Care Home: Armstrong House

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What the care home does well The home is clean and comfortable and provides an attractive environment for the people who live here. A good variety of activities, entertainment and outings are offered to help people meet their social needs and maintain contact with the community. Health and safety is promoted through safe systems of work, staff training and regular checks of the building, equipment and facilities. People`s personal finances are kept safe. What has improved since the last inspection? Care plans have been reviewed and brought up to date to reflect people`s current health and welfare needs. The plans are recorded in greater detail and include preferences to guide staff on providing more individualised care. The ways in which people are cared for and supervised have improved through changes to care practices, increased staffing levels and staff being better organised and supported. The management of medication is now more robust and is regularly audited to identify any deficits. More support is given to people to help them exercise control and make decisions in daily living. People`s nutritional needs are closely monitored and the mealtime experience has been improved by offering more choices and ensuring individuals are properly assisted with eating. Complaints about the service are acted upon promptly and thoroughly. Management make sure that the Commission is notified of any events that affect the well-being or safety of people living at the home. Staff have been provided with further training and supervision to develop their skills and competency. Systems to monitor the quality of the service now include observing care provision and getting the views of people living at the home and their advocates. What the care home could do better: The home has achieved compliance with the Care Quality Commission enforcement action that was taken to improve outcomes for service users and must now demonstrate that it can sustain these improvements to ensure people are safeguarded from harm and receive a consistent standard of care that fully meets their needs. Care plans should continue to be developed using a person centred approach. Clear records should be kept that show how people are supported to meet their personal hygiene and continence needs. The staff rotas need to include clear details of the use of external agency staff. Wherever possible employment rather than character references are to be obtained when recruiting new staff. A record of the decision and authorisation to employ any person with previous conviction(s) needs to kept. Staff should be provided with dignity in care training and dementia training is to be organised for those staff who have not yet completed the course. The manager should apply to be registered without delay. Staff supervision should focus more on performance and development and be recorded in full detail. Key inspection report Care homes for older people Name: Address: Armstrong House 110 Lobley Hill Road Bensham Gateshead Tyne and Wear NE8 4YG     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: Elaine Malloy     Date: 1 4 0 5 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 31 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 31 Information about the care home Name of care home: Address: Armstrong House 110 Lobley Hill Road Bensham Gateshead Tyne and Wear NE8 4YG 01914606220 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): armstronghouse@schealthcare.co.uk Southern Cross OPCO Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 71 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 71 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, maximum number of places: 32 Old age, not falling within any other category Code OP, maximum number of places: 39 Date of last inspection Brief description of the care home Armstrong House is a care home situated in the Bensham area of Gateshead which provides accommodation and personal care for seventy one people. The building is in a well-established residential area with several newly built residential estates nearby. Care Homes for Older People Page 4 of 31 Over 65 0 39 32 0 2 6 1 1 2 0 0 9 Brief description of the care home The home was first registered in September 2006 and has been purpose built for the people who live there. Peoples rooms are on three floors, with 32 people who have dementia living in two areas on the second floor and 39 older people living on the ground and first floors. The service is operated and managed by Southern Cross OPCO Limited who have owned the home since August 2007. The building provides 71 single rooms, all with their own toilet. There are also communal toilets, showers and bathrooms situated throughout the building, which are fitted with adaptations to help people who are frail or have a physical disability. Each floor has several lounge and dining areas which have been set out to make best use of the daylight and views of the gardens and the surrounding area. There is a separate lounge where service users can go if they wish to smoke. There are many car parking spaces at the front of the building including disabled parking bays near the entrance. There is easy access into the building through the main doors into the reception area. Armstrong House is a short walking distance from local shops, and a short bus or car ride from shops on both the Team Valley and Central Gateshead. There is access to local transport directly outside the building. Details of current weekly fees are available by contacting the home. The costs of newspapers, hairdressing, private chiropody and toiletries are not included in the fees. Care Homes for Older People Page 5 of 31 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 quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. The inspection was carried out by: Looking at information received since the last key inspection on 26th November 2009. Reviewing the findings of random inspections conducted on 5th January 2010, 9th February 2010, 24th March 2010 and 21st April 2010. These inspections were carried out to monitor standards at the home and check compliance with enforcement action that the Care Quality Commission had taken with the provider. This action concerned poor standards of care planning, the care and supervision provided to service users, dignity of service users, medication issues and management of the home. Care Homes for Older People Page 6 of 31 Two regulatory inspectors visiting the home unannounced on 12th May 2010 and a further visit by one inspector on 14th May 2010. The visits took ten hours to complete. Talking to the people living at the home, visitors, management and other staff about the service. Looking at records about the people who use the service and how well their needs are met, and observing care provision and practices. Looking at a range of other records that must be kept. Checking that staff have the knowledge, skills and training to meet the needs of the people they care for. Checking if improvements required from previous inspections had been made. We told the management of the service what we found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The home has achieved compliance with the Care Quality Commission enforcement action that was taken to improve outcomes for service users and must now demonstrate that it can sustain these improvements to ensure people are safeguarded from harm and receive a consistent standard of care that fully meets their needs. Care plans should continue to be developed using a person centred approach. Care Homes for Older People Page 8 of 31 Clear records should be kept that show how people are supported to meet their personal hygiene and continence needs. The staff rotas need to include clear details of the use of external agency staff. Wherever possible employment rather than character references are to be obtained when recruiting new staff. A record of the decision and authorisation to employ any person with previous conviction(s) needs to kept. Staff should be provided with dignity in care training and dementia training is to be organised for those staff who have not yet completed the course. The manager should apply to be registered without delay. Staff supervision should focus more on performance and development and be recorded in full detail. 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 31 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 31 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. Whilst there have been no new admissions to the home there are systems available to guide the pre-admission process and make sure peoples needs are assessed. Evidence: At the time of the inspection there was reduced occupancy of 41 service users. No new service users have moved into the home as admissions continue to be suspended by Gateshead Council. The standard concerning pre-admission assessment could therefore not be checked at this visit. The home has an assessment document that is designed to give staff a way of recording information about the needs of the people who are considering moving into the home or staying for a short period. The assessment tool assists the staff to find out about all of the aspects of peoples lives and needs. The manager was confident that it gives them the information they need to make the judgment about offering a place.The document can also be used for service users returning to the home from Care Homes for Older People Page 11 of 31 Evidence: hospital if their needs have changed. Potential service users can visit the home and spend time in the communal areas prior to making the decision to move in but those spoken to on the day had relied on their relatives to make the choice for them. The Care Quality Commission and Southern Cross have been informed that Gateshead Council has made decision to decommission placements at the home for people with dementia. The Council has held meetings with relatives and allocated care managers to people with dementia to reassess their needs. Some people had recently moved out of the home to alternative care settings. Care Homes for Older People Page 12 of 31 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. The provision of care, care planning and arrangements for medication have improved to meet peoples health and personal care needs. Evidence: Following the last key inspection of the home in November 2009 the Commission took enforcement action with the provider as there were breaches of regulations concerning the standards of care, supervision and dignity of service users, care plans and medication. We followed up these issues at further inspections in January, February, March and April 2010 and found that the home had complied with the requirements of Warning Letters and Statutory Requirement Notices. At this inspection we found that the home was well staffed and people were properly supervised and more sensitively supported. People were dressed for the activities they were undertaking and looked comfortable and tidy. Care was given in a discreet manner, with people being asked about the support they needed in a way that did not make it obvious what they were being asked, for example if they wanted to go to the toilet. The staff were kind and polite with cheerful banter taking place throughout the Care Homes for Older People Page 13 of 31 Evidence: day. The staff spoken to could describe the needs of individuals and were clear about the way that they had to record the care given and the need to report any relevant issues to senior staff. A number of people were positive about the care they were being given and were complementary about the staff. People said they felt well cared for by the staff, comments included They are lovely, and, The staff are always there to give me a hand when I need it. A visiting relative told us there had been substantial improvements in the home recently and he was waiting to see if things would continue to improve. We examined a sample of care records. These showed that a range of assessments were updated monthly to reflect peoples current needs. People with dementia now have a mental health assessment to identify and monitor their psychological needs. Risk assessments and management plans were in place to address individuals areas of vulnerability including nutrition, risk of falls and and deterioration in skin condition. Weekly body mapping was recorded to show that the persons skin integrity was being observed, and any bruising or damage was recorded and acted upon as necessary. Observation records were kept where people require more frequent checks by staff due to their risk of falls or behaviour that puts them at risk. Care plans matched with assessed needs and, where applicable, incorporated advice from health care specialists such as the challenging behaviour team and a dietitian. The standard of care plan recording had continued to improve and was more person centred though there was scope to develop this further. Care plans were evaluated at least monthly and were being recorded in greater detail to indicate whether the plan was working towards meeting the persons needs. Charts relating to support with personal hygiene and continence needs were still not being consistently completed. People were supported to access NHS services and facilities as and when they need to. Individual records are kept of visits by professionals including general practitioners, the urgent care team, paramedics, dietitian, optician, dentist, chiropodist, an older persons specialist nurse, and hospital appointments. The home has appropriate equipment to minimise the risk of people developing pressure ulcers including nursing care beds which can be adjusted up and down to assist when staff are delivering care and pressure relieving mattresses and seat cushions. Community nursing staff are accessed for advice when necessary. People identified as being nutritionally at risk continue to be closely monitored through Care Homes for Older People Page 14 of 31 Evidence: assessment, care planning, dietetic advice and regular weighing. Records were kept of food and fluid intake, and fortified food and additional calorific snacks and drinks between meals were provided. The management continue to meet weekly with the catering staff to review peoples nutritional needs and weights. Care plans indicated individuals food preferences and evidence of weight gain. Food and fluid intake records showed more specific recording of soft diets and were generally better completed. The last inspection of the homes medication system was in April 2010 when requirements of enforcement action were checked and found to have been complied with. Senior care workers have been assessed as competent to administer medication and the records of assessment were now signed and dated appropriately, as previously recommended. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with good social activities and community contact, and support with nutrition and exercising choice in daily living has improved. Evidence: The home continues to employ two full time activities co-ordinators who organise a good variety of social activities, entertainment and outings. Staff were knowledgeable about peoples social and recreational care needs. This was confirmed by people living at the home and shown in the care records where there were individual social profiles and social care plans. One person described some of the opportunities they had been offered and although they felt that this was enough they did not always want to take part. People said that they were free to join in social activities if they wish and they are not made to join in activities if they do not want to. A relative commented that they were aware of the activities that the staff organises for the service users. On the day of the inspection there were outings in the morning and afternoon to the Discovery Museum and the coast at Whitley Bay. People spoken to confirmed they were given the opportunity to choose the outing they wanted to participate in. A number of people had been out the day before and one person described how they had enjoyed the trip. Care Homes for Older People Page 16 of 31 Evidence: People were encouraged to maintain contact with their families and friends and can use either their own rooms or the communal areas to receive visitors. Relatives were given good assistance to help them to be as involved in the care as they feel comfortable. A visitor told us that he was positive about the way he had been supported in assisting to provide care to his relative. The homes management said staff consult with service users and relatives at care reviews and when individuals care plans were being revised. Care records showed that staff maintain records of communication with relatives such as telephone contact to inform relatives of health issues. Separate meetings with service users and relatives were also being held to provide information and get their views on the service. Further efforts had been made to offer people living at the home more choices and support them to make decisions in daily living. Individual preferences were now recorded in care plans and included preferred gender of care worker to assist with personal care, preferred clothing, using cosmetics, and personalised bed time routines. There was also evidence that care plans were updated to acknowledge personal choice, for example sensitively recording that a service user did not respond well to staff of ethnic origin, and changing support with personal hygiene needs to body washes when a service user regularly refused baths and showers. A choice pack with photographs, pictures and symbols was being used with people with dementia to help them communicate their preferences. This included individuals food likes and dislikes and preferred choice of clothing and toiletries. The home uses the NUTMEG catering system that aims to provide people with a nutritionally balanced diet and the cook was continuing to develop and adapt the menus to suit people living at the home. The kitchen was clean, tidy and well organised and there was a good selection of fresh, frozen, dried and tinned food. Full fat milk and butter is used. There was information on those people who require special diets and service user birthdays. The cook had a list of peoples weights with details of where they were maintaining or increasing their weight. There was a clear pattern of peoples weights improving and there were now only three service users who had lost weight. The cook was aware of these individuals and was very clear about how they have the calorific content of their diet increased. On discussion the cook confirmed that he had visited the service users who were at risk of weight loss and discussed individual choices. He was aware of the need to provide a healthy diet and there was good evidence that the content of the food is taken into account when he prepares the meals. Care Homes for Older People Page 17 of 31 Evidence: Meal times were better organised and staff were attentive to peoples needs. At lunch time the food looked and tasted pleasant and the meal was well presented. People were complementary about the food and they were supported to choose between the two main courses on offer. Service users are asked their choice of meal the day before, however when they did not seem to want or be enjoying the choice they had made they were offered the alternative. There was a very good emphasis on people being offered choices and this ranged from the drinks they had with the meal and the condiments they used. All staff were very careful to ask individuals if they wanted assistance and did not impose their help without permission. The meal served was a choice of steak pie, cabbage, carrots, and boiled potatoes or smoked haddock quiche. The most popular choice was the pie, however a number of people also had other alternatives such as jacket potatoes with savoury filling and a side salad. There was spotted dick and custard for pudding and some people who did not want this were offered ice cream or yoghurts. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst complaints about the service are better managed there are outstanding safeguarding issues to be addressed to ensure people are fully protected. Evidence: The complaints procedure is available within the guide to the service and is displayed in the home. The complaints file showed that six complaints were made in the period since the last key inspection by relatives of people living at the home and concerned various care issues, the environment, clothing and laundry. Each complaint had been investigated promptly and there was evidence of written responses including offering apology and reimbursing costs. Comments books had recently been introduced into each bedroom for the service user and visitors to record in. These were being reviewed weekly and a record was kept of the response or action taken as a result of comments made. The home has policies and procedures on recognising and preventing abuse. Information on the safeguarding process and contact details were also displayed in the home as guidance to staff and others. Staff receive safeguarding training during induction and the training matrix showed that the majority of staff had either completed further training provided by Gateshead Council or were in the process of doing a distance learning course. Care Homes for Older People Page 19 of 31 Evidence: The Care Quality Commission (CQC) has been notified by the home about circumstances affecting the well being and safety of service users. Incidents between service users and issues about individuals health and welfare have lead to safeguarding alerts being raised with the local authority safeguarding team. The homes management said that alerts were currently being reviewed by the safeguarding team. CQC is awaiting clarification from the local authority about ongoing and concluded safeguarding alerts, and the action taken as a result of the alerts including whether protection plans are in place for individuals using the service. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a good standard of environment that is clean, comfortable and attractive and equipped to meet the needs of the people living there. Evidence: Armstrong House is a three storey, purpose built home constructed to provide accommodation for older people. The building is sited in a mainly residential area. The lower ground and ground floors accommodate people who have physical care needs and the top floor provides care for people with dementia. The home is appropriately maintained and access into, and within it, is good and meets the needs of those people who have mobility difficulties or have use of walking aids or wheelchairs. There are assisted bathing facilities for people who have moving and handling needs and require assistance from staff to bath safely. All bedrooms and toilets have suitable locks on the door to ensure privacy. This provides the opportunity for people to remain independent and enjoy good levels of privacy. There are sufficient numbers of communal areas for people living in the home to choose from. These include a range of lounges, dining rooms and communal spaces that people can use, and these were well decorated and clean. Care Homes for Older People Page 21 of 31 Evidence: The bedrooms are of varied shapes and sizes and were well decorated and furnished and personalised to the taste of the occupant. There has been a programme of redecoration and replacement of the bedroom furniture. People living at the home were asked how they felt about their rooms and all were happy with the level of cleanliness. The staff on the day had good understanding of health and safety issues and safety checks were carried out in line with the homes policies. There were no unpleasant odours anywhere in the home. Staff were trained in control of infection procedures, and were using these practices throughout the day, to minimise the risk of cross infection. There are sluice disinfectors in the home, both of which were operational. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a more stable and skilled staff team to meet peoples diverse needs, though some aspects of recruitment and training need to be made fully robust. Evidence: The home had continued to work to increased staffing levels despite reduced occupancy, and following recruitment the majority of staff working at the home were now permanent. Rotas confirmed that current levels were 12 care staff on early shift, 11-12 on late shift and 6 staff at night. Management was confident these numbers made sure people living in the home had their personal and health care needs met. They said that they would notify the Commission if there was any proposal to reduce staffing resources in the future. There were separate rotas for the residential and dementia care units that showed how staff were deployed. There was still some use of external agency staff to maintain the staffing numbers and management said they had limited this to using four agency staff who were familiar with the home. There was usually one or two agency staff working on night shift as the home had recruited some new night care workers but they did not take up their posts. Further recruitment was taking place and management said that once new night staff were appointed the home would no longer need to use agency staff. The full names and status of agency staff needed to be recorded on the rotas. There were sufficient numbers of domestic and catering staff on Care Homes for Older People Page 23 of 31 Evidence: duty, all of whom had appropriate training in using chemicals safely. A new assistant cook was recently appointed and was due to take up post. Additional information was kept in the rota file including daily sheets for allocating duties and responsibilities to staff, a summary of the needs of each service user and medical history, and guidance to staff on recording and what to do in the event of incidents, injuries, observations, hospital visits/admissions and concerns. Three staff recruitment files were examined. These contained photograph and proof of identification, application forms with employment history, medical questionnaire and interview records. References, in the main were obtained from suitable sources including the applicants last employment or education placement. A character reference was sought from a referees own home address when a professional reference could have been obtained direct from the employer. Staff were employed subject to Criminal Records Bureau (CRB) checks. Management were advised that a record of the decision and authorisation to employ any person with previous conviction(s) should be kept. Over 50 of staff have achieved National Vocational Qualifications (NVQ) in care at levels 2 and 3. There was evidence in staff files that new staff had undertaken induction training. The training matrix showed that there had been significant provision of training for staff since the last key inspection on fire safety, moving and handling, food hygiene, first aid, health and safety, infection control, safeguarding, nutrition, safe handling of medication and updates, and dementia awareness. Management reported that further challenging behaviour training was planned and more training on safeguarding, mental capacity and deprivation of liberty legislation was being organised. A minority of staff were still to complete dementia training and management said the dementia care unit manager had completed facilitator training so she could deliver training to staff. A senior carer and a care assistant have taken on the roles as dignity champions in the home, however the matrix showed only seven staff to date have had dignity training. The matrix did not indicate the full extent of care planning training that had been provided and needed to be updated. Care Homes for Older People Page 24 of 31 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. Whilst standards of care have improved, more consistent management and assurance of sustaining a quality service are needed to demonstrate that the home is run in peoples best interests. Evidence: There has been no Registered Manager in post since January 2008 and since this time there have been numerous changes to managers and senior management overseeing the home. This lead to the Commission sending Warning Letters to the provider regarding our concerns about the management of the service and the lack of a strategic approach to improving standards. At a random inspection in March 2010 we were informed that the person managing the home at the time would be submitting a registered manager application. The Commission was then subsequently informed by the provider that a new manager had been appointed. Cheryl Glenton took up post in April 2010 and is to submit application to be approved as the homes Registered Manager. She has 12 years care experience including seven Care Homes for Older People Page 25 of 31 Evidence: years managing and has previously been registered as a manager of a care home. She has completed the Registered Manager Award qualification and National Vocational Qualification in care at Level 4. She has held meetings and introduced herself to service users, relatives and staff. Management cover was being provided in the home each day from 8am to 8pm by the manager and a support manager both working four days each week. A unit manager has also been appointed for the dementia care unit. Staff duties allocation sheets had been introduced to make sure there is an appropriate skills mix and accountability. Systems to monitor and assure the quality of the service were examined and discussed with management. A quality team from the provider company were carrying out bi-monthly visits to the home to look at standards of records, meal and laundry services and talk to service users and relatives. Audits were conducted in January and March 2010 to assess the home meeting National Minimum Standards for Care Homes for Older People and quality themes of care and support, environment, staff, and management and leadership. An area manager was visiting regularly and each month he conducts a visit and report on the conduct of the home. The format of these reports had been changed to include more focus on getting the views of people living at the home, visitors and staff, and extensive comments were recorded. Objectives with timescales were set following quality audits and area manager visits for management to action. The manager and support manager do at least daily walkarounds to observe care provision, check peoples appearance and the environment, and to be visible to meet and talk with service users and visitors. They also carry internal audits of care records, medication, meals and laundry. Daily reports were being emailed to the area manager with any significant issues concerning peoples care, concerns, updates on recruitment, and confirming internal audits were completed. Management were having regular meetings with staff including heads of department meetings with staff responsible for housekeeping, catering, maintenance, administration and activities. Minutes showed that meetings focussed on improvements needed and support to staff. A monthly newsletter was now being produced. The May 2010 newsletter contained an introduction to the home and the new manager, the duties of keyworkers, birthdays this month, information on hairdressing, chiropody, religious services, events this month and forthcoming events in June, a recipe corner, photographs of service users at activities and outings and a suggestions page. The home has a general comments box, food comments books in the dining rooms and comments books were recently put in all bedrooms for service users and visitors to record in. There was evidence that these were routinely checked and action taken Care Homes for Older People Page 26 of 31 Evidence: as a result of comments made. Visitors and professionals had completed questionnaires about the service in recent months. Responses and comments had been collated and the majority indicated satisfaction with the service and noted the improvements that were being made. Three meetings had been held with relatives during March and April 2010 and the minutes showed discussion on the action being taken by Gateshead Council, the homes standards and updates, staffing and recruitment, food, social activities and management. The home has a system to assist service users in managing their personal finances/allowances. The individuals records were kept on a computer system, although information can be provided to service users or their representatives in a printed form. Receipts were kept for any purchases made on behalf of the service users and there were systems in place to make sure that people in the home were provided with money to buy the items they need. The records were audited and on the day the records for two people were checked and found to be accurate. The support manager was currently providing individual supervision to staff. A supervision schedule was in place with completed and forward planned dates of sessions. All senior carers and care assistants had received at least two supervisions, and often more, so far this year. Ancillary staff were also included on the schedule. Supervisions in recent months had concentrated on identified practice issues and themes such as nutrition, medication and care planning. Advice was given to record discussion in full and have more focus on individual performance and development. There were plans for some supervisions to be delegated to senior carers to carry out in the future, though they would need to be provided with supervisory training before doing so. The support manager said he would also make sure that seniors received practical experience of supervision sessions. The home has a health and safety policy and range of associated procedures. Staff were provided with training on health and safety and safe working practices. Meetings were held with the maintenance person, seniors and ancillary staff to review safety issues and the minutes of the last meeting held in May 2010 showed discussion on accidents, training, any identified hazards and action/risk assessment, and fire safety. Records were kept of monthly room checks with details of any faults found and action taken, and checks of the call system, water temperatures and wheelchairs. Servicing contracts were in place and inspection certificates were on file for equipment and facilities within the home. Accident analysis was carried out and staff have guidance on accident follow up, body mapping and care planning. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 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 33 24 Improvements to standards of care must be sustained through provision of effective and consistent management and quality assurance systems. To ensure that service users live in a well managed home that is run in their best interests and receive a good quality of care. 13/08/2010 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 7 Records of personal hygiene and continence management should be consistently completed to show all assistance provided. Care plans should continue to be developed using a person centred approach. Staff rotas should clearly show the names and status of external agency staff working in the home. Employment references, as opposed to character Page 29 of 31 2 3 4 7 27 29 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations references should be obtained when recruiting new staff. A record of the decision and authorisation to employ any person with previous conviction(s) should be kept. 5 30 Dementia training should be provided for those staff who have not yet received this training. Staff should be provided with dignity in care training. 6 7 31 36 The manager of the home should apply to the Care Quality Commission to be registered without delay. Staff supervision should focus more on the performance and development of individuals according to their role. Supervision should be recorded in sufficient detail to evidence a summary of the discussion and agreed action and support. Care Homes for Older People Page 30 of 31 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. 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