Care Home: Argyle (The)

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What the care home does well People are well assisted and informed throughout their admission to the home. Overall peoples` needs are met and accounted for from staff that is effectively recruited and trained. Who treat them with sensitivity and respect. Promote their rights to dignity, privacy and choice and who they enjoy good relationships with. We received many positive comments from people and their representatives about the standards of care, including `My wife has been very poorly lately, staff have done an amazing job and she is brighter now and comes down to the lounge again. She gets the care she needs, including medical care.` `Staff are brilliant. They always tell us what is happening and consult with me.` `Food is plentiful and we are asked about our likes and dislikes.` Peoples known lifestyle preferences and choices are respected within their daily lives at the home and they received nutritious wholesome food in accordance with their assessed needs. Peoples rights to complain are promoted and upheld and complaints received are listened to, acted on and effectively accounted for and they are suitably protected from harm and abuse. People live in a home that is kept clean, comfortable, safe and well maintained and which suits their needs. The home is overall managed and run in peoples best interests and their health safety and welfare is usually promoted and protected. What has improved since the last inspection? We made 7 requirements at our last key inspection in January 2009. 8 of these are complied with although one is not fully complied with. However, given work in progress in respect of changes to their needs assessment and and care planning format, we have extended the timescale for the latter. Improvements include, Provision of revised service information for people, including up to date information about how to complain. Ensuring safe arrangements for the transportation of peoples` medicines around the home and for the purposes of their administration to people. Total upgrade and refurbishment to the ground floor communal toilet, making it accessible and fit for purpose and with ongoing upgrading, repair and renewal of the environment in accordance with the home`s own rolling programme. Provision of suitable dispensible hand washing facilities and equipment in communal toilets and bathrooms so as to promote good infection control. Ensuring that monthly visits are undertaken to the home by a representative of the registered provider and with provision of reports of those visit. Ensuring recorded risk assessments are undertaken for specified potential environmental risks and hazards to peoples safety. What the care home could do better: We have made 5 requirements and a number of quality recommendations at this inspection. The areas these cover are referred to below, including where a requirement is made. Specify the range of fees charged to people in the revised service guide, including what they cover and arrangements for their payment. Requirement. (And provide a copy of the guide in each persons own room). Ensure individual needs risk assessment tools are fully and accurately completed and reviewed at least monthly intervals. So as to consistently and accurately account for any potential risks to peoples health and welbeing. Requirement. Introduce the use of a recognised trigger tool for nutritional risk assessment to assist in the timely referral to outside health care professionals where necessary. Include consideration of individuals mental capacity to consent to their care and treatment within the home`s needs assessment format. Develop a related policy and procedural guidance to assist staff in implementing the considerations of the Mental Capacity Act 2005 in their day to day practise. Provide a suitable cupboard for the storage of controlled drugs to ensure their safe storage. Requirement. Review the arrangements for care staff deployment into the laundry to ensure best infection control practise. Requirement. Maintain staff induction records in accordance with sector skills workforce training targets. Ensure that the monthly visits to the home that are conducted on behalf of the registered provider are properly conducted. Requirement. Further develop quality assurance and monitoring systems. So as to provide greater accountability and evidence that the home meets its own service aims and objectives and national standards concerned with the care of older people. Including by way of information provided in our AQAA return. Develop existing policy and procedural guidance in relation to - Infection control procedures for staff to follow. Ensuring they are up to date and accord with Department of Health guidance. - In the event of Emergencies and crises in the home. - Falls prevention and management. Ensure records kept in respect of any monies held by the home for safekeeping on behalf of any service user are regularly audited to ensure they are accurately maintained and in accordance with best practise. Key inspection report Care homes for older people Name: Address: Argyle (The) 24/25 Broad Walk Buxton Derbyshire SK17 6JR     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: Susan Richards     Date: 2 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) 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 33 Information about the care home Name of care home: Address: Argyle (The) 24/25 Broad Walk Buxton Derbyshire SK17 6JR (01298)23059 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Argyle Residential Home Ltd care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Bedroom 6 cannot be occupied until it meets with National Minimun Standards. Date of last inspection Brief description of the care home The Argyle is registered to provide personal care for up to twenty four people. It is a large period building that is homely and welcoming, located in Buxton, overlooking The Pavilion Gardens. A small garden area is provided to the front and side of the building, with a sitting area for service users. Accommodation is provided over three floors that are accessed via a passenger lift. Many bedrooms are large bed sit type and mainly single room accommodation and with a large number providing en suite provision. Although bedroom 6 is not accessible to any service user until such time as it meets with National Minimum Standards for Older Persons, which is a condition of the homes registration. There is a large communal lounge and separate dining room to the ground floor and a quiet library room to the second floor. Some areas of the home do not provide for disabled access, including the front entrance having steps. Care and support is provided from a team of care and hotel services staff led by the registered manager/provider and with a high company profile in the home. An activities coCare Homes for Older People Page 4 of 33 Over 65 24 0 2 6 0 1 2 0 0 9 Brief description of the care home ordinator is also employed on a part time basis. Information as to the range of fees charged and what they cover can be obtained directly from the home. 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: 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 quality rating for this service is 2 stars. This means the people who use the service experience good quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the Care Homes for Older People Page 6 of 33 service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. Our inspection visit included assessing compliance with previous requirements made and the meeting of key national minimum standards. We sent out 10 surveys to people living in the home and received no responses. We sent out 10 surveys to peoples relatives or representatives via individual service users and 5 staff surveys. We received no responses from peoples relatives or representatives and none from staff. At our visit we saw that surveys to residents and relatives were distributed into each residents post trays. The manager advised these were placed there for some time. There were 23 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. We were assisted by the manager/provider. (Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff). Case tracking was used during our visit where we looked more closely at the quality of care and services received by people 3 living in the home. We did this by speaking to them and/or their relatives, observation, reading their care records, and talking to staff. All of the above was done with consideration to the diversity needs of people accommodated at the home. All people accommodated were British white and of Christian based religion. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? We made 7 requirements at our last key inspection in January 2009. 8 of these are complied with although one is not fully complied with. However, given work in progress in respect of changes to their needs assessment and and care planning format, we have extended the timescale for the latter. Improvements include, Provision of revised service information for people, including up to date information about how to complain. Ensuring safe arrangements for the transportation of peoples medicines around the home and for the purposes of their administration to people. Total upgrade and refurbishment to the ground floor communal toilet, making it Care Homes for Older People Page 8 of 33 accessible and fit for purpose and with ongoing upgrading, repair and renewal of the environment in accordance with the homes own rolling programme. Provision of suitable dispensible hand washing facilities and equipment in communal toilets and bathrooms so as to promote good infection control. Ensuring that monthly visits are undertaken to the home by a representative of the registered provider and with provision of reports of those visit. Ensuring recorded risk assessments are undertaken for specified potential environmental risks and hazards to peoples safety. What they could do better: We have made 5 requirements and a number of quality recommendations at this inspection. The areas these cover are referred to below, including where a requirement is made. Specify the range of fees charged to people in the revised service guide, including what they cover and arrangements for their payment. Requirement. (And provide a copy of the guide in each persons own room). Ensure individual needs risk assessment tools are fully and accurately completed and reviewed at least monthly intervals. So as to consistently and accurately account for any potential risks to peoples health and welbeing. Requirement. Introduce the use of a recognised trigger tool for nutritional risk assessment to assist in the timely referral to outside health care professionals where necessary. Include consideration of individuals mental capacity to consent to their care and treatment within the homes needs assessment format. Develop a related policy and procedural guidance to assist staff in implementing the considerations of the Mental Capacity Act 2005 in their day to day practise. Provide a suitable cupboard for the storage of controlled drugs to ensure their safe storage. Requirement. Review the arrangements for care staff deployment into the laundry to ensure best infection control practise. Requirement. Maintain staff induction records in accordance with sector skills workforce training targets. Ensure that the monthly visits to the home that are conducted on behalf of the registered provider are properly conducted. Requirement. Further develop quality assurance and monitoring systems. So as to provide greater accountability and evidence that the home meets its own service aims and objectives and national standards concerned with the care of older people. Including by way of information provided in our AQAA return. Care Homes for Older People Page 9 of 33 Develop existing policy and procedural guidance in relation to - Infection control procedures for staff to follow. Ensuring they are up to date and accord with Department of Health guidance. - In the event of Emergencies and crises in the home. - Falls prevention and management. Ensure records kept in respect of any monies held by the home for safekeeping on behalf of any service user are regularly audited to ensure they are accurately maintained and in accordance with best practise. 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 10 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 11 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. The revised service guide should better inform people about the care and services they are to received and their needs are mostly, but not always consistently accounted for. Evidence: In our AQAA, the provider told us they always ensure peoples needs are assessed before their admission to the home. That they have further secured improvement in this area to obtain all of the information they need in respect of each new service user, including from outside professionals concerned with their placement there. They also told us they have revised the format of their key service information for people. We saw at our visit that this was produced by way of a standardised pack, also available in large print format. Although we saw that the actual range of fees charged per week is not specified, or what they cover and the arrangements for their payment. Care Homes for Older People Page 12 of 33 Evidence: People told us they received information about the service, which helped them choose the home and that their needs were being met. Peoples recorded needs assessment information was reasonably well recorded, although did not contain any information as to their individual mental capacity to make key decisions about their care and treatment. We also found areas where key risk assessments were not fully completed or regularly reviewed. For two people we case tracked, their pressure ulcer risk assessment scoring tool was not fully completed on admission. This meant that the baseline risk score determined from this, was not accurate and did not effectively account for the level of potential pressure ulcer risk posed to those persons. Whilst we saw that their written care plans realting to those risks did account for their current needs, including for their pressure area care. The failure to accurately complete and regularly review health risk assessments could potentially result in ommissions of care. As we had made a requirement at our last key inpsection about ensuring the regular review of individual needs assessments relating to risks to personal safety. We discussed this with the manager who gave assurance would be addressed with priority. We have therefore given a short extended timescale for this to be achieved. We also saw that the home had developed a nutritional risk assessment tool, although this did not provide for a trigger for any necessary referral to outside healthcare professionals as may be necessary, including for dietetic advice. However, since our inspection the provider has confirmed they have sourced a recognised tool for this purpose, which they are now introducing for use. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, peoples healthcare needs are suitably accounted for and staff treat people with respect and promote their rights to dignity and choice. Evidence: In our AQAA the home told us they record comprehensive and holistic care plans for each service user and provide a choice for people to retain and manage their own medicines where capable. They did not tell us about any improvements made or aimed for relevant this the standards in this outcome section. Although under the Choice of Home section told us they told us they are making revisions to their individual needs assessment and care planning format and considering the introduction of computerised records for the future. They gave us some statistical information that we asked for. This tells us that staff have undertaken training in assisting people to eat and drink over the last 12 months and that at the time they completed their AQAA return, they had no pressure ulcer Care Homes for Older People Page 14 of 33 Evidence: incidence in the home over that time period. At our visit people said that they felt their health care needs are usually met, including for their medical needs and that staff treat them with respect and sensitivity. We received many positive comments from people. These included, My wife has been very poorly lately, staff have done an amazing job and she is brighter now and comes down to the lounge again. She gets the care she needs, including medical care. Staff are brilliant. They always tell us what is happening and consult with me. I visit every day. The staff have been really good with our father. They know what works and he is more settled now. Peoples care plans were reasonably recorded within a combined needs assessment and care intervention document. People had signed their daily living care plan, or where not able, their relative had signed these. They included peoples choices and preferences concerned with their daily living routines. However, written care plans were not always regulary reviewed and some did not specify the necessary care interventions for staff to follow. For example, one person we case tracked, did not have a falls management plan, despite their daily record and accident logs recording 2 recent falls and also being identified as at risk of falls. The same person had a care plan in place for their aggression, although this did not provide clear and specific care interventions for staff to follow. Discussions with staff and feedback from that persons family relating to their care and management of their aggression, told us that staff were conversant with that persons needs here and staff described suitable care interventions that they carry out for these. We also found there are no specific falls awareness tools in use or training provision for staff in this area. We have made a recommendation about this under the management section of this report. We discussed those omissions that we saw in care plan records, as referred to above, with a senior care staff and saw that revised format for indiviudual needs assessment Care Homes for Older People Page 15 of 33 Evidence: and care planning was in the process of being introduced, with some files completed, which were more specific. Inputs from outside healthcare professionals were recorded in each persons care files, including for the purposes of routine health care screening and individual weight monitoring. We found the arrangements for the ordering, receipt, storage, administration and disposal of peoples medicines to be satisfactory and in accordance with recognised practise, with the exception of one area. This relates to the cupboard used for the storage of controlled medicines, which is not of the correct type and with controlled medicines stored therein. We found the home has complied with the two requirements we made at our last key inspection concerned with the storage and transportation of peoples medicines around the home and for the purposes of their administration. With regard to the controlled medicines cupboard in use. We understand from speaking with staff at this inspection, that they had received conflicting advice about this from their local pharmacist supplier. We discussed the required arrangements with staff responsible and also the provider. Since our visit the provider has confirmed that a suitable type of cupboard has been ordered for these, to be suitably fixed on receipt. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples known lifestyle preferences and choices are respected within their daily lives at the home and they received nutritious wholesome food in accordance with their assessed needs. Evidence: In our AQAA the home told us they ensure regular provision for people to engage in social and recreational activities and entertainments including seasonal celebrations. Providing a dedicated creative theraptist for 3 sessions per week, regular fund raising coffee mornings and in ensuring people are able to maintain contacts with their families and friends. They also told us they provide people with good home cooked food with variety and choice. They told us about some improvement they have made. These include commencement of a regular newsletter for people relating to home life, restablishing regular church services and supporting individual arrangements for people to worship. That they aim to improve over the coming 12 months, by further developing activities provision to tailor these more to individual choices. At this inspection we saw that newspapers are regularly delivered to the home for Care Homes for Older People Page 17 of 33 Evidence: people and that there is a visiting hairdresser and a quiet reading room, with comfortable seating and suitable lighting provision. People told us there are usually some activities they can choose to join and that they are consulted and supported in their daily living routines. Although some felt there could be more offered. Each person has a daily living plan for both and day and night, signed by them or their representative and accounting for their preferred daily living routines and lifestyle preferences. Information about activities is displayed on the residents noticeboard, along with community information, and including how to access local advocacy services and there are photographs displayed in the home of people engaging in various activities and seasonal celebrations. A dedicated phone is also provided for residents use, although many residents have their own phones in their rooms. On the afternoon of our visit people enjoyed an inpromptu musical entertainment and singalong provided by a regular visitor to the home. We saw that the home welcomes visitors, with many residents receiving these through the course of our visit. Some chose to stay in the lounge areas and some the privacy of their own rooms. People told us that they enjoyed the food provided. This was reflected in the homes most recent satisfaction survey returns from people who rated the food as good or excellent. We also received many positive comments. These included, Excellent home cooked food. The cook regularly talks to me about my wifes known choice of menu as she is not able to express this herself. We saw that whilst many people chose to eat their lunch in the dining room, some chose to have their meals delivered to their own rooms. Many of the bedrooms are large bedsit type rooms with dining tables and chairs there. Tables were attractively set with good quality table linen and equipment, including drinking glasses as opposed to plastic cups and china cups and saucers. People were offered a choice of drinks and a three course lunch. A lot of people said they couldnt remember what was for lunch, but confirmed the cook speaks with them to assist with menu planning. There was no menu displayed to assist people in their recall. People were asked if they would like some background music on during lunch and were consulted as to their choice. We saw that people received the assistance and support they needed from staff in a calm, unhurried and sensitive manner. 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. Peoples rights to complain are promoted and upheld and complaints received are listened to, acted on and effectively accounted for. People are suitably protected from harm and abuse. Evidence: In our AQAA they home told us they ensure all complaints are recorded and dealt with within 28 days and that people are safeguarded from harm by the homes policies and arrangements, including by way of effective staff recruitment procedures and checks. They told us about improvements they have made to further safeguard people from harm and following an incident last summer regarding a missing resident. The resident was found safe and well and the home notified us in writing about this at the time, including suitable measures taken to reduce the risk of this reoccuring. At our visit we saw that a copy of the complaints procedure is displayed and accessible to people, and also provided with the service guide. We also saw there is a complaints and suggestions book left out for people to use as they choose. People said they knew how to complain and who to speak with if unhappy about any matter. Care Homes for Older People Page 19 of 33 Evidence: We looked at the homes complaints record and saw there were four complaints recorded there during the last 12 months. All complaints were clearly recorded, together with details of their investigation and outcomes and timescales within which these were dealt with. All are recorded as resolved. Staff spoken with were conversant with the action to take in the event of witnessing or suspecting the abuse of any resident and confirmed regular access to training in this area. Confirming there are also written procedures in place for these that they can refer to. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is kept clean, comfortable, safe and well maintained and which suits their needs. Evidence: In our AQAA the home told us they provide a good accessible environment for people that is clean, safe and well maintained, with well kept gardens. They told us about some improvements they have made over the last 12 months, including the repair and upgrade of the ground floor communal toilet and provision of suitable dispensible hand soap and disposable paper towels to all comunal hand washing areas. In accordance with requirements that we made about these at our last key inspection and which we saw at this inspection visit. They also identified further aims for improvement which focus on some aspects of their laundry arrangements. At our visit we saw that the home is kept in a good state of maintenance and repair, is safe, clean and odour free, well decorated, furnished and equipped. We also saw that the home had won the local authority Gardens in Bloom competition for 2009. However, we found that their policy and procedural guidance for staff to follow in Care Homes for Older People Page 21 of 33 Evidence: respect of infection control is not comprehensive or up to date and that there is no policy or procedural guidance for staff to follow concerned with emergencies and crises, except for fire procedures. We have made a recommendation about these under the management section of this report. We saw recent correspondence from the Fire Officer of Derbyshire Local Fire Authority, following their inspection indicating some matters to be addressed relating to fire precaution. At our visit, this work was underway. We also saw a report from the local Environmental Health Officers last visit to the home, conducted in January 2008 which described well organised food operations following their inspection of the kitchen and catering facilities. Results of the homes most recent satisfaction survey conducted with people told us that they are satisfied with their environment and people told us at our visit that the home is always kept clean and odour free. Many peoples bedrooms are very large bedsit type, with en suite provision and all that we saw were personalised, including with some peoples own furnishings that they had chosen to bring into the home with them. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with care from staff that is effectively recruited and trained and who treat them with respect and promote their dignity. Although care staff deployment arrangements does promote best practise concerned with infection control. Evidence: In our AQAA the home told us that they ensure staff is effectively recruited and trained, including to at least NVQ level 2. They told us about some improvements they have made and are making. These include for the regular quality monitoring of their staffing arrangements and the review of their staff induction arrangements. They also gave us some statistical information that we asked for concerned with staffing employed and their deployment. At our visit we saw that their proposed recording format for staff induction was not yet introduced. Staff files that we looked at contained very basic information relating to their induction, which currently do not reflect nationally recognised training standards for staff induction. However, discussions held with staff, including more recent staff starters tells us that there are suitable overall arrangements in place for their training. We discussed with the manager, the need to ensure that suitable records are kept of each staffs induction. The manager confirmed that priority would be given to ensure their revised staff induction packages would be fully introduced. Care Homes for Older People Page 23 of 33 Evidence: People told us that staff is usually available when they need them and that they listen and act on what they say. Staff that we spoke with described overall satisfactory arrangements for their recruitment, training and deployment. However whilst there have been no recent outbreaks of infection in the home, the current practise in redeploying carers into the laundry between personal care duties may not promote best infection control practise. We discussed this with the manager and with reference to their limited infection control policy and guidance for staff. We have also made a recommendation under the Management section of this report relating to the latter. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is overall well managed and run in peoples best interests and their health safety and welfare promoted and protected. Evidence: In our AQAA, the home told us they regularly consult with people who live and work at the home and who have an interest there about the quality of its care and service provision. They told us about improvements they are making and aim to make. These are mostly concerned with improving management and administration systems in the home, including for record keeping. They also gave us some other information that we asked for about their arrangements for the servicing and maintenance of systems and equipment at the home, which are satisfactory. Care Homes for Older People Page 25 of 33 Evidence: At this inspection we discussed the contents of the AQAA with the provider, who gave us all the information that we asked for in Part 2 for the Dataset. However, information provided in Part 2, which concentrates on quality assurance and review relating to the National Minimum Standards in Care Homes for Older People, was limited and not always relevant to the particular outcome section, specific or measurable. We saw that quality assurance and monitoring systems are in place in the home for regular formal consultation with people who live, work at and visit the service, or who have an interest there. We looked at returns from their last satisfaction surveys conducted with people and for recent reports from a representative of the registered providers monthly visits to the home for the purposes of quality monitoring. Results of their most recent annual satisfaction surveys with people and also surveys conducted with people six weeks after their admission to the home indicate their overall satisfaction with the quality of care and services they receive. With most nominating an overall rating as excellent or good. Some identified specific areas as fair, including for activities and laundry arrangements, giving suggestions for improvement. Action being taken by the home for these is identified under the relevant sections of this report. However, the home does not formally publish or routinely share the results of these with people, or their action plans arising from these. We found that the monthly visits to the home by a representative of the registered provider are not conducted by persons specified under Regulation 26 of the Care Homes Regulations 2001 to undertake such visits. We saw from information provided in the AQAA and discussions with staff, that the home provides the majority of key policies and procedures for them to follow and to assist them in performing their role. However, there is no procedure for staff to follow to assist them in applying the considerations of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2009. Their infection control policy is out of date and requires development to ensure it complies with recognised national guidance. There is also no policy in place for staff to follow in the event of emergencies and crises. We found overall safe and suitable arrangements for the safekeeping and handling of personal monies on behalf of service users that request this for storage purposes only. Whilst monies stored were checked and balanced, record keeping for these did not Care Homes for Older People Page 26 of 33 Evidence: always provide best accountability. The home does not manage monies on behalf of any person and where people choose to retain and manage their own finances, they are provided with safe storage facilities for this. Staff spoken with described suitable arrangements for their supervision and support and for the most part in ensuring safe working practises, including for their training and provision of equipment. Records that we examined and observations that we made confirmed this and discussions with the manager indicate good health and safety awareness in relation to the environment. Although, as referred to under the Healthcare section of this report. There are no falls awareness tools or training in this area for staff. We also saw that a requirement we made at our last key inspection relating to ensuring specific environmental risk assessments, was complied with. Care Homes for Older People Page 27 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 3 13 Recorded needs assessments 31/03/2009 in respect of individual personal safety and risk must be consistently accounted for and regularly reviewed. So as to ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Not fully complied with at this inspection. Extended timescale agreed to 31/03/2010 Care Homes for Older People Page 28 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 1 5A The service guide must specify the range of fees charged by the home, what they cover and the arrangements for their payment. So as to ensure people are provided open and transparent fees information, to inform and assist them in choosing a home. 31/03/2010 2 9 13 A cupboard must be installed for the storage of controlled drugs that complies with the Misuse of Drugs Safe Custody regulations. This cupboard must be located and fixed in accordance with those regulations. 31/03/2010 Care Homes for Older People Page 29 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 So as to ensure the safe storage of controlled medicines. 3 27 18 A review of care staff redeployment arrangements must be undertaken in respect of homes current practise of care staff undertaking laundry duties in between personal care duties. 31/03/2010 To ensure peoples best interests and to promote their health and welfare by ensuring best infection control practise. 4 33 26 Visits to the home by the registered provider must be conducted by persons as specified under Regulation 26 of the Care Homes Regulations 2001. Reports of those visits must account for all matters identified under that regulation. So as to ensure that the visits are conducted by a suitable person who undertakes that which is specified under this regulation. To inform as to the conduct 31/03/2010 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 of the home and the standard of care provided there. 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 Consideration as to peoples individual mental capacity to consent to their care and treatment should be included in the homes recorded needs assessment format. A recognised nutritional risk tool, such as the MUST score, should be fully introduced. Peoples care plans should be reviewed at monthly intervals. Consideration should be given to displaying a daily menu in a prominent position in the dining room, or by providing individual daily menus on dining tables. Records of staff induction should be kept in respect of each staff member employed at the home, which ensure an accurate record of their induction and reflecting nationally recognised workforce training targets, such as Skills for Care. Results of satisfaction surveys conducted with people should be shared with them/made available, including any action plans that may arise as a result of these. The home should develop its infection control policy and procedures for staff, in line with recognised Department of Health guidance. The home should continue develop their quality assurance and monitoring systems. So as to provide greater accountability and evidence of their service provision against nationally recognised standards, including by way of information provided in our AQAA return. Staff should be provided with written policies and procedural guidance to assist them in applying the principles of the Mental Capacity Act 2005 and to know 2 3 4 3 7 15 5 30 6 33 7 33 8 33 9 33 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 what steps to take in the event of emergencies and crises. 10 35 Written records kept in respect of monies held for safekeeping on behalf of any resident should be accurately maintained and provide two signatures for the recording and witnessing of any deposit or withdrawal of monies. The home should develop falls awareness tools and training for staff relating to their use and to falls prevention and management. 11 38 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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