Care Home: Aronmore Residential Care Home

What the care home does well Prospective residents are assessed prior to admission to ensure the home is able to meet their needs. Service user plans are in place and these are comprehensive and up to date. Healthcare needs are being identified and met. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity, and there was a good atmosphere throughout the home. Cultural and religious needs are identified and met and there were no issues identified with equality and diversity. The activity provision in the home is good and work is ongoing in this area to improve it and to better meet residents individual and collective needs and interests. The home has a visiting policy, which is open with the exception of mealtimes as these are `protected`, and visiting is encouraged. Information on advocacy services is available in the home. The food provision at the home is good, offering variety and choice, to include meeting cultural dietary needs. The home has procedures for the management of complaints and safeguarding adults issues, and these are followed. The home has a redecoration and refurbishment plan for the premises and there was evidence of works being done to make environmental improvements to the home. Procedures are in place and are being followed for infection control. The home is being appropriately staffed to meet the needs of the residents. There is an induction programme that is completed by all staff and over 50% of the staff have either completed or are in the process of completing NVQ level 2 in care, with some staff studying for higher levels. In addition, training in dementia care and mental health has been undertaken by most staff. The management team consists of the registered manager and the senior manager, and they have the skills and experience to manage the home effectively and maintain a good standard of care. There is a system in place for quality assurance to ensure an ongoing process of audit and review. The home does not manage monies on behalf of residents. Health and safety is being well managed in the home, thus protecting residents, staff and visitors. Comments received from residents and representatives included: `They are very caring. The home is always very clean and tidy. The food is excellent.` `Everything is good, staff and food are very good.` `Everything is provided and everybody is wonderful.` `Everything is good and well-managed.` `activities and meals` are done well. Comments received from staff indicated that the home provides a safe and secure environment for residents to live in, and that they feel that the quality of care provided is good and focuses on the care of the residents. What has improved since the last inspection? The statement of purpose has been updated to reflect the change of company name so that residents and their visitors are clear on this, and work is ongoing on this and the service user guide. Work has been done to ensure monies are available to purchase items on behalf of new residents if they do not have a representative to do so for them. The home has a redecoration and refurbishment plan and there is evidence that work is ongoing to improve the environment. The wheelchair provision of the home has been replaced and there is evidence of servicing for those in place. The home was clean and smelled fresh throughout. The staffing times have been reviewed to provide better cover from 7am in the morning and there is evidence that residents are getting up and going to bed at times more consistent with their wishes. Accidents and incidents are being recorded and where necessary reported to CQC. Staff have undertaken training and updates in health and safety topics. What the care home could do better: Although medications were overall being well managed, some shortfalls were identified to include fridge temperature recording and the dating of liquid medications on opening, plus some good practice recommendations have also been made. These should be easy to address and thereafter maintained. Staff records seen did not contain a recent photograph of each member of staff. We have also made some good practice recommendations in respect of staff signing and dating care plan documentation, ensuring that the up to date policies and procedures are available in hard copy in the home, and that a copy of the social services assessment be obtained for all prospective residents and those admitted under emergency conditions. Key inspection report Care homes for older people Name: Address: Aronmore Residential Care Home 64-66 Hallowell Road Northwood Middlesex HA6 1DS     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: Clare Henderson-Roe     Date: 0 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Aronmore Residential Care Home 64-66 Hallowell Road Northwood Middlesex HA6 1DS 01923825940 01923842631 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.ventry-care.com Brownlow Enterprises Limited T/A Ventry Residential Care Name of registered manager (if applicable) Mrs Permilla James Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 27 The Registered Provider may provide the following category of service only: Care Home only - code PC to service users of the following gender: Either Whose primary care need on admission to the home fall within the following categories: Dementia - Code DE, maximum number of 8 Old age, not falling within any other category - Code OP, maximum number of 27 Date of last inspection Brief description of the care home Aronmore Residential Care Home is a 27-bedded home for residents who require personal care. The Homes current category of registration is for old age and dementia care. Aronmore Residential Care Home was converted from a large family house and is Care Homes for Older People Page 4 of 30 Over 65 0 27 8 0 Brief description of the care home situated in a quiet residential area in Northwood. It is located within close proximity to the High Street and is within easy access to public transport. There is a spacious dining room with a small sitting room attached to it. In addition there is a second sitting room with a large conservatory. There are 19 single bedrooms and 4 double bedrooms, most of which have en suite facilities, with further work ongoing to provide all rooms with en suite facilities. Assisted bathrooms are available on each floor, and toilet facilities are situated near to the communal rooms, for ease of access. There is a large rear garden with good wheelchair access, mainly laid to lawn with shrubs and which has an attractive veranda for seating. There is parking space available to the front of the building and also in the road. Fees range from £450 to £500 per week. Care Homes for Older People Page 5 of 30 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: This was an unannounced inspection carried out as part of the regulatory process. A total of 7 hours were spent on the inspection process. We met with the registered manager plus the senior manager, who provides support to the registered manager and also deals with some general and specific management areas for the home. For the purpose of this report we have used the two titles, and have also referred to the management where both managers are involved in the process or discussion. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Several residents and 5 staff were spoken with as part of the inspection process. The CQC Annual Quality Assurance Assessment (AQAA) document completed by the home, plus surveys from residents and staff have also been used to inform this report. Comments received via the surveys were fed back to the registered manager in general terms and some Care Homes for Older People Page 6 of 30 comments are included below. Overall the responses on the surveys were very positive and indicated that the home is running well. It must be noted that it is sometimes difficult to ascertain the views of residents with dementia care needs. The home was re-registered in November 2009 due to a change to the company name. A random inspection was carried out on 11th November 2009 to follow up concerns received. This is the first key inspection of this service under the new registration. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The statement of purpose has been updated to reflect the change of company name so that residents and their visitors are clear on this, and work is ongoing on this and the service user guide. Work has been done to ensure monies are available to purchase items on behalf of new residents if they do not have a representative to do so for Care Homes for Older People Page 8 of 30 them. The home has a redecoration and refurbishment plan and there is evidence that work is ongoing to improve the environment. The wheelchair provision of the home has been replaced and there is evidence of servicing for those in place. The home was clean and smelled fresh throughout. The staffing times have been reviewed to provide better cover from 7am in the morning and there is evidence that residents are getting up and going to bed at times more consistent with their wishes. Accidents and incidents are being recorded and where necessary reported to CQC. Staff have undertaken training and updates in health and safety topics. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An up to date statement of purpose is available, thus providing residents and visitors with clear information about the home and the services it offers. Residents are assessed prior to admission and given the opportunity to visit the home, thus ensuring that the home can meet the residents needs and that the person is happy to live at the home. Evidence: Following the random inspection the statement of purpose was reviewed in order to clearly set out the new name of the company who own the home. The senior manager said that work is ongoing on the statement of purpose and service users guide to ensure it meets the new regulations that come into force in October 2010. The home receives referrals from various placing authorities and requests a copy of the social services assessment, which it usually receives. We discussed the importance of following this up with the relevant social services department should the Care Homes for Older People Page 11 of 30 Evidence: assessment not be forthcoming. The home has a comprehensive pre-admission assessment document and the assessment is carried out by the management of the home who respond promptly to any referrals received. Prospective residents are encouraged to visit the home prior to admission and some residents had stayed at the home on respite care before becoming a permanent resident. Care Homes for Older People Page 12 of 30 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 service user plans are clear and identify the needs of each resident and how these are to be met, thus ensuring staff have the information to care for residents effectively. Healthcare needs are identified and action taken to meet them, to maintain residents at their optimum level of health. Medications are being well managed overall although some shortfalls were identified that must be addressed and thereafter maintained. Staff care for residents in a gentle and professional manner, respecting dignity, privacy and individuality, and providing a caring and contented atmosphere for residents to live in. Evidence: The company has introduced new care plan documentation, which is comprehensive and covers all aspects of care. We viewed 3 service user plans and these provided a good picture of each resident, their needs and how these are to be met. The risk assessment documentation allows for any risks to be identified and and assessment made to minimise the risk to the individual. Daily records were viewed and new documentation has been introduced to clearly show the daily progress of each resident, and the records are updated 3 times a day, to include any visits from health, Care Homes for Older People Page 13 of 30 Evidence: social care professionals and family and friends. In addition there is a night duty record maintained hourly for each resident, to evidence the checks carried out throughout the night. The new care plan documentation is not yet in use for all residents, and the senior manager said that they are in the process of completing this task. The need to involve residents and/or their representatives in the service user plans is commented on under Standard 37. Assessments for moving and handling, pressure area risk and nutrition are carried out and continence care needs are also clearly identified. Care plan sections are completed to address any areas of need identified by the assessments. Residents are weighed monthly, and should they not wish to be weighed then a visual assessment is done so that should there be a marked weight loss then this can be acted upon. There was evidence of input from the GP, community nurse, optician, chiropodist, psychiatrist and community psychiatric nurse, and clear records are maintained of each visit. We sampled the medication records and management in the home. All receipts to include medications received mid-cycle had been recorded, as had administration and returns of medications. The home has a tracking system for when the monthly prescriptions are sent to the GP, collected and then passed onto the chemist, which is good practice. There is a photograph plus other relevant information available with the medication administration record (MAR) charts for each resident, plus any known allergies had been recorded. There is a list that is signed in full by the person carrying out each medication round. We noted that 2 staff were only using one initial to sign the MAR and the need to use both initials was discussed, and the registered manager said that this would be addressed. Some medication entries on the MAR were handwritten and had not been signed. It is good practice for any handwritten entries to be checked by 2 staff and for both people to then initial the entry. For one medication that has very specific administration instructions, these had been printed onto the MAR for 1 resident, however were not available for others on the same medication. The registered manager said that all staff administering medications are very clear about the instructions to be followed for this particular medication and that she would write the instructions on the MARs concerned, then discuss with the GP the inclusion of these instructions on the relevant MARs in the future. The medication storage temperatures for both the room and the fridge were being recorded weekly. We discussed increasing the frequency of recording for the room temperature to daily during periods when it is near to 25 degrees centigrade. The fridge thermometer did not allow for the minimum, maximum and actual temperatures to be recorded, and this was discussed with the senior manager who said he would get the correct thermometer. Also, when the fridge is being used to store any medication, the temperature reading must be done daily. Creams, liquid medications and eye drops Care Homes for Older People Page 14 of 30 Evidence: had not been dated when opened, and this must be done in order to accurately identify how long they have been open for, as some have a limited shelf life. It is acknowledged that the majority of these medications are only used for one 28 day cycle and any residue is returned to the dispensing chemist for disposal, however one medication in use had a 14 day shelf life after opening, which highlights the importance of dating these medications on opening. Overall medications are being well managed, and the shortfalls identified should be easy to address. Staff were seen caring for residents in a gentle, friendly and professional manner, respecting their privacy and dignity. Residents clothing is discreetly labelled and residents were dressed to reflect individuality, and looked very well cared for. At the random inspection we discussed ensuring provision is made for ensuring any resident without a representative can have items bought on their behalf, and the management said that this has been addressed. Residents spoken with said that they were very happy living at the home and that the staff are very caring. One person described it as a six star hotel. Several very complimentary comments had been written on the CQC surveys, and some have been included in the summary of this report. The home recognises the religious and cultural needs of the residents and ensures that opportunities are provided for these needs to be met. An example of this is regular visits from a representative from the Catholic Church. Also where residents have cultural dietary needs then these are identified and the chef was clear regarding ensuring these needs are catered for. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities programme is varied and work is ongoing to further enhance the activities provision, thus working to meet the residents individual interests and abilities. Overall visiting hours are flexible, encouraging residents to maintain contact with family and friends. Advocacy information is available in the home, thus respecting residents right to independent representation. The food provision at the home is good, providing choice and variety and meets any cultural and personal preferences of the residents. Evidence: The home has a activities programme on display in the main day room, and on the day of inspection residents were taking part in a music and movement session, which they were clearly enjoying. In the afternoon bingo was also taking place. The company have recently appointed an activities co-ordinator who we were informed is currently undergoing training and will then be visiting all the homes to advise and work with the staff to review the activities provision and build on and enhance the current activity programmes. An extract from the AQAA states: We work towards ensuring that each service user has their social, cultural, religious and recreational interests and needs satisfied. We Care Homes for Older People Page 16 of 30 Evidence: invite our service users to excercise choice in relation to food, routines, leisure and activities, and religious observation. We have a registration category to include dementia and so we provide recreational activities which suit the needs, preferences and capacities of cognitively impaired service users. We discussed the homes visiting policy. The senior manager explained that they do have protected mealtimes, in order that residents can enjoy their meals and also to provide a atmosphere free from distraction at these particular times. Otherwise the home has open visiting hours throughout the day and visiting is encouraged. The senior manager explained that all residents do have representatives, most of these being a family member, but where this is not possible, then social services ensure an advocate is available to represent the resident. Advocacy information for the Hillingdon Rethink Advocacy service was available in the reception area. The menu offers 2 main choices at mealtimes and alternatives are also provided. The main meal is at lunchtime and the meals on the day of inspection were well presented and it was clear that care had been taken provide for the individual preference of each resident, for example, providing different sauces with the meal to meet the residents wishes. A list of residents individual choices for each meal is maintained and this also identified the alternatives chosen that day by 2 residents. On certain days the home also provides a cultural diet for 2 residents to include curry dishes, and the chef was clear on the cultural dietary needs of the residents. We observed the lunchtime meal and it was a social occasion with staff available to offer assistance as needed. There are drinks and snacks available throughout the 24 hour period. Residents are weighed monthly and any concerns are referred to the GP, and dietary supplements were available for residents who required them. It was clear that the chef has a good knowledge of each residents dietary preferences and needs and works hard to meet these. We viewed the kitchen and there was a good supply of fresh, frozen, tinned and dried foodstuffs available. Kitchen records were up to date and at the last environmental health inspection the home attained a 4 Star Very Good rating for food hygiene. Care Homes for Older People Page 17 of 30 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. Policies and procedures are in place for complaints and safeguarding adults, and these are adhered to, thus protecting residents. Evidence: The home has a complaints procedure that is available in the reception area of the home, and is also included in the statement of purpose. There is a suggestions and feedback form available in the receiption area for residents, visitors and any interested parties to complete. There had been no complaints received in the last 12 months. Residents spoken with said that if they had any concerns they knew who they could speak with and the CQC surveys returned by residents also indicated that people know how to make a complaint. The registered manager is a visible presence in the home and is available to speak with residents and their visitors, and each resident has an allocated key worker who they can get to know and speak with. The ethos is to listen to and address any concerns, however minor, promptly and effectively so that the resident knows they can express themselves freely and will be listened to. The home has a safeguarding adults policy and also follows the Hillingdon safeguarding adults procedures, copies of which are available in the home. Staff spoken with were clear to report any concerns and were aware of safeguarding adults procedures. Residents spoken with said that they knew who they could speak to if they had any concerns. Care Homes for Older People Page 18 of 30 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 is being maintained and work is ongoing to improve the environment, providing the residents with a clean, maintained and homely place to live in. The equipment provision in the home meets the needs of the residents. Infection control procedures are in place and are adhered to, thus providing a clean and fresh environment for residents, staff and visitors. Evidence: We carried out a tour of the home. We viewed some of the bedrooms, which were bright and personalised. Provision for maintaining privacy is provided in the double rooms. The main sitting room is bright and airy, plus there is a small sitting area for residents who may wish to sit quietly for a time. The dining room was set out for lunch and the tables looked attractive. There was a homely atmosphere throughout. There was evidence of works taking place, with a new laundry being fitted and a new kitchen storage area in place. Work is ongoing for the provision of en suite facilities on the ground floor and remedial action had been taken to make good some areas identified at the random inspection. The home has an attractive, well maintained garden, with wheelchair access and a patio area for residents and visitors to sit out on, plus a covered designated smoking area. The senior manager provided CQC with a redecoration and refurbishment plan to evidence the recent work completed and ongoing work planned up to April 2011. Care Homes for Older People Page 19 of 30 Evidence: Since the random inspection the wheelchair provision at the home has been reviewed and we saw 2 wheelchairs that had been serviced in January 2010. The senior manager explained that the company now has a pool of wheelchairs that are maintained in good working order, and so any wheelchairs that are in need of repair can be replaced promptly. There is a call bell system in place in each room and we tested one call bell point, and there was a prompt response from staff. The laundry area was clean and tidy. There are 2 washing machines and 2 dryers, one of which is used as a back up to the main dryer. The washing machines have a sluice programme for infection control purposes. A new laundry room is in the process of being fitted out. There is a contract in place for clinical waste disposal, and the registered manager said that the community nurses remove any clinical waste or sharps that are generated from the care they provide. The manager said that following the random inspection all carpets in the home had been deep cleaned and at this inspection the home was clean and smelled fresh throughout. On each floor there is an infection control station with disposable gloves and aprons plus sanitising hand gel, which is also available at the reception area for visitors to use. Protocols and procedures are in place for infection control. Care Homes for Older People Page 20 of 30 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. The home is being staffed appropriately to ensure that the needs of the residents and the home in general can be met. The staff receive training to provide them with the skills and knowledge to care for residents effectively. Staff employment records did not have all the required information, which could potentially place residents at risk. Evidence: The staffing for the home is as follows: 4 care staff in the morning, 3 care staff in the afternoon and 2 waking care staff at night, plus the registered manager is present during the day Monday-Friday. Following the random inspection, action has been taken to provide a member of the day staff on duty from 7am in order to ensure that if 2 staff are assisting residents with personal care at this time there is someone available to answer calls and to supervise the other residents. At the random inspection we noted that several residents were getting up very early in the morning, and there has since been a review of this in line with resident wishes. The home also has catering and domestic staff and can access maintenance staff also as needed. At the time of inspection the home was being staffed to meet the needs of the residents. The home has 16 care workers, some of whom also work in ancillary areas, plus 2 non-care staff. All the staff have completed induction training that includes the Skills for Care common induction standards, and the management explained this is to provide all staff with a good basic knowledge of the needs of residents and how to Care Homes for Older People Page 21 of 30 Evidence: meet them. 7 staff are qualified to NVQ level 2 in care or have an equivalent qualification, and 5 staff are currently working towards NVQ level 2, with 2 staff working towards levels 3 and 4. There is also evidence of staff undertaking training in topics relevant to the needs of the residents, to include dementia and mental health. Staff spoken with said that they do receive training and updates at regular intervals. We viewed 3 staff recruitment files. These did contain the majority of the information required, however they did not have a recent photograph of each member of staff. The need to get photographs was discussed with the senior manager, who deals with the recruitment files, and he said that this would be addressed. For staff who are also students, clear information was contained in the file to evidence the number of hours each person can work during college holidays, and the senior manager was very clear about this. Care Homes for Older People Page 22 of 30 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 registered manager and the senior manager have the skills, training and experience to manage the home and do so effectively. There are systems in place for quality assurance and these are followed, thus providing a process of audit and review that is ongoing to make further improvements in the home. The home does not handle residents personal monies. Resident documentation does not evidence input from the resident or their representative, so it is unclear what involvement they have in the care planning process. Health and safety is being well managed in the home, thus protecting residents, staff and visitors. Evidence: The registered manager has worked at the home for some years and has been the registered manager for 1 year. She has completed NVQ 4 in management and and care and has undertaken periodic updates in health and safety topics plus dementia and mental health, to include deprivation of liberty safeguards. She stated that there were no residents to whom this applied at the present time, and was aware how to refer any issues that could arise in this area. The senior manager is experienced in Care Homes for Older People Page 23 of 30 Evidence: managing care homes and has also attained NVQ level 4 in management and care. The senior manager supports the registered manager and also covers the business and administration elements of the homes management, with the registered manager concentrating on the care of the residents and day to day management of the home. Comments received were very positive about the management of the home and the care and support the registered manager provides to residents and staff. The home has a system in place for quality assurance. with the registered manager concentrating on the care of the residents and day to day management of the home. There is a suggestions and feedback form available in the reception area and a suggestion box had been ordered so that residents and visitors can complete and return the forms. In addition a survey form covering catering and food, personal care and support, daily living, premises, management and visiting has been developed, and the senior manager said that this would be sent out in May 2010. Regulation 26 unannounced visits are carried out by the Responsible Individual for the home, and copies of the reports are available in the home, with the most recent ones being forwarded to CQC for viewing following the inspection. These provided a good picture of the home and evidenced that residents and staff are spoken with as well as the home itself being viewed at the visits. There are also meetings held for residents and staff, and the management have an open door policy, encouraging residents, visitors and staff to speak with them and raise any issues they may have. The AQAA stated that the homes policies and procedures had been reviewed in April 2009 and we did see evidence of some updated documentation. Some of the policies and procedures for aspects of care that were available in the main file were dated as having last been reviewed in 2007, and it is important that the up to date policies and procedures are printed off and made available for staff, so that staff are provided with up to date information in line with current good practice and legislation. The home does not hold any personal monies on behalf of residents. Any monies that residents spend, for example on toiletries, are invoiced retrospectively to the resident or whoever manages their finances. The chiropodist and hairdresser provide individual invoices that are sent out by the home on their behalf and paid directly by the person managing each residents finances. The statement of purpose clearly identifies the items that are not included in the fees. The new care plan and assessment documentation contains a section for the resident and/or their representative to sign to say they have been involved in the formulation of the care plan and agree with the content. We did not see any evidence of input from residents and/or representatives in the care plans viewed, and the importance of ensuring they do have the opportunity to be involved in their plan of care was Care Homes for Older People Page 24 of 30 Evidence: discussed. There was also no evidence that the residents had been involved when the care plan was being reviewed, and this was also discussed. Also, the care plans had not always been signed and dated by the staff, and it is good practice to do so. Entries in the daily record and the monthly reviews had been signed and dated. We sampled servicing and maintenance records and those viewed were up to date. The registered manager carries out the weekly health and safety checks on top of her management duties, and we discussed with the senior manager consideration of reallocating this task to someone else who also has the skills to carry it out. A fire risk assessment dated 10/09/09 was available, as well as a fire risk assessment checklist and guidance. There was evidence of fire drills taking place during the day, at times when some of the night staff were on duty also, and we did discuss with the registered manager ensuring that all staff continue to be involved with fire drills at the required intervals. The health and safety at work policy includes good practices and health and safety guidance for all areas of risk in the home. COSHH risk assessments and a workplace environment risk report were also available. Accidents and incidents had been recorded and where necessary are being reported to CQC under Regulation 37. There was evidence that staff had attended training and updates in health and safety topics at the required intervals. We did not note any health and safety issues on the tour of the home and health and safety is being well managed in the home. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 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 9 13 That the minimum, maximum and actual fridge temperatures be recorded for the medications fridge daily when medications are being stored in the fridge. To ensure that medications are being stored at the correct temperature at all times. 01/05/2010 2 9 13 All liquid medications to include eye drops with a limited shelf life must be dated when opened. To ensure that medications are not used beyond the shelf life once opened. 01/05/2010 3 29 19 The recruitment files must contain all the information required, to include a recent photograph. For the protection of residents. 14/05/2010 Care Homes for Older People Page 27 of 30 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 4 37 15 Unless it is impracticable to do so, input from residents and/or their representatives must be sought when formulating and reviewing the service user plan. So that the wishes of the resident in respect of their care needs are known and can be respected. 01/06/2010 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 3 That any instances where a copy of the Social Services assessment for prospective residents and those who have had an emergency admission to the home are not received are followed up, to ensure the home is provided with this information. That staff use both initials when signing the MAR in order to clearly identify themselves. That all handwritten entries on the MAR are checked and then signed by 2 members of staff. That the home works with the GP and the pharmacist to ensure there are full administration instructions on all prescribed medications. That hard copies of the up to date policies and procedures are available in the home so that staff have up to date information in line with current good practice guidance and legislation. That the member of staff completing the service user plan documentation sign and date it to clearly evidence when it was completed and by whom. That the task of the weekly health and safety checks be Page 28 of 30 2 3 4 9 9 9 5 33 6 37 7 38 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 reviewed in the light of the registered managers other responsibilities, and, if appropriate, for this task to be allocated to someone who also has the skills to complete it. Care Homes for Older People Page 29 of 30 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). 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