Care Home: Ashley House

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What the care home does well Ashley House provides a homely atmosphere and the residents at the home are happy to live there and speak positively about the staff team. Comments included `I feel secure and at home`, `I like it here, as a small home the staff know you as a person`, `its not the Ritz, but the carers are helpful day and night and they make sure that you are OK` and `I am very pleased with the care`. The standards of care provided are generally sound and person centred. The staff know the residents well and speak about them in an individual way. Residents have choice in their daily lives/routines and the meals service at the home is good and residents comment positively on the food provided. The management team listen to complaint and deal with them objectively. Staff are recruited properly and trained well in some aspects of their work. What has improved since the last inspection? Stability in the staff team has helped with bringing about improvement in the home, both in relation to care standards and the premises. We are keen to see that that these are sustained and built upon. Key improvements noted since the last inspection include a clearer management structure and identified areas of responsibility, refurbishment of bedrooms, staffing levels and having a designated cook and more person centred care planning that identifies preventative actions needed to promote the health of residents. What the care home could do better: Whilst the care planning/management system in the home has improved there remain areas for work, primarily around risk assessments and following medication procedures and developing a more robust audit to check this. One of the key areas that requires work is the social care and activities for residents. This needs a more structured approach with residents` needs fully assessed. Staff need to organise entertainment and provide social care that retains, for example, residents` interests, independence and self worth. Some parts of the home still require some investment and this includes the bathrooms. More effort is also needed to keep some of the bedrooms odour free. Whilst staff training takes place, the management team need to have a system in place to ensure that all staff are up to date with required training. This will be helped if the home continues to retain a stable care team. The management team have quality assurance systems in place and they do consult with residents. However this could be developed further in order to provide more regular feedback and a more robust approach. Key inspection report Care homes for older people Name: Address: Ashley House Ashley House Moulsham Street Chelmsford Essex CM2 9AQ     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: Diane Roberts     Date: 1 4 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Ashley House Ashley House Moulsham Street Chelmsford Essex CM2 9AQ 01245494674 01245493254 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Amrit Kaur,Dr Kuldip Singh care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 22 The registered person may provide the following categories 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: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Ashley House is a large detached house, located in a residential area close to a park and a supermarket, and only a short distance from the centre of Chelmsford. The home has parking to the front, and a garden area to the rear. Accommodation is over two floors, with access via a through floor lift. There are ten single bedrooms (two with en-suite toilets) and six double bedrooms (one with en-suite toilet). The home has three bathrooms, several toilets, and two communal lounge areas (one with an integrated dining area). The home is registered to provide care and accommodation to 22 older people; it does not provide nursing care, and is not registered to admit Care Homes for Older People Page 4 of 29 Over 65 22 0 Brief description of the care home residents with a diagnosis of dementia. A Service User Guide is available at the home from the managers office. The current range of fees is from £444.00 to £580.00 dependent on the level of care each resident requires. Residents pay for their own additional expenses such as hairdressing, chiropody, newspapers and personal toiletries. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home for a whole day and met with the manager and her team. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to residents and staff at the home and prior to that we sent out surveys to residents, relatives and staff asking for feedback on the home. The response was quite good and these comments are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? 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 7 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can generally expect to be properly assessed before coming into the home to ensure that their needs can be met but they cannot always be confident that they would have all the information they would need about the home. Evidence: An out of date inspection report, from 2007, was on display in the main hallway along with the service users pack, which includes the service users guide. The guide was seen to be basic and not user friendly for the resident group, with the regard to the font size etc. This document requires a review in order to ensure that it supplies both new and existing residents with the information they need about the home, in a format that is suitable for them. We highlighted this at the last inspection. Residents records show that they were given a service user pack but on discussion with new residents they confirmed that they had not seen the pack. The managers AQAA says, we make sure that the service user pack is displayed on the information board at all times along with the latest inspection report. We would not fully concur with this. Care Homes for Older People Page 9 of 29 Evidence: The manager has a pre-admission assessment system in place. At the current time the deputy manager takes the lead on assessing prospective new residents. Two preadmission assessments were reviewed and the standard was variable. The most recent assessment was of a good standard and gave a detailed picture of the resident and their needs, including what care plans would need to be put in place. The assessment was quite person centred, giving some preferences and abilities, although this could be developed more, as residents who could have given plenty of verbal information, were not always asked about their preferences etc. The earlier assessment had not been completed fully, for example, there was limited information on what support would be needed with regard to personal care. In addition to the assessment, information from the referring authority was also available if appropriate. Residents spoken to confirmed that they had been assessed prior to admission. They said that the staff had helped them to settle in well and I settled in much better than I thought I would and I have not fallen since I have been here, not like when I was at home and the staff made me feel so welcome, they could not have done more, I feel secure and at home. Care Homes for Older People Page 10 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have their care provided in an individual way that respects their choices. Evidence: The manager has a care planning system in place. Two care plans were reviewed along with one further plan for cross referencing. Since the last inspection the care planning system has been developed to give a more person centred approach and overall the new care plans that are in place are much improved, giving more detailed individual information on the support needed and residents preferences and abilities etc. Care plans were seen to be in place for nearly all the assessed needs, those missing included care of catheters and pain management, where needed. On discussion with staff, they were aware of residents needs in relation to pain management. At the moment two care planning formats are in place and this needs to be addressed to ensure continuity for the care staff and to bring the older care plans up to the better standard of the new ones. Residents had a range of risk assessments in place that were up to date. More work is needed to show what action has been taken when a risk has been identified, for Care Homes for Older People Page 11 of 29 Evidence: example, for those at a high risk of pressure sores. Those residents who were at risk had the correct equipment in place but this was not detailed in their plan of care. Residents who were noted to be using bed rails did not always have risk assessments in place and these should be completed to ensure that they are a safe piece of equipment for the resident to use. It was also noted that residents at the risk of wandering did also not have a risk assessment in place although the risk was evident in the care records. This should be completed to ensure that everything is being done to reduce risk where possible. The team are not currently using a nutritional risk assessment and in some cases records showed that residents were not being weighed regularly or on admission. The managers AQAA confirmed that they do not nutritionally screen each resident but they do take action to meet the needs of people at risk of malnutrition. A more robust system would be in place with the use of a nutritional screening tool. One resident confirmed that they had been weighed on admission, to ensure that the specialist bed they were using was set up correctly, but staff had failed to record this. On discussion the manager said that they have recently purchased sit on scales and residents have been weighed regularly since June 2009 and the records seen would concur with this. The management team at the home are also aware that some of the risk assessments still require work in order to bring them up to an acceptable standard. Records showed that residents are seeing their doctors when needed and that medication reviews are undertaken. It is also clear that they see other health care professionals such as opticians and a chiropodist. Overall residents health care was seen to be dealt with in a proactive way. Residents who commented on the care provided said the staff make me as comfortable as they can, I would love to have a shower but there is no facility here, I like it here, as a small home the staff know you as a person, its not the Ritz, but the carers are helpful day and night and they make sure that you are OK and I am very pleased with the care. Staff interaction with the residents was seen and heard to be caring and respectful. Staff were heard to ask residents whether they would like to go to the toilet rather than just taking them. On discussion with staff about individual residents, they knew them very well and all their preferences, talking about them in a very person centred way. The team at the home use a blister pack system for the administration of medication. This was reviewed and found to be generally in good order with medications checked in, dated and audited. However two shortfalls were noted and these related to staff omissions in signing, where it was likely that the medication had been given as it was not in the blister pack and omitting medication because residents were asleep. If staff Care Homes for Older People Page 12 of 29 Evidence: have a person centred approach to the administration of medication they must go back to the residents when awake and not omit medicines. It was also noted that where a resident was self medicating a risk assessment was not in place, although staff had discussed this in the daily notes. These shortfalls were discussed with the management team and it is recommended that, whilst audits take place, a more robust and comprehensive audit is undertaken regularly to ensure that standards are maintained. Medication was seen to be dispensed over a 2 hour period in the morning. On discussion with staff, they say that they are taking a person centred approach to dispensing the medication giving residents their tablets etc. when they were ready. Staff showed that were very aware of the need to follow specific instructions with some medicines, i.e before food or with timing, for example with Parkinsons medications. Staff spoken to said that they had attended courses on administering medication and that they were monitored by the deputy manager until they were competent. Care Homes for Older People Page 13 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents have choice in their day to day lives, their social needs may not always be met, affecting their quality of life. Evidence: From discussion with residents and staff and review of the records, it is clear that the routines of the day are generally resident led. Staff speak about residents choice and residents confirm that they have choice in their daily routines. For example, staff said, some residents choose not to get up early in the morning so they are helped as they either need or want it, breakfasts and the medication times are flexible. On arrival at the home, just after 9:00 a.m, the majority of the residents were up although some had still to get dressed etc. Gentle music including some birdsong was playing on a CD and people were reading the morning papers. Each residents has a getting to know you form completed and this gives staff a good picture of the residents past lives, including social interests, work, family etc. enabling them to appreciate the resident as an individual. These also detail residents wishes with regard to participating in social activities in the home and whether they would like to make their own bed, dust their room etc., promoting independence and self worth. Daily records within the care plans show that residents have choice regarding their daily routine and are encouraged to, if able, come and go from the home as they please. Night routines are also detailed in Care Homes for Older People Page 14 of 29 Evidence: the care plan and show residents choices regarding this. Residents comments included my routine is all down to me, I can do what I want and its absolutely my choice what I do, when I get up etc. There is no set breakfast time and lunch can be flexible as well if you want it. In the AQAA the manager said people who use our services are able to make choices about their lifestyle. Whilst the care records contain some good information a social care plan would be of value to actually assess a residents social needs, in order to further promote independence, the retention of skills and self worth. A social care assessment and plan would also help the team develop the activities programme so that it was more person centred and met residents individual and group needs. The manager does not employ an activities officer but is giving this some consideration. At 10.45 on the morning of the inspection, care staff were heard to offer residents a game of snakes and ladders or other board games. All of the residents in the lounge declined and many went back to sleep. No alternative activity was offered or any individual, one to one time. One resident said that I go out a lot due to the lack of social stimulation, another said I dont like to sit in the chair all day, I go out to town with my family, I went out yesterday. Other comments included the social activities ?, I dont indulge - I dont like it, I cannot hear well, that is why I dont like the residents meetings or social activities, I sometimes have a dance and am playing games that I have not played for years !, I cant do gardening anymore but I am still interested in it, they do ask you if you want to do things. Activity records showed that residents had taken part in reading, exercises, watching television, church services, crosswords and visits from family. As the activities are not linked to a plan of care or, on the whole, to residents recorded preferences it is not possible to say whether residents individual and group needs are being met. On speaking to care staff, it was clear that their understanding of residents needs in this area was limited as when asked how activities are arranged, they outlined a group, unstructured approach, linked to a limited range of opportunities, i.e snakes and ladders, reading, television. Comments included we just decide between us whether its games or exercises, a lot of residents just like to read. Large print books are available in the home. Minutes of meetings showed that residents were happy with the activities offered, some did not wish to take part and that the deputy manager was trying to arrange some voluntary outside entertainers to come into the home. Residents were requesting a large television. On discussion with the proprietor, she confirmed that this would be purchased in the near future, but other items had been prioritised before it because of breakdowns. The cook was seen Care Homes for Older People Page 15 of 29 Evidence: and heard during the day to be discussing food choices with residents and ensuring that their cultural needs were being met. Minutes of residents meetings showed that they were generally happy with the food provided in the home. On discussion with the cook, who had worked at the home 2 months, but was very experienced, was in the process of updating the menus. She had asked residents what they would prefer and was also using her experience of working in another care home to develop a suitable menu. A choice is offered with the main meal and the cook said that she asks residents what they would like when they have their morning coffee. The cook was aware of the specialist diets in the home and of the cultural needs of any residents. She was unable to confirm whether she had a current food hygiene certificate. From observation and discussion with residents, they have choice regarding mealtimes and some residents positively choose to have breakfast late, when they would like it. Comments from residents included the food is lovely, you get enough choice, the food is very good, good honest food, there is a choice and its hot, I eat well here, Im not giddy anymore, the food is pretty good, cook always tells you what the main meal is and the alternative if you want it and there are homemade sponges and scones but visitors have to bring fruit in for you. The tables were laid by staff who omitted to provide condiments until later during the meal. Residents were offered second helpings and residents comments about the meal were variable with some saying that it was very nice and some not liking it at all. When one residents said to a member of staff that they did not like the food the staff member just replied OK and did not offer any alternative. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect that their complaints would be listened to and dealt with properly and that they would be protected, as far as possible, from abuse in the home. Evidence: The complaints procedure is displayed in the home but does require a review to ensure that people know all of the agencies that they can contact should the need arise. The manager has a recording system in place for complaints and these were reviewed and seen to be satisfactory. Six complaints have been received since the last inspection and these related to staff approach, missing laundry and other minor issues. The complaints and subsequent investigations were recorded well. Residents spoken to knew how to raise a complaints and felt confident to do this. Comments included I have no complaints to make about the place and they have residents meetings and you can raise a complaint there if you want, its very open. Staff spoken to showed a good understanding of how to deal with any complaints that residents or visitors may raise. Some residents who responded in our surveys were unsure how to raise a complaint and the manager needs to address this. In the AQAA the manager said we always listen to the service users and take their concerns seriously, whatever they may be. It was also possible to see compliments received by the team at the home and these included thank you for all the care and support you gave, wonderful care, the staff Care Homes for Older People Page 17 of 29 Evidence: are friendly and thoughtful, a kind and professional team and My relative has been cared for extremely well by the staff, X is a different person and would be happy to come back for respite. The manager has local guidance in place regarding the protection of vulnerable adults and staff spoken to showed an understanding of such matters. Training records showed that nearly all the staff have attended training on safeguarding vulnerable adults. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely clean, generally safe and in part well maintained home that, on the whole, meets their needs. Evidence: A tour of the home was undertaken with the manager. All communal areas and bathrooms were seen along with a number of bedrooms. The home has one large lounge and a smaller lounge with a television. The smaller lounger was seen to contain a previous residents belongings, awaiting collection. As this is a communal part of the home for the use of residents this is not seen as an appropriate place to store items and an alternative place should be considered. Overall the furniture was seen to be in a good state of repair throughout the home. Some of the corridors are bare and give an institutional feel and may benefit from some pictures. On touring the home it was noted that some radiator guards were not actually attached to the wall and this needs to be addressed as some are positioned where residents may use them as support. The bedrooms were in a good state of decoration and since our last inspection items such as furniture, duvets, bed linen, carpets and curtains had been replaced. Residents have been able to personalise their bedrooms. Some bedrooms were noted not to have call bell leads and this should be addressed. The home does have a high number of double bedrooms but screen was available in these rooms. Some bedrooms were noted to have an odour but this was restricted to Care Homes for Older People Page 19 of 29 Evidence: the bedroom. However some odours were noted in double rooms and this needs a more proactive approach to ensure that it does not affect the quality of life for some residents in the home. The toilets and bathrooms were an acceptable standard but compared to the rest of the home, they require some work/refurbishment and bringing up to date. There is no shower facility available although the manager is looking into this. The home benefits from a large secluded garden, primarily laid to lawn with a patio to the side of the lounge. Overall the standard of the facilities and rooms in the home has improved since our last visit but there are still some shortfalls that need to be addressed. Residents comments included my bedroom is fine, its very clean the domestic lady is very conscientious with the cleaning and the beds are very clean and the rest of the home is reasonably clean. The manager in her AQAA said that we maintain a safe and comfortable environment throughout the home. From the AQAA it was also clear that the manager had started to put in place some of the planned improvements such as replacing tumble dryers and fridges and freezers. The provider employs a maintenance man who works 7/8 hours a week. Staff identify and record any items of work that are needed to be done. Records show a proactive approach to checking items and from staff, keen to ensure that things are right for residents. The proprietor said that the care staff check hot water temperatures but no records could be found to evidence this. The manager has a fire safety risk assessment in place that was reviewed this year. All other records related to fire safety were checked and found to be in order with, for example, staff attending fire drills and regular testing of alarms etc. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for by a staff team who know them well but who may not be fully trained to appreciate all their responsibilities. Evidence: Staff turnover at the home has been high at times during the last year, but at the time of our inspection it had settled and there was only one night carer vacancy. Residents spoken to did comment about the high staff turnover and said it is an issue as new staff do not know you and it can affect the care you get. At the current time for 16 residents the rota shows that there are 3 staff on duty throughout the day and 2 at night. The proprietor remains on the rota as manager. Staff spoken to confirmed that 3 staff are on duty during the day and also commented that the turnover of staff had stabilised as there was now more of a team atmosphere. They also commented positively on the new deputy manager and her abilities to improve on standards in the home. Residents who commented said that the staff are wonderful, there are usually three staff on during the day, sometimes more and the staff are very caring, helpful and kind. Staff confirm that they are undertaking NVQ qualifications and on the day of our visit an NVQ assessor was visiting the home. Records show that out of 15 staff, 6 have an NVQ qualification. Care Homes for Older People Page 21 of 29 Evidence: Two staff files were reviewed in order to check the robustness of the recruitment procedures at the home. Overall these were in good order with all the required checks and documentation in place. It would be of value to record interview notes so the management team can record that they have explored any gaps in employment on application forms. Staff had received a basic induction to the home but had yet to undertake the Skills for Care induction. New staff also did not have any evidence of supervision during their probationary period. The manager in her AQAA said that staff receive regular supervision and they find this very helpful. On the evidence available we can concur with this statement. The training matrix submitted by the manager showed that compliance with manual handling training was good along with adult protection, but there were significant gaps in training for fire safety, infection control, food hygiene and health and safety. This needs to be addressed to ensure that the residents are cared for by a competent team. The manager also stated that staff had attended training on, for example, care planning, stoke awareness and epilepsy awareness but no figures were given as to how many staff attended. Staff spoken to commented positively about the training provided and said that they had attended sessions on manual handling, adult protection, stroke awareness, dementia and medication. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is generally run with their best interests in mind. Evidence: The provider is currently acting as manager in the home, with a new care manager taking the lead on resident care. This arrangement is working well and since our last visit there have been marked improvements in both the care, the records and the premises. As previously, the home remains without a registered manager and the provider is discussing the way forward with the care manager. The management team are meeting with staff and the minutes show that they are promoting good practice, improving standards and resident choice. Staff meetings are held every six months and consideration should be given to consulting with staff more often. The manager has a quality assurance system in place that primarily consists of residents feedback questionnaires. These are sent out on an ongoing basis and were seen to be comprehensive, covering all the services that residents experience, including admission and how well they settled into the home. The questionnaires need Care Homes for Older People Page 23 of 29 Evidence: to be dated. Overall the results of the questionnaires showed that residents positive comments about the home and the services offered. Comments included staff approach - excellent, The staff listen to everyone, I like it here very much and Most of the staff are very good. It is clear that residents also feel comfortable to raise any queries or concerns on the questionnaires, but there is no evidence at the current time of any subsequent action taken. For example, residents said that they would like a notice board and some are concerned that when the staffing level drops to two on duty they have to wait for the toilet. The manager needs to review this aspect of the system. The manager reports that she uses an independent visitor to the home to help residents complete the questionnaires if needed, rather than using the care staff team. Minutes of residents meetings for March 2009 were available and these showed that residents had been asked for their views on the food and activities provided in the home. Prior to this the last meeting had been September 2008. More regular consultation may be of value. The manager said, in the AQAA, that we have regular resident and relatives support group meetings. On the evidence available, we would not fully concur with this statement. It may be of value for the manager to consider other audits in order to monitor and improve on standards in the home, for example, a more robust medication audit, care plan audit and staff audit covering training, recruitment and supervision. Residents and relatives who commented in our surveys about the home said that its very homely and the staff do the best for the residents and they care for people well. It was noted that a cupboard near the main stairs that says it must be kept locked was unlocked and upon opening this consisted of a small room with steps leading down into it. Domestic items are stored here and for this reason and the risk with regard to the step, this must be kept locked at all times when not in use. Occasionally oxygen may also be stored here and if that is the case the door should also be signed to say that is the case and the fire safety risk assessment updated. This was discussed with the manager on the day of the inspection. The accident records at the home were reviewed. These were completed fully and there were no causes for concern. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Ensure that residents have all the risk assessments in place that they need and that any action taken to reduce risks is documented. So that any risks to residents are reduced as much as possible. 14/10/2009 2 9 13 Ensure that staff follow the medication procedures laid down in the home. To ensure that residents alway receive their medication as they should. 14/10/2009 3 12 16 Provide an activities programme that meets both the assessed group and individual needs of residents. So that residents social care needs are met and their abilities optomised 31/10/2009 Care Homes for Older People Page 26 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 19 23 Keep all parts of the home safe, in good repair and suitable for residents needs. So that residents live in a safe home that meets their needs. 14/11/2009 5 30 18 The staff must be fully trained for the roles and responsibilities that they have. So that the residents are cared for by a competent staff team. 14/11/2009 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 1 Review the service users guide to ensure it contains all the recommend information and that it is in a format suitable for the resident group. Provide residents and visitors with access to the most recent CQC inspection report. Introduce a nutritional screening tool into the care planning system. Keep all parts of the home free from offensive odours. Contiune to encourage staff to undertake NVQ qualifications to imporve the knowledge base of the staff team. New staff should be more supported to undertake recognised induction courses and be supervised in the home, especially during their probationary period. The management team should continue to develop the quality assurance systems in the home to include internal audit tools and more frequent consultation with residents. 2 3 4 5 8 26 28 29 6 33 Care Homes for Older People Page 27 of 29 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 7 38 The home must be kept free from hazards so that it is safe for residents. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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