Care Home: Arden Lea Nursing Home

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What the care home does well Service users needs are assessed before they move into the home, unless an emergency admission is required, so that staff know how to meet service users needs. Service users privacy and dignity is respected. Service users receive a nutritious and appetising diet with individual preferences being met. Service users feel able to raise concerns and complaints and are confident that the registered manager will act on them and staff know how to safeguard service users from abuse. The home has robust recruitment and training procedures There is evidence that the home is run in the best interests of the service users What has improved since the last inspection? Medication is safely administered to service users and an accurate record is kept. Risk assessments and care are now in place to identify service users needs both of which are undergoing a review process by the registered manager. The unsafe window covering identified at the previous key inspection has been removed. What the care home could do better: Some shortfalls were identified in relation to the recording of dates and assessors names within the assessment documentation. More effort is required in relation to the development of the service users care planning documentation to ensure they are effective in promoting the service users health and wellbeing. Service users are provided with the opportunity to participate in some recreational activities and can maintain social contacts but further developments are required in this area. Shortfalls were identified in relation to the standard of hygiene at the home. There may not always be enough staff on duty to meet the needs of service users. It could not be evidenced that the registered manager is provided with appropriate resources and support to effectively manage the service. Systems for managing service users finances could not fully demonstrate that service users are safeguarded. Key inspection report Care homes for older people Name: Address: Arden Lea Nursing Home 25 Mayo Road Sherwood Rise Nottingham NG5 1BL     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: Steve Keeling     Date: 2 0 0 4 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Arden Lea Nursing Home 25 Mayo Road Sherwood Rise Nottingham NG5 1BL 01159621100 01159113292 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): None Atheray Organisation Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accomodated is: 27 The registered person may provide the following category of service only: 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, Dementia code DE Date of last inspection Brief description of the care home Arden Lea is a 27-bed home situated close to the city centre with many local amenities and well served by local transport. All areas of the home are accessible to service users. The home provides 24-hour care with nursing for older people but 5 places may Care Homes for Older People Page 4 of 33 Over 65 0 27 0 12 0 5 2 1 0 4 2 0 0 9 Brief description of the care home be used by people with a physical disability between the ages of 18 and 65 years. weekly fees range from £339 to £344 for residential care and £522 to £644 for reidential care with nursing. The Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspection undertaken by the Quality Care Commission is upon outcomes for people who use the service (service users) and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practise, and focuses on aspects of service provision that needs further development. One inspector conducted the unannounced visit over two days. The main method of inspection used is called case tracking which involves selecting service users and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. The registered manager and members of staff were spoken with as part of the visit, records relating to medication management was also inspected to form an opinion Care Homes for Older People Page 6 of 33 about the quality of care provided. A partial tour of the building was undertaken which included service users bedrooms and communal areas they frequent to make sure that the environment is homely and safe. A review of all the information we have received about the home since the last key inspection was performed on the 21.04.2009 was considered in planning this visit which included the Annual Quality Assurance Assessment which was provided by the registered manager on the 12th February 2010, the six responses we received to Have you Say service user surveys and the five responses we received from staff surveys which were distributed in the home prior to the site visit. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Some shortfalls were identified in relation to the recording of dates and assessors names within the assessment documentation. More effort is required in relation to the development of the service users care planning documentation to ensure they are effective in promoting the service users health and wellbeing. Service users are provided with the opportunity to participate in some recreational activities and can maintain social contacts but further developments are required in this area. Shortfalls were identified in relation to the standard of hygiene at the home. There may not always be enough staff on duty to meet the needs of service users. It could not be evidenced that the registered manager is provided with appropriate resources and support to effectively manage the service. Systems for managing service users finances could not fully demonstrate that service users are safeguarded. Care Homes for Older People Page 8 of 33 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are assessed before they move into the home, unless an emergency admission is required, so that staff know how to meet service users needs. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states Arden Lea visits all potential service users funded and private prior to admission to ensure that we can meet their needs. (Arden Lea has had several service users who have been admitted as an emergency admission and as far as possible social services have sent their needs assessment to the home prior to their arrival) A social services assessment is obtained and input from families service users enable us to form a life story to implement their needs assessment and care plans. The initial assessment is made by the manager. Potential service users have the choice of visiting the home for a day or a weekend to enable them to make an informed choice. Service users who use the home for intermediate care are provided with access to relevant professional bodies and equipment with the aim of returning to Care Homes for Older People Page 11 of 33 Evidence: their homes, we work closely with other professional bodies and families to achieve maximum independence for the service user. The Have your Say pre inspection questionnaire asked service users Did you get enough information about the home before you moved in so you could decide if it was the right place for you and Have you been given written information about the homes terms and conditions (sometimes called a Contract), all six respondents stated Yes. Records showed that the case tracked service users had undergone a needs assessment before gaining residency and additional information from Social Services Departments are incorporated into needs evaluation when available. It was noted that some of the needs assessments were not dated and signed by the assessor, the registered manager stated that she would address the issue by ensuring that all staff sign the assessment documentation. Staff confirmed that the needs of all new service users are discussed at staff handovers and that the needs assessments are always available for reference and guidance if required. Care Homes for Older People Page 12 of 33 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 service users care planning documentation needs further development to ensure they are effective in promoting the service users health and wellbeing. Medication is safely administered to service users and an accurate record is kept. On the whole service users privacy and dignity is respected. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states The service users care plans incorporate all the needs of the service user to ensure that all aspects of health, social care and personal care is maintained. The care plan incorporates relevant professional documentation and are reviewed on a monthly or when necessary basis and all service users are assessed on their capacity Service users and their families are encouraged to participate in the care plan. Service users are monitored and any professional advice sort when needed and equipment supplied to ensure their well being. The medication is audited on a regular basis. The Have your Say staff surveys asked Do you feel you have enough support, Care Homes for Older People Page 13 of 33 Evidence: experience and knowledge to meet the different needs of the service users, four respondents stated Always and one respondents stated Usually. The Have your Say pre inspection questionnaire asked service usersDo you receive the medical support you need, five respondents stated Always and one respondent stated Sometimes. A service user spoken with on the day of the inspection confirmed that she is able to see her General Practitioner on request and records showed that service users had received interventions from community based specialist nurses, chiropody services and opticians as required. More effort is required in relation to the development of the service users documentation as the case tracking process showed that some care plans and risk assessments had not been signed or dated by the assessor. Consent to the content of the care plans had not always been sought from the service users or a representative of theirs. Some care plans were out of date and the reviewing process had not highlighted the changing needs of the service users and some instructions identified within care plans had not been followed effectively. Furthermore some care plans were very bulky which could impede the information gathering process for the care staff. The registered manager agreed that the current care planning format requires amendment and demonstrated that she is proactive in addressing the identified shortfalls as she has recently devised a template that she intends to use in a reviewing process which will be undertaken on all the service users care plans and risk assessments within the next three months. It was confirmed by the manager and members of staff that medications are only administered by a qualified nurses. A medication round was briefly observed, the Medication Administration Records (MAR) were maintained effectively and a qualified nurse was administering service users medication in a safe and competent manner. It was noted that the lock on the homes medication room was faulty which could compromise the safety of the service users. In addressing the shortfall the registered manager arranged for a locksmith to replace the lock on the day of the inspection. Information provided by the registered manager in the Annual Quality Assurance Assessment states All service users are addressed by their preferred name. There is access to a telephone for the service users. All service users are given respect and privacy throughout the home and staff are trained to ensure this is maintained. Service users clothes are named and changed daily or more if required to ensure their Care Homes for Older People Page 14 of 33 Evidence: dignity and hygiene needs are met. All service users are given care and support when dying and their preferences recorded. The Palliative care nurse from the PCT is involved when planning end of life care. The Have your Say pre inspection questionnaire asked service users, Do you receive the care and support you need three respondents stated Always and three respondents stated Usually. Throughout the inspection process staff were observed to be addressing service users in a polite and respectful manner. Service users spoken with on the day of the inspection said that the care staff respect their privacy and dignity whilst performing personal care and comments included I like it here they [care staff] are very nice, they are busy, but it is alway like that, they try their best. Another service user, when asked about the staffs ability to promote her respect and dignity stated The staff are really nice but on one occasion I was calling for help and they dont come for some time and I wet myself, which was embarrassing, but usually they are very good. Care Homes for Older People Page 15 of 33 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. Service users are provided with the opportunity to participate in some recreational activities and can maintain social contacts although some service users would benefit from further developments in this area, as it would offer them more stimulation and enjoyment. Service users nutritious and appetising diet with individual preferences being met. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states Arden Lea ensures that all service users experience a home from home atmosphere and are encouraged to participate in life skills. We offer activities taking into account personal choice, likes and dislikes and this is documented in their care plans. We take into account capacity, capability and physical and sensory disabilities. All staff are now trained in dementia awareness. Service users are asked their views and requests and have an active participation in what they do. Service users are encouraged to maintain their outside community contacts and we encourage the community to come to them, service users that are able go out to the shops to buy clothes etc, however those unable to go out are provided with the means to shop from within the home. Service users have up to date information on what is going on in the home on the notice board.There are no visiting restrictions. Families are sent Care Homes for Older People Page 16 of 33 Evidence: information on events occurring in the home. The home has entertainers who visit the home and during the spring and summer the home offers outings for the service users. Service users have a choice of decorating and personalising their rooms. All service users are assessed as to the capacity to holding their own finances and assistance is given as necessary. All service users have a choice of menu and this is documented, all specific dietary needs or preferences are discussed on admission and documented in the care plans, the menu changes daily and drinks and snacks are available throughout the day. The Have your Say pre inspection questionnaire asked service users Does the home arrange activities that you can take part in if you wish, two respondents stated Always, three respondents stated Usually and one respondent stated Sometimes. We discussed the provision of social activities with a service user on the day of the inspection. The service users stated I like to sit and knit most of the time but we have guest entertainers coming in, sometimes we have sing-songs and I go to Church on Sundays which is nice. The service user also confirmed that their family and friends can visit the home at any time and that visitors are made very welcome. We observed that two service users were accommodated in a shared room at the top of the building. Both service users had restricted mobility and had not been out of the room for several weeks. A television was on but following a discussion with the registered manager it was established that limited social activities were provided for these service users. In addressing the issue the registered manager stated that the residents will be offered accommodation on the ground floor of the building where staff can interact with them on a regular basis. In addition the registered manager stated that she would be consider employing a designated activities coordinator to ensure the home can provide an effective activities programme for all the service users. The Have your Say pre inspection questionnaire asked service users Do you like the meals provided, three respondents stated Always and three respondents stated Usually. On the day of the inspection we asked service users if they enjoyed the meals provided at the home, comments included, I normally have cereal for breakfast but I could have a fry up if I wanted, the food is very good and Yes the food is not bad at all. Care Homes for Older People Page 17 of 33 Evidence: It was observed that service users who required support from care staff during mealtimes were assisted in a relaxed and discreet manner thus promoting their respect and dignity. Care Homes for Older People Page 18 of 33 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. Service users feel able to raise concerns and complaints and are confident that the registered manager will act on them. Staff know how to safeguard service users from abuse Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states Arden Lea has an open door policy and complaints are taken very seriously acting promptly on any concerns or complaints. If the complaint needs to go to an external body or advice needed then the relevant agency is contacted immediately. A record of all complaints are logged in the complaints file and care plans and service users and families are kept informed at all times. The home has a complaints procedure situated in the home. Service Users and families are made aware of the complaints procedure on onset and service users are assisted to to facilitate outside advocacy if they lack capacity. All staff are CRB and POVA checked prior to employment and all staff have training in recognising abuse. All service users monies are kept in the office safe and audited monthly. The Have your Say pre inspection questionnaire asked service users Is there someone you can speak to informally if you are not happy and Do you know how to make a formal complaint, all six respondents stated Yes. The Have your Say pre inspection questionnaire asked staff Do you know what to Care Homes for Older People Page 19 of 33 Evidence: do if someone has concerns about the home, all five respondents stated Yes. We asked a service user, on the day of the inspection, if she felt confident in highlighting any issues of concern to the registered manager, her response was I feel safe here and well looked after, the staff would sort anything out if I was unhappy. We examined the homes complaints book, three complaints were recorded and the records showed that the registered manager addressed them in a satisfactory manner. We spoke to a member staff to determine her level of understanding in relation to Safeguarding Adults. The member of staff stated that she has received training in this area and demonstrated an acceptable level of knowledge and competency. Furthermore the registered manager provided us with a staff training matrix which shows that all staff have or will receive refresher training in this area by the 25th June 2010. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls were identified on the day of the inspection in relation to the standard of hygiene at the home but the housekeeping procedures generally provide service users with clean and homely surroundings. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states Arden Lea provides a warm clean and friendly environment and prides itself on being odour free the majority of the time. Service Users are consulted about the environment they live in as are their families. Staff are also consulted about the environment. All staff are trained in infection control and there are policies in place in relation to the control of infection. Waste bins are stored away from the building and Clinical waste and sharps are disposed of by a recognised contractor. The lifts are serviced regularly as are the hoist and scales. All electrical, gas and plumbing is done by qualified engineers and certificates obtained. The Have your Say pre inspection questionnaire asked service users Is the home fresh and clean, all six respondents stated Usually. We asked service users if they are satisfied with the standard cleanliness in the home, comments included Yes I like it, its clean and Yes, I am satisfied. Care Homes for Older People Page 21 of 33 Evidence: The home has recently had a infection control audit performed by Nottingham City NHS trust and was assessed as Falling within minimum compliance levels. The audit process identified several areas of improvement, not all of which had been addressed at the time of this inspection. We spoke to a representative of the infection control team who stated that she has recently received an action plan from the registered manager which appeared to address the issues of concern. Service users bedrooms and the communal areas that service users frequent were inspected. The service users bedrooms were maintained to an acceptable standard of hygiene and service users stated they were satisfied with their bedrooms. Not all communal areas were maintained to a satisfactory standard of hygiene, faecal matter was present on a toilet seat and on the floor in a toilet area. Furthermore soiled continence pads and dressings were evident outside the lift on the second floor, all of which constitutes a infection control risk. The sluice door was open. Given that some service users accommodated at the home have impaired cognitive abilities it would present the risk of mistaken ingestion of the strong chemicals which were being stored in this area. We discussed these issues with the registered manger who agreed that the home was not maintained to a satisfactory standard of cleanliness. She stated that the homes cleaner was not at work due to sickness and in her absence the homes handyman was undertaking cleaning duties. On the second day of the inspection it was evident that all the areas of concern had been addressed by the registered manager in a satisfactory manner. The external environment was free from obstacles and accessible to service users with impaired mobility and the registered manager stated that work on replacing windows was due to commence in the near future. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has robust recruitment and training procedures but there may not always be enough staff to meet the needs of the people living in the home. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states All staff are commenced on NVQ training at the beginning of employment, all staff have or are sitting either National Vocational Qualification 1,2 or 3. The home uses the residential forum to ascertain staffing requirements and is adjusted accordingly. All staff receive an induction programme at onset of employment. Skills and abilities are taken into account to ensure an even skill mix is provided. Staff are employed using our recruitment procedure and necessary documentation obtained before employment. All staff are employed to adhere to the employment handbook and code of conduct. All staff receive supervision appraisals and assessment and are trained and competent in their role and are aware of the changing needs and settings of the service user and are able to adapt to changing influences. Arden Lea uses outside providers for training needs. All staff files have the relevant documentation required under the Care Standards Act. The Have your Say pre inspection questionnaire asked service users Are staff available when you need them, four respondents stated Always and two respondents stated Usually. Care Homes for Older People Page 23 of 33 Evidence: The Have your Say pre inspection questionnaire asked staff Are there enough staff to meet the needs of all the service users, two respondents stated Always, two respondents stated Usually and one member of staff did not comment. On the day of the inspection we asked the registered manager and a qualified nurse if they felt the current staffing levels were meeting the needs of the service users, both individuals stated that more staff would improve the service provision. A member of the care staff stated, and records showed, that on the weekend of the 17th and 18th April 2010 only one qualified nurse and two care staff were on duty which did not meet the holistic needs of all the service users. On examining the homes accident book it was evident that 57 accidents had been recorded in the previous 12 months. The registered manager stated that one reason for the high level of accidents could be attributed to the current staffing levels being insufficient to allow effective monitoring of the service users. In determining the staffing requirements at the home the registered manager is currently liaising with a representative of the Primary Care Trust (PCT) and formulating a staff needs analysis on the 13th May 2010 to ensure that the staffing levels are in such numbers that are appropriate to maintain the health and wellbeing of service users. We examined two staff recruitment files and it was evident that they contained, Protection of Vulnerable Adult checks, Criminal Record Bureau Checks, an application form, two written references and proof of identity and met national minimum Standards. Staff confirmed that an induction process was provided when they commence employment and the registered manager confirmed that induction is now based on Skills for Care common induction standards. Information provided by the registered manager within the Annual Quality Assurance Assessment shows that the service has 62 of staff with, or working towards an National Vocational Qualification in care, which exceeds National Minimum Standards. We were provided with a newly devised staff training matrix which showed that staff have been provided with appropriate training to ensure they have the competency and skills to meet the needs of the service users. The staff training matrix also showed that refresher training has been arranged in the near future from an accredited Care Homes for Older People Page 24 of 33 Evidence: training agency. Care Homes for Older People Page 25 of 33 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. It could not be evidenced that the registered manager is provided with appropriate resources and support to effectively manage the service. There is evidence that the home is run in the best interests of the service users but it could not fully demonstrated that service users financial interests are safeguarded. Evidence: The home has a new registered manager in post who demonstrated to the Care Quality Commission on the 13.10.2010 that she has the required skills and experience to manage the home. The registered manager is also in possession of a recognised degree level qualification in management. The registered manager has been in post for a relatively short period of time and recognises that improvements are required at the home to meet all the National Minimum Standards. On the day of the inspection and following the inspection the registered manager demonstrated a commitment to improve service provision and has demonstrated to the Care Quality Commission that she is willing to work with us and Care Homes for Older People Page 26 of 33 Evidence: other organisations. The Have your Say pre inspection questionnaire asked staff Does your manager give you enough support and meet you to discuss how you are working, four respondents stated Regularly and one respondent stated Often. The Have your Say pre inspection questionnaire asked staff What do you think the home does well, comments included All staff member interact extremely well with the service users and the care given is of a very high standard and A warm environment, friendly staff and a good manager to lead the team. The Have your Say pre inspection questionnaire asked service users What do you think the home does well, comments included Its really friendly here, nice outgoing staff and always someone there when needed and they help with all our needs such as washing, dressing and keeping us safe. I would like to say they care for us very well and the staff are great. On the day of the inspection we asked a service user if she was confident in the registered managers abilities in relation to managing the service, comments included Yes very confident, she is very good and she is always available if needed. The registered manager stated and staff confirmed that the homes policies and procedures are readily accessible to all staff and information provided by the registered manager in the Annual Quality Assurance Assessment shows that all the policies and procedures were updated on the 15th February 2010. On the day of the inspection the registered manager and care staff confirmed that formal staff supervision and appraisals have been performed and staff stated that the registered manager always provides the opportunity to discuss any issues of concerns relating to the service provision either at staff meetings, which are performed on a monthly basis or at the designated staff supervision sessions. As mentioned earlier in the report the homes accident showed that 57 accidents were recorded since last key inspection was performed. It is the responsibility of the registered manager to inform the Care Quality Commission of any of the accidents which have resulted in an injury to the service user. This managerial function had not been undertaken in all instances. The registered manager was informed that all significant events must be reported to the Commission and our records now show that compliance has been achieved. Care Homes for Older People Page 27 of 33 Evidence: The registered manager expressed concerns, and the Commission has concerns in relation to the managers ability to run an effective managerial service. The registered manager stated that she not employed on a supernumerary basis and is often expected to provide direct care to the service users when staffing levels are low. The manager also confirmed that she does not have any administration support and she would find this very beneficial in enhancing her managerial role. Service users are provided with the opportunity to have small amounts of spending money securely stored within the home. We examined the financial records relating to financial transactions and it was shown that all transactions are recorded and receipts are obtained. The registered manager stated that four service users have money paid into a residents account. We were not able to examine the account to determine if service users financial interests are being safeguarded as the registered manager stated that she does not have any details relating to the account. Information provided by the registered manager within the Annual Quality Assurance Assessment shows that service users health, safety and wellbeing is promoted by the provision of effective routine maintenance which includes electrical circuit safety tests, the maintenance of hoists and lifts, gas appliance and fire fighting equipment. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 People using the service 18/06/2009 must be involved in the care planning process. This will ensure that people are enabled to have a say in how they wish their care to be delivered and how they wish to be supported. Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 You must ensure that service users care plans and risk assessments are A. Signed and dated by the assessor. B. Effectively reviewed to highlights the changing needs of the service users. C Instructions documented within the care plans are followed. To ensure the health and wellbeing of service users is promoted. 30/07/2010 2 27 18 The registered provider must demonstrate that the staffing levels and skill mix are appropriate to meet the assessed needs of the service users and takes into account the size, layout and purpose of the home. 30/07/2010 Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the staff levels meet the holist needs of the service users. 3 31 19 The registered provider 30/07/2010 must provide evidence to the Care Quality Commission that the registered manager is provided with the resources and support to effectively manage the service. To ensure that the management structure is effective in promoting the health and wellbeing of the service users. 4 35 16 The registered provider must provide a copy of all the documentation relating to the residents account and ensure that documents relating to service users financial management is always available for inspection. To demonstrate that service users financial interests are safeguarded. 30/07/2010 Care Homes for Older People Page 31 of 33 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 The registered provider should ensure that all pre admittance assessment documentation is signed and dated by the assessor in all instances so as to demonstrate an effective audit trail. The registered provider should ensure that irrelevant information in the service users care plans is removed to aid the information gathering process for the care staff. The registered provider should ensure that the newly devised care planning format is used for all the service users at Arden Lea. The registered provider should consider employing a designated activities coordinator to ensure the home can provide an effective activities programme for all the service users. The registered provider should ensure that recommendations made by the infection control team at Nottingham City NHS trust are addressed. The registered provider should ensure that chemicals are stored in a safe manner to minimise the risk of ingestion by service users with impaired cognitive abilities. 2 7 3 7 4 13 5 19 6 19 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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