quality Assurance Assessment (AQAA) document that had been completed by the care manager, and comments received from people who use the service and their relatives. The key National Minimum Standards for Older People were identified for this inspection and the methods in which the information was gained for this report included case tracking, general observations, document reading, speaking with staff, people who use the service and their visiting relatives. A tour of the environment was also undertaken. At the end of our inspection feedback was given to the care manager, outlining the overall findings of the inspection, and giving information about the recommendations Care Homes for Older People Page 6 of 29 that we would make. People spoken with were very positive about the care they were receiving. We observed people who were unable to communicate. Our observations showed that these people were well cared for, and were happy in their surroundings. There had been one anonymous complaint which included a Safeguarding referral, made to the Care Quality Commission since the previous inspection, this resulted in an early morning visit by the Commission and Social Services to the service, which is documented within this report. There were no requirements, and 7 recommendations made as a result of this unannounced inspection. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The Annual Quality Assurance Assessment completed by the care manager told us about the following improvements made since the previous inspection: We have kept our statement of purpose under review and have developed a service user guide to better inform residents about the services and type of care we offer at Anson House. We now have the statement of purpose in Braille format, audio and large print. We have reviewed how we monitor and record information about each persons care and health needs. This has resulted in documents that are more thorough and consistent. We have an activities organiser who is able to do a wide range of activities with our residents. We also have singers and other entertainers coming in to the home. We have restructured the kitchen and created the position of chef manager to oversee the catering department. We have updated our policies on Complaints and Concerns Procedures. We have reviewed the Residents Finance policy and put in place more safeguards. We have trained staff in safeguarding and behaviour that challenges. We have now completed refurbishment to all communal areas of the home to include Upgraded fire safety to ensure correct fire partitioning and upgrades to the fire alarm system. Upgraded fixed wiring within the home. Upgraded the water safety of the home with correct thermostatic mixer valves. Decorated the external areas of the building to include replacing windows and redecorated woodwork. New lighting in communal areas. Repainted with new carpet and curtains to all communal areas. Resited the laundry to provide a larger area with adequate storage. Refurbished 2 communal bathrooms. Purchased new furniture for communal areas. Replaced the kitchen flooring. We have invested over £300k on this work in the last financial year. Recruited more full time staff to avoid using agency staff. We have reduced the agency use significantly. Care Homes for Older People Page 8 of 29 We developed a better training program to include mandatory topics and more specialist areas. We have a collective training matrix to monitor training. Each staff has an individual training file. We have enrolled some staff onto the NVQ level 3 program Our staff team receives regular supervision sessions. The manager and head of care have recently attended staff appraisal training and we are planning to roll this out to all staff. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information they need to choose a home that will meet their needs. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: A Statement of Purpose is available to all prospective Residents, and we have recently updated our Service user Guide thus, ensuring the information provided is correct and available in various formats and is made available to all prospective residents and relatives. A needs assessment is carried out by the Manager or the Registered Nurse, before a placement is offered to ensure the home can meet the residents needs. This is used to develop a plan of care. During the pre assessment stage we invite the prospective resident to visit to enable them and in some cases the family to assist in making the final decision as to whether or not they wish to accept the placement. In some cases this may not be possible, therefore, a senior member Care Homes for Older People Page 11 of 29 Evidence: team member would arrange to visit the prospective resident in their own home or indeed hospital. During this visit the preassessment documentation would be completed and reviewed for suitability of the home in meeting those assessed needs. All residents are issued with a Licence Agreement before or at the point of moving in to the care home. All residents are admitted initially for a trial period to ensure that the home can meet their needs and expectations. We avoid emergency or unplanned admissions wherever possible for permanent placements. We found that one of the three pre admission assessments we looked at contained only basic information about the individual concerned. We were told that the deputy manager is now responsible for assessing people prior to their admission to the service. The shortfall was highlighted, and discussed with the care manager during our visit. The Statement of Purpose and Service User Guide are currently under review, and are available in Braille, audio and large print formats. We discussed the need to include information under Schedule 1 of the National Minimum Standards in order to fully meet that Standard. We also requested that a copy of the revised documents are forwarded to the Care Quality Commission. We were told that the service has four reablement beds. These are under contract with the Local Authority, and are for people who have been in hospital, and require reablement prior to going home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. However, the principles of respect, dignity and privacy are not being promoted and put into practice. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: Each resident is supported to make decisions and each resident has their own individual care plan which is evaluated monthly. Each care plan includes the residents photograph. All care plans include Risk Assessments to identify Personal Risk Screening, Moving and Handling, Nutritional monitoring, Pressure Care and the Prevention of Falls. Residents privacy and dignity is respected by all staff. This is discussed with staff during induction and other training courses. We promote privacy and dignity through the training and supervision and we ask all staff to read the policies and to sign to say they have read and understood them. We looked at a total of six care plans. Three of those were examined in relation to the Care Homes for Older People Page 13 of 29 Evidence: preferred times of rising for the people using the service. We found that the times of rising did not tally with the actual time that people were up when we arrived at the service. We looked at three care plans in relation to social care and health. These evidenced that regular reviews are undertaken for individuals, including Local Authority annual reviews. Efforts had been made to ensure that care plans were signed. We discussed the need to involve next of kin and representatives in this, particularly if the person has communication or mental health needs, and is unable to sign for themselves. We were assured by the care manager that this is normal practice. We found during our early morning visit that some people had been got up out of bed, washed and dressed by six oclock in the morning. We noted that some people were already sitting at the dining room table at that time, and two people were still there two hours later, asleep. This is the subject of a complaint, and a Safeguarding referral made to Social Services, which is ongoing at the time of this report. This evidence points to the fact that although preferred rising times are recorded in individual care plans, the actual practice of the staff at the home does not promote a persons wishes, dignity or respect. Care plans sampled evidenced that all activities of daily living are assessed, and we were told that there are currently four reablement beds at the home. These are for people leaving hospital, but needing reablement before going back to their own home. We did not look at care plans in relation to those individuals. But did discuss how the home enables people to return home. We were told that the contract with the Local Authority for those beds is due for review and renewal in April 2010. Care plans sampled evidenced that health and social care needs are being met. There was evidence of visits by health care professionals, including General Practitioner, District Nurse, and hospital or clinic appointments made for individuals. Appropriate and up to date risk assessments were evident in all care plans seen, however, we highlighted and discussed the need to have clearer and more comprehensive control measures in place for each risk area identified. Accident and or incident forms were filed in the back of each care plan, these had been appropriately completed. People using the service were observed being supervised by staff in an appropriate, dignified and respectful manner. People we spoke with confirmed that they were satisfied and happy with the services provided at the home. Comments received included the following, the food is good, and we get plenty of it, we sometimes have Care Homes for Older People Page 14 of 29 Evidence: to wait for the staff to come to us, but we know that there are other people needing them too, I enjoy having my hair done, and my nails done each week. They always give me my medication, I never remember to take it otherwise. I can see the doctor if I want to, or if I dont feel too well. The care manager and staff spoken with confirmed that the care staff responsible for the administration of medication had attended medication training. There had been no issues raised regarding the administration of medication. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to make choices about their life style, however, the practice of early rising times used by staff means that this practice does not reflect what is written in the individuals care plan. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: We offer a choice at mealtimes and we also cater for special diets, e.g. diabetic and pureed diets. Hot and cold drinks are provided throughout the day. We encourage all residents to become involved in activities, we have in the home for example painting, gardening exercises. We also do one to one work with individuals. The Snoozlem room has been refurbished and residents are encouraged to make use of it. The local church conducts services on site for those that wish to attend. We observed activities being undertaken during our visit. These were being carried out by staff and the activities person, and included 1:1 conversation with individuals, music, puzzles and craft work. We were told that there are two activities coordinators, each working 25 hours weekly, making a total of 50 hours per week. Care Homes for Older People Page 16 of 29 Evidence: There is an organised programme of activities for people to take part in, if they wish. Staff and people spoken with confirmed this. There is a weekly activities programme sheet posted up on each floor, upstairs and downstairs. Activities include puzzles, sing along, ball games, quiz, bingo, art and craft, sound and rhythm, exercise and motivation, board games, painting. Activities are documented at the end of each session. There is a Snoozalem room available, during our visit this was being used as a quiet area, for one individual. There is a visiting minister from the local church, and regular church services are held in the home. We were told by staff and people using the service that there is an open visiting policy at the home, and that visitors are welcome at any reasonable time. We were also told by staff that friends and families are welcome to join in activities, and that they often attend organised events. We saw photographs of people enjoying trips out and other special events. We were told by staff that people using the service can always choose whether to join in with activities or not, and that anyone who prefers to stay in their own room can do so. We observed the lunchtime meal, which was roast lamb, followed by pudding and custard. This looked appetising and nutritious. Individuals spoken with confirmed this, and told us that they liked the food at the home. People were observed to be chatting and conversing with each other during the meal. We were told that special diets, e.g. diabetic, are catered for, as well as being aware of individual preferences and choices. We are aware from our early morning visit that individual wishes in regard to rising times are not being adhered to by staff. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate 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 are able to express their concerns, and have access to a robust complaints procedure. However, individuals must be protected from abuse, and be able to live in a safe environment. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: Concerns and complaints are listened to and taken seriously and acted upon. We have a complaints procedure that is included in our Statement of Purpose and a laminated copy of the procedure in size A3 is clearly displayed in the care home. The address of the CSCI is given in the procedure. Records of all complaints and actions taken are maintained. Complaints leaflets have been developed and every resident has been issued with a copy of the leaflet We discuss the said procedure with staff, residents and relataives. We ensure that all staff are CRB and POVA checked before they commence employment. All staff attend safegaurding training as part of their core training We follow the safegaurding guidance procedure from the local authorities and Abbeyfield There are stringent financial procedures in place to protect residents from financial abuse. Staff are not allowed to accept gifts, or become involved in the making of a will. The home has a safe for the safekeeping of residents money or valuables if required and all money or property held on behalf of residents is recorded and all transactions have two signatures. The home has a challenging behaviour policy to ensure that staff know and understand how to deal with physical and or verbal Care Homes for Older People Page 18 of 29 Evidence: aggression, we have provided training in this area. Following an anonymous complaint, an unannounced early morning visit (0600hrs) was undertaken by the Care Quality Commission and Social Services. This was followed by a Key inspection of the service. We arrived at 0600hrs, and were kept waiting on the doorstep for 10 minutes before being let in. We observed that staff were running up and down the corridors, and had clearly seen us waiting at the front door. We found a total of 17 people upstairs and downstairs were up, washed and dressed. Two people in the downstairs dining area were able to speak to us, and stated quite clearly that they had chosen to get up at that time. However, two people in the same area were in wheelchairs, and were at the dining table, both asleep. We noted that the same two people were still at the dining table two hours later when we went into the office to commence the Key inspection. We went upstairs and found 11/12 people in the upstairs lounge which services the dementia care unit. We were told that the reason people were up was because the carpet and floor fitter was coming to replace the flooring upstairs, which we were subsequently told was in the communal areas, and that staff had been told that people had to be got up. We spoke with 5 night staff on duty, they included a senior carer, and a qualified agency nurse. We were later told that one carer had called in sick that night, and that they had not called in an agency worker because they had managed the shift without one. We were told by two staff that it is usual practice for the home to get people up starting at 0530 hrs. When we went to visit the Chetwynd unit lounge, the care assistant on duty was down the other end of the corridor, and not available, despite there being 11 or 12 people in the lounge at the time. The staff member could not hear us calling him. This happened on two occasions, during our visit, and resulted in us having to wait for someone to come and let us out of the unit via the keypad system. We discussed the complaint and Safeguarding referral in detail with the care manager for the home. We fedback our findings to her at the time. We discussed the need to ensure that rising times are recorded in the care plan, and that these times should be adhered to. We also highlighted and discussed the practice of night staff getting people up at 0530 which is not acceptable, and discussed the need to have an extra member of staff on duty in the Chetwynd unit, to ensure the health, safety and welfare of the people using the service. Care Homes for Older People Page 19 of 29 Evidence: We were told that staff did not answer the door, because they did not hear the bell. The care manager assured us that she would be raising our concerns with staff at the next staff meeting, and would speak with night staff personally about the rising times, and the fact that two people were left at the dining table asleep for more than two hours. She agreed to undertake regular night spot checks, accompanied by the deputy manager. We discussed other elements of the complaint, which will also be addressed by the care manager. The outcome of the complaint is still ongoing at the time of this report. No other complaints and or Safeguarding matters had been raised since the previous inspection. There is a clear and accessible complaints procedure in the home, which is posted up on the wall in the main entrance. We are aware from the previous report, and from discussion with the care manager, that the service does have a complaints procedure, and complaints would be logged and dealt with by the care manager. We suggested a grumbles book for minor grumbles to be logged and dealt with. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: The home is situated in the countryside just of the main A51. We have a full time handyman who does the internal painting, decorating, maintaining the gardens. Residents are able to furnish their own rooms with their own furniture and personal belongings. Equipment is provided for residents with limited mobility, grab rails, passenger lifts, hoists and moving and handling equipment. The home has been refurbished throughout with new carpets, lounge chairs, coffee tables, dinning tables and chairs, we have refurbished 2 bathrooms with Malibu baths, The laundry has had new washing machines and dryers. The home is well maintained and a homely place to live. Our observation of the environment included a tour of the building. All areas were maintained and decorated to a good standard. Bedrooms viewed evidenced that they were personalised and adapted to the needs and wishes of the person using the service. People told us during our visit that they were happy with their rooms, and Care Homes for Older People Page 21 of 29 Evidence: were observed relaxing and conversing in the communal areas throughout the home. They said that the decoration of the home had really improved. We saw that new carpets had been laid in some areas that needed this, new lounge chairs, coffee tables, dining tables and chairs had been purchased. Two bathrooms had been refurbished with Malibu baths, and the laundry had new washing machines and dryers. The upstairs lounge carpet and flooring to the corridor was due to be relaid during our visit. Appropriate adaptations and aids were used throughout the home, including bath chairs, hand rails, and a passenger lift. Staff reported that they always use the hoist with the appropriate size of sling for the person using the service. Hoists had been serviced. Laundry facilities evidenced that infection control measures were in place. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home should be trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the home. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: Before appointing new staff we ask for an application form and interview them. We obtain at least two written reference and a CRB check is done. We have thorough recruitment policies and the recruitment process is supported by the human resources department. Staff rotas are completed in advance and any changes need to be agreed by the manager. We use minimal agency staff to ensure consistency of care for residents. Staff are offered 1:1 sessions. Our early morning visit evidenced the need for an extra member of staff to be employed on the Chetwynd unit, this was to ensure the health, welfare and safety of the people using the service. This was highlighted and discussed with the care manager during our visit. We spoke with eight staff in total. Five of whom were night staff, and three were day staff, including the deputy manager. They confirmed that they had received Care Homes for Older People Page 23 of 29 Evidence: appropriate training in order to do their job. For example, moving and handling including the use of the hoist, dementia awareness, health and safety, infection control, fire. The care manager told us that Abuse training was booked for staff on 10th April 10, and that she was attending dementia care mapping training in January. However, when we asked for an up to date training matrix for the staff team, this was not complete and up to date. Some names of staff were missing from the matrix. We noted that Mental Capacity Act 2005, and Deprivation of Liberty training had not been undertaken. We subsequently highlighted and discussed this, and asked the care manager to forward an up to date matrix as soon as possible. We spoke with one of the two activities coordinators, and discussed her role. She was very knowledgeable about the people using the service, and confirmed that she needed training in dementia care, specifically for activities. We highlighted this to the care manager, and recommended that this training would be needed for both coordinators. We looked at three staff recruitment files. These evidenced that there was a robust and safe sytem of recruitment in place. We saw two references, a completed application form, with appropriate Police security checks, therefore Criminal Records Bureau and Protection of Vulnerable Adults checks. Staff spoken with confirmed that they had received an appropriate induction, which had been signed off by a senior person at the home. Staff spoken with confirmed that they do receive regular formal supervision, they could recall what date they had received their previous supervision, and confirmed that it was documented and signed for. Staff were not aware of the Mental Capacity Act 2005 or of the Deprivation of Liberty guidance. We highlighted the shortfall, discussed this with the care manager, and recommended that training should be undertaken. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is based on openness and respect. However, the manager must ensure the health, safety and welfare of the people using the service. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: All accidents are recorded. Accidents records are regularly reviewed and patterns reviewed with a view to reducing accidents. The manager is aware of the nms and her responsibilities to record and report incidents and events to CSCI, the Police and Adult Protection. New Incident reports and procedures have been introduced this year. The Registered Manager of the Home is competent and experienced to run the Home. The Manager is working towards her NVQ Level 4 qualification. The Care Home has updated all Policies and Procedures. Records are kept relating to residents monies and property that are kept in the safe. Residents are able to look at records about themselves kept by the Care Home. All staff receive regular supervisions. Care Homes for Older People Page 25 of 29 Evidence: The Annual Quality Assurance Assessment document had been well completed, and returned to us on time. It was clear and comprehensive, and told us how the service plans to improve. Discussions with the care manager identified that she was knowledgeable and had the necessary skills and experience to manage the delivery of care in the home. She was enthusiastic in her approach and was observed to have a good rapport with the people using the service, and the staff in the home. She confirmed that she worked well alongside the deputy manager. However we had undertaken an early morning visit with Social Services, as a result of our having received an anonymous complaint which had resulted in a Safeguarding referral being made. This was discussed in detail with the care manager, and shortfalls had been identified. We asked the care manager to ensure that she ratified the issues and the concerns raised during our visit. We also asked that she keep us informed of progress to enable our monitoring of the situation. Health and safety checks of equipment and systems within the home were evidenced to be in order. Accident and incident recording was completed in line with requirements. We were told that people using the service are encouraged to manage their own monies wherever possible, sometimes with the support of relatives and or representatives, but that otherwise the administrators of the home will provide support for this. There is a quality assurance system for the service, which is used across the organisation. Visits made under Regulation 26 are continuing, and those reports were available for us to view. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Pre admission documentation should be completed comprehensively, and should contain enough information to enable a decision as to whether the service can meet the persons individual needs. Staff should treat individuals with the respect they deserve, and should ensure that their dignity is promoted. The routines of daily living should be flexible to suit the persons needs and wishes. People using the service should feel safe, secure and be protected from abuse. Staff on the Chetwynd unit should be in sufficient numbers to safely support the needs of the people using the service. Staff should receive training according to their role and responsibilities. This should include Dementia Care training for the two activities coordinators, Mental Capacity Act 2005 and Deprivation of Liberty training for all staff. The manager should ensure the monitoring of the service, includes regular auditing, and spot checks in regard to staff practice, attitude, and competence. Page 28 of 29 2 3 4 5 6 10 12 18 27 30 7 38 Care Homes for Older People Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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