Care Home: Arden House

What the care home does well The atmosphere in the home is welcoming, friendly and homely and the interaction between staff and residents seen to be positive and fulfilling. The residents all seemed to enjoy each others company and visit each other in their rooms or the communal areas. The staff were supportive and knowledgeable regarding the people who use the service and were kind and courteous. The menus evidence a balanced diet with a varied choice of food in line with resident`s preferences. Residents comments regarding the food included: `Tasty and always a choice`. `Not bad`. The dining area was pleasant and the mealtime observed was inclusive and support given discretely when required Quality assurance systems are in place which enables the service to monitor and improve their service and ensure the home is run in the best interests of the residents. There is an open house policy which welcomes visitors at all reasonable times Satisfactory arrangements are in place to safeguard residents finances Robust recruitment practices are being followed and the staff receive the necessary training to care and support their residents. People who use the service have access to a clear complaints procedure. Whilst the homes processes and staff training should protect residents in the event of an allegation of abuse. The staff provide a range of activities and residents are supported and enabled to visit family and friends away from the home. Residents have a freedom of choice which includes going out shopping or for walks all within a risk assessment framework. What has improved since the last inspection? The Statement of Purpose and Service Users Guide has been developed to ensure that all prospective residents have the information needed to make an informed decision about moving in to the home. The pre-admission processes has been reviewed and is now including a member of staff from Arden House. All residents that live in the home now have a care plan in place to meet their needs. The infection control measures in the home have been improved and protect the people who use the service. Advice was sought following the last key inspection from the Fire Service Agency regarding the propping open of doors and this practice was reviewed. What the care home could do better: Discussion took place regarding the further development of the care plans to include the more specific individual care needs, e.g nutrition and dementia traits and as the manager confirmed that she would address these areas immediately a requirement has not been made at this time, but will be reviewed in depth at the next key inspection. There are aspects of medication practices that need to be tightened up to ensure the health needs of the residents are protected and promoted. To ensure that residents well being and safety is being protected the staffing levels at night are to be reviewed against the needs of the residents and the layout of the home. Key inspection report Care homes for older people Name: Address: Arden House 4 - 6 Cantelupe Road Bexhill on Sea East Sussex TN40 1JG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Calveley     Date: 2 6 0 5 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 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: Arden House 4 - 6 Cantelupe Road Bexhill on Sea East Sussex TN40 1JG 01424211189 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.angelhealthcare.co.uk Angel Healthcare Ltd care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Arden House is a care home registered to accommodate a maximum of 35 older people. It is one of four residential care homes owned by Angel Healthcare Limited. The premises are situated in a quiet residential area of Bexhill on Sea, within walking distance of all local amenities and the sea front. Comfortable and spacious accommodation is provided over four floors and a shaft lift enables ease of access to all floors. There are 31 single rooms and 3 rooms that can be used as double rooms. All have en-suite facilities and there are 5 separate bathrooms and toilets. The home has two general hoists and a bath hoist to support those residents who are less mobile. Two lounge areas, a spacious dining room and a large conservatory/sun lounge Care Homes for Older People Page 4 of 29 Over 65 35 0 Brief description of the care home overlooking the rear garden, provide communal space. The home welcomes prospective residents or their representatives to view the premises and discuss their needs with the Manager. The fees do not include hairdressing, chiropody, residents telephone calls and any sundries, such as newspapers: these are charged as extras. Information about the service, including a link to access the Commissions inspection reports, is available on the Organisations website (Angel Healthcare) and from the Homes Manager. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Arden House will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with residents representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6 hours on the 26 May 2009. There were fifteen residents living in the home on the day of which five were case tracked and spoken with. During the tour of the premises six other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key Care Homes for Older People Page 6 of 29 standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff and the chef were spoken with in addition to discussion with the Manager. Telephone contact was made with visiting professionals following the visit and one relative was spoken with during the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received from the Manager completed in full prior to this key inspection. The weekly fees as of the 01 April 2009 range from 350 pounds to 420 pounds. This does not include extras such as newspapers, toiletries, hairdressing and chiropody. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 29 Discussion took place regarding the further development of the care plans to include the more specific individual care needs, e.g nutrition and dementia traits and as the manager confirmed that she would address these areas immediately a requirement has not been made at this time, but will be reviewed in depth at the next key inspection. There are aspects of medication practices that need to be tightened up to ensure the health needs of the residents are protected and promoted. To ensure that residents well being and safety is being protected the staffing levels at night are to be reviewed against the needs of the residents and the layout of 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 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. Whilst the home provides prospective residents with an adequate level of information about the home its facilities and the services available, the information needs to be developed to include the terms and conditions of residency and the costs involved. The admission procedures ensure that all prospective residents are fully assessed by a competent person before admission and they are assured in writing that their needs can be met by the home. Evidence: The statement of purpose and service users guide was available on request They are written in a comprehensive and user- friendly format. Areas of the documents that need to be developed include the terms and conditions of residency with the range of fees clearly displayed so as to enable prospective residents and their families to make an informed choice in choosing a home. This was discussed in full and will be adressed and therefore a requirement has not been made. Care Homes for Older People Page 11 of 29 Evidence: The latest admissions to the home were viewed as part of the inspection process. They evidenced that an assessment is completed prior to their admission to the home by the manager and or the registered provider. It has been discussed and agreed that when the registered provider undertakes an assessment, a senior member of the staffing team will also attend to ensure a smooth transition in to the home and to provide the prospective resident with a familiar face. It was again a concern that the latest admission to the home had been admitted with a diagnosis of dementia. The homes Statement of Purpose does not reflect that the home have the skills and knowledge to care for people with dementia and therefore there is a need to ensure admissions to the home are safe and appropriate ensuring that another move is not required. All pre admission assessments should be dated and signed by the person completing the assessment and include the venue where it was performed. Since the last key inspection the home now writes to new residents or their representatives confirming the terms and conditions of residency the room they have agreed and that the home is able to meet the assessed needs of the prospective resident. Residents always have with a trial period so they can assess whether the home is suitable for them, they are welcome to visit the home and meet other residents and staff before making the decision to move in. Emergency admissions are not accepted and intermediate care is not provided. Respite care can be provided if there is a vacant room. The staff confirmed that respite residents are free to join in the daily life of the home. In this way they can get to know the staff and residents and try residential life before they commit to a permanent stay. The home no longer offers a day care service to older people in the community. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although in most cases individual plans of care set out residents personal health and social care needs with risk assessments being used these are not written in consultation with the resident or their representative and need to developed in certain areas to ensure a person centred approach is used. Residents health care needs are met with specialist advice sought as necessary. Care is delivered in such a way that promotes and protects the residents privacy dignity and individuality. Evidence: The care documentation pertaining to five residents were reviewed as part of the inspection process and each of these residents were met with during the inspection visit to the home. The care plans reviewed contained a good level of information that provides guidance in meeting the individual residents basic care needs, however as discussed specific health needs such as promoting continence, monitoring and guiding staff in dealing with behavioural traits and hearing deficits need to be developed into a plan of care. Care Homes for Older People Page 13 of 29 Evidence: The home use a wide range of risk assessments to ensure the residents are protected and their needs met consistently. The staff weigh residents monthly and more often if there is an identified problem however they are not transferring this in to the care plan with a plan of action for staff to follow to fortify food or seek advice from the G.P. Two residents records viewed evidenced weight loss with no follow through, which place residents at dietary risk. These areas were discussed in full and acknowledged by the new manager. The documentation evidenced community health care professionals input when contacted and daily records are maintained by the care staff. As discussed some entries are minimal and contain very little information and staff would benefit from further training as to how to complete the daily records. The staff spoken with said that they receive a full handover on every shift and this was confirmed by direct observation. Records indicated that the plans of care have been reviewed on a regular basis but there was no evidence to confirm that they are completed in consultation with the resident or their representative there are some very capable residents living in the home that could provide valuable consultation. The manager has been in post for six months and was aware that there are still areas that need to be developed, it is a work in progress and therefore a requirement has not been made at this time. The residents spoken to during the inspection visit were positive about the care received nice staff kind and patient. There are policies and procedures in place for staff to refer to regarding the safe administration storage disposal and recording of medication. There is a self administration policy in place, but it was brief and generic and not specific to the home. This was discussed in full with the manager, who agreed and will develop a more detailed policy. Medication is provided by a local pharmacy in blister packs with pre printed medication administration records. The systems for recording and checking controlled drugs were found to be thorough. The Medication Administration Records (MAR) were examined and gaps were identified and as discussed for best practice the staff need to follow up the gap and check to see if the residents have received their prescribed medication. The staff are using the appropriate codes when medication is either refused or omitted but are not using the charts to record the reason for non administration, this will be included in the staff medication training. Since the last inspection all residents have an identification photograph in place on their MAR sheet or care plan and it would be beneficial to date and then update them Care Homes for Older People Page 14 of 29 Evidence: regularly. A suitable lockable medication trolley is used and when not in use is stored in the dining area attached to the wall. The trolley is too big for the lift shaft to the top floor and since the last inspection medication cupboards have been installed on each floor, thus promoting safe administration of medication. There is a small medicinal fridge which is kept locked and stored in the dining room. Residents that self medicate and are prescribed as required medication need to have appropriate risk assessments in place in their care plan that include triggers to monitor the use of these medications and individual guidelines need to be provided so that residents receive medicines as they need them, e.g analgesia. As discussed it would be also be beneficial for each residents medication to be listed in their care plan with the reason for being prescribed, the side effects and the effects of non administration. This had been identified by the manager as area to be developed. During this visit staff were observed being respectful kind and attentive to the residents who they clearly know very well. Staff spent individual time with residents finding out what they wanted and ensuring when they were assisting them that they were not rushed. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle experience by residents at this time meets their expectations choices and expectations. Meals remain good in respect of both quality and variety that meets the majority of residents tastes and choice. Evidence: There are planned activities in the home which are displayed on a notice board in the lounge area. It evidenced that on five days a week there is a planned event such as exercise to music shopping trips music for health and quizzes. Residents get together for a glass of sherry either at lunchtime or on Sundays. Feedback from talking to residents is that their personal interests could be more constructively linked to the activity programme. Residents social interests are documented in their care plan and the staff use an activity book to record who attended but do not reflect the residents level of involvement and this needs developing and is a work in progress. There are some residents that prefer to stay in their own rooms that are in most cases very personalised and seen as their own. Residents were enthusiastic about the lifestyle in the home and the atmosphere was light and the relationships between the residents Care Homes for Older People Page 16 of 29 Evidence: was great to see. Residents religious needs are explored and they are supported and enabled to follow their religious wishes. Visiting is very much encouraged and it was clear from observation and contact with relatives that people are welcomed and feel comfortable when they visit. There are communal areas throughout the home that are available to residents and their visitors for private meetings if required. The conservatory runs along the back of the house and overlooks the rear garden one resident uses the conservatory for peace and chatting privately to friends. It was observed during the inspection that the routines at the home are flexible residents spoken with confirmed that they were consulted about all aspects of their lives. There are residents that regularly go out for walks and shopping. The home has an advocacy policy in place and it was confirmed that the information regarding this is available to all residents. The kitchen area is situated next to the dining area. The dining is pleasantly furnished and decorated with good quality furnishings it has plenty of natural light and is spacious allowing for staff to assist residents if required. All the tables are set with tablecloths, napkins and water jugs. The meal provided was presented well and nutritious and was enjoyed by residents. There are two chefs employed with one working five days and the other working two days. The chef spoken with demonstrated a good understanding of residents needs and individual likes and dislikes. The daily menu is displayed on a board and residents confirmed that they can ask for an alternative if they should wish so. Most residents confirmed that they are satisfied with the meals provided. Fresh fruit is readily available. From direct observation many plates from the main meal were returned with little eaten, it was said that those residents had small appetites. It was discussed that it would be more appropriate to serve smaller portions on a smaller plate to accommodate this. There is no formal recording of meals eaten and from the records of weights viewed and the food returned it would benefit the residents if this was commenced so as to monitor weight loss and seek expert advice pro-actively. The kitchen was seen to be adequately clean and staff follow cleaning rotas to ensure that the kitchen is kept clean and hygienic. The staff were seen wearing appropriate aprons whilst serving food and entering the kitchen. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. Evidence: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated to the inspector during her visit to the home. The home has received two complaints since the last inspection and these were documented in the complaint book the documentation needs to have the investigation and the action taken included. Relatives and residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the protection of vulnerable adults and staff have received appropriate training.. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. The home encourage residents to share their niggles and deal with before they Care Homes for Older People Page 18 of 29 Evidence: become complaints. Resident meetings encourage residents to share their views. Residents spoken to said that any concerns that they had would be dealt with if they raised them with the manager. The home has appropriate Safeguarding of Vulnerable Adults and whistle blowing procedure along with the local policies and procedures. It was evidenced that staff have received training on Protection of Vulnerable Adults. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arden House provides a comfortable clean and safe environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room and rooms are homely and reflect the residents personalities and interests. Evidence: Arden House is conveniently situated near to the main town area of Bexhill. It is a large detached property that provides accommodation over four floors all of which can be accessed by stairs or shaft lifts. The home continues to follow an improvement programme that has benefited the residents and visitors to the home and provided a welcoming and comfortable environment this is on going. The tour of the home evidenced that work has been undertaken with further plans in place. The dining area is attractive and welcoming. The two lounge areas were clean and comfortable the conservatory was comfortable and overlooks a good-sized garden which looked well cared for. Resident rooms are individual in size layout and furnishing. Residents can bring in their own furniture if they wish and this was evidenced during the tour of the building. There are a number of rooms that are unoccupied at present and these are being upgraded and redecorated on a rolling plan. There are a sufficient number of communal toilets and bathrooms. However not all were found to be welcoming and in good repair, and two, a shower room and Care Homes for Older People Page 20 of 29 Evidence: bathroom were not in use. Risks to residents from scalds or burns are minimised by radiator covers to radiators in high-risk areas and safe temperature valves to hot water outlets used by residents. It was confirmed in the AQAA that water temperatures are tested regularly The home has two passenger lifts which between them give level access to each floor. A small number of rooms require use of a small flight of stairs to access them. The home contracts with a lift service company who carry out any work needed promptly. Other aids and equipment are provided as needed including toilet riser seats, bath hoists, grab rails and mobility aids, all adequately maintained to encourage residents indpendence. A call system is installed with points in each bedroom and communal areas, which residents use when they require assistance. A fire risk assessment has been carried out by an appropriate agency and ensures that staff and residents are protected by the homes policies and procedures. The laundry facilities were seen and were appropriate for the size of the home with staff confirming that the washing machines have sluice cycles that can be used for soiled laundry. The residents were complimentary regarding the laundry service. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment procedures are in place to protect residents and staff training ensures they are aware of their roles and are able to provide the support and care the residents need. Evidence: There were fifteen residents living in the home on the day of the inspection. The staffing rota was viewed and the staffing levels were seen to be two carers in the morning, two carers in the afternoon and one waking staff and one sleep in staff at night. The staffing levels should be kept under close review due to the layout of the home being on four floors and the fact that they do have residents that wander and need supervision. The call system has been set up so that the call can be heard and identified on each floor. Senior staff are on call on a rota basis if there is an incident that impacts on the safety and well being of the residents. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. There was evidence of health questionnaires, POVA first and Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. Care Homes for Older People Page 22 of 29 Evidence: The AQAA stated that the induction programme in line with Skills for care is now in place and has been introduced for all staff. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the manager. The home Staff and the training list seen confirmed that compulsory training such as manual handling, adult protection, first aid, infection control, food hygiene and fire safety are being undertaken by all staff. There is a list in the office which evidence a refresher programme. The have 11 permanent care staff and of those 4 have a National Vocational Qualification (NVQ) with a further 7 undertaking an NVQ. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall management of this home is good with effective systems in place to protect residents. Evidence: The manager has been in post for 6 months but has worked in the home as deputy manager for some years. She is in the process of submitting her application to be the registered manager. She has the necessary experience and skills to run the home and is due to commence her registered managers award qualification. The staff spoken with said that they felt supported by the management structure of the home. Residents were aware of who the manager is and of her role in the home and were seen to relate positively with her. Relatives and visitors stated that the manager was helpful and efficient and that they felt that they could approach the management at any time. The ethos of the home is to focus on the residents and staff were observed doing this. Care Homes for Older People Page 24 of 29 Evidence: The quality assurance systems in the home include questionnaires sent out to residents and relatives following admission to the home. The introduction of this formal quality assurance and quality monitoring systems has enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. The manager confirmed that the results of the audits are shared with te residents relatives and staff. There are regular staff and resident meetings that contribute to the quality assurance systems as does the Regulation 26 visits conducted by a senior member of the Angel Healthcare Organisation. The Regulation 26 reports were quite informative and also included an action plan section that is to be acted on immediately after discussion with the people who use the service. There are residents who manage their own financial affairs and a relative or solicitor who acts on their behalf supports the others. The home does not act as the appointee for any resident. If staff are asked to shop for a resident, receipts and any monies held on behalf of that resident are kept in a locked cupboard, thus protecting the residents financial interests. Staff supervision was discussed and staff supervision has been commenced and is proving beneficial in ensuring that staff are supported in caring for the residents living in the home. Staff spoken with confirmed that they receive supervision. The AQAA completed by the manager and received prior to the inspection stated that all the necessary safety checks for electricity, gas, equipment and shafts lift are in place and up-to-date and therefore ensure the safety and well being of the residents living in the home. Incidents are reported to the commission as required. The accident book was viewed and there is still a need to audit accidents and follow through with a plan of action to prevent a reoccurrence and protecting residents. In the main good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 3 14 That the registered person ensures that that all admissions to the home are appropriate and reflected in the Statement of Purpose and that the staff have the necesary training to meet their needs. To promote the service users safety and well being. 30/07/2009 2 9 13 That the registered person 30/07/2009 ensures that staff follow the home medication policies and procedures in respect of the recording and administration of prescribed medications. To ensure the health safety and well being of the residents. 3 15 13 That the registered person ensures that a record of service users meals and amounts are recorded so as 30/07/2009 Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to monitor appetite traits and weight loss To promote and protect the health and well being of the service users. 4 27 18 That the Registered Person ensures that there are sufficient staff with the knowledge, qualifications, skills and experiance on duty to meet the assessed needs of the service users living in the home throughout the twenty four hours. To protect and promote the safety of the 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 30/07/2009 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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