Care Home: Autumn Gardens

What the care home does well People’s needs are assessed prior to their admission into the home. This assists to ensure that people’s individual needs can be met. People living in the home make clear decisions about their lives were possible and their involvement in the home is fully promoted. This makes people feel valued. People living at Autumn Gardens undertake a range of activities both in the local community and within their own home which promotes their independence. People are encouraged to have appropriate relationships and maintain contact with family and friends, which promotes their emotional wellbeing. People are offered a healthy varied diet, which ensures their health and well being is promoted and protected. The home is well maintained to a high standard. There are effective health and safety procedures in place which assist to protect people living in the home. What has improved since the last inspection? Autumn GardensDS0000069167.V378749.R01.S.docVersion 5.2The Statement of Purpose and service user Guide have been updated. People that want to use the service are clear about what is provided. Staff have received dementia training. This has provided them with additional knowledge and skills to meet people’s needs. An air conditioning unit has been obtained. This assists to ensure that medication is stored in a professional manner. This ensures that medication is effective for use. This promotes the health and wellbeing of the people living in the home. Staff have undertaken a range of training including first aid, safeguarding, fire and health and safety. A range of further training has been booked. The service has worked hard in this particular area. This will improve the quality of care provided to the people living in the home. The levels of staff have been improved to ensure that there are enough people on shift to meet people’s individual needs. The recording and response to complaints is clearly recoded with both written documentation and face to face meetings taking place. What the care home could do better: Care Plans are being updated by the acting manager. They need to be detailed, specify people’s individual goals and provide clear guidance to staff in relation to how support is going to be provided to the people living in the home. This will continue to improve the quality of care provided in the home. The manager is also reviewing all risk assessments to ensure that all identified risks to people living in the home are minimised. The quality and consistency of recording needs to be improved in areas such as, health care appointments and medication. This will promote clear communication and promote the health and well being of the people living in the home. The recruitment records need to ensure that two references and a photograph are available on file. This protects the people living in the home.Autumn GardensDS0000069167.V378749.R01.S.docVersion 5.2Staff supervision needs to take place more regularly to ensure that consistent professional guidance is provided to staff. This will further improve the care provided to people living in the home. Key inspection report CARE HOMES FOR OLDER PEOPLE Autumn Gardens 73 Trent Gardens Southgate London N14 4QB Lead Inspector Wendy Heal Key Unannounced Inspection 25th November 2009 9:15: DS0000069167.V378749.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.2 Page 2 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 Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Autumn Gardens Address 73 Trent Gardens Southgate London N14 4QB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8344 2600 020 8344 2610 info@autumn-gardens.com Ourris Properties Limited Eleni Constantinou Care Home 40 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 Dementia - Code DE The maximum number of service users who can be accommodated is: 40 20th October 2009 2. Date of last inspection Brief Description of the Service: Autumn Gardens is a registered care home for 40 older people including people with dementia. The home opened in April 2007. Autumn Gardens is located in a residential area in Southgate, North London, and is close to community resources and facilities such as a supermarket, local shops, places of worship and public transport. There are 40 single rooms on three floors, all with ensuite facilities. 8 bedrooms also have their own shower. The home has 3 lounges and a separate dining area. There is a large attractive garden at the rear of the home Autumn Gardens has been set up to provide a home primarily for older people from the Cypriot community. Fees are available on request. A copy of this report can be obtained direct from the provider or via the CQC website Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The rating for this service is one star – adequate service. This means the people that use the service experience adequate outcomes. This was an unannounced inspection and took place as part of the inspection programme. Compliance was checked against key standards and took approximately 9 hours. The inspection took place on the 25th of November 2009. The inspection involved speaking with people who use the service, the staff on duty, the provider and acting manager. The inspection also included an assessment of a range of the homes records, procedures and forms as well as observation and a tour of the home. We would like to thank the people living in the home, the staff and relatives for their assistance with the inspection process. What the service does well: People’s needs are assessed prior to their admission into the home. This assists to ensure that people’s individual needs can be met. People living in the home make clear decisions about their lives were possible and their involvement in the home is fully promoted. This makes people feel valued. People living at Autumn Gardens undertake a range of activities both in the local community and within their own home which promotes their independence. People are encouraged to have appropriate relationships and maintain contact with family and friends, which promotes their emotional wellbeing. People are offered a healthy varied diet, which ensures their health and well being is promoted and protected. The home is well maintained to a high standard. There are effective health and safety procedures in place which assist to protect people living in the home. What has improved since the last inspection? Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.2 Page 6 The Statement of Purpose and service user Guide have been updated. People that want to use the service are clear about what is provided. Staff have received dementia training. This has provided them with additional knowledge and skills to meet people’s needs. An air conditioning unit has been obtained. This assists to ensure that medication is stored in a professional manner. This ensures that medication is effective for use. This promotes the health and wellbeing of the people living in the home. Staff have undertaken a range of training including first aid, safeguarding, fire and health and safety. A range of further training has been booked. The service has worked hard in this particular area. This will improve the quality of care provided to the people living in the home. The levels of staff have been improved to ensure that there are enough people on shift to meet people’s individual needs. The recording and response to complaints is clearly recoded with both written documentation and face to face meetings taking place. What they could do better: Care Plans are being updated by the acting manager. They need to be detailed, specify people’s individual goals and provide clear guidance to staff in relation to how support is going to be provided to the people living in the home. This will continue to improve the quality of care provided in the home. The manager is also reviewing all risk assessments to ensure that all identified risks to people living in the home are minimised. The quality and consistency of recording needs to be improved in areas such as, health care appointments and medication. This will promote clear communication and promote the health and well being of the people living in the home. The recruitment records need to ensure that two references and a photograph are available on file. This protects the people living in the home. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.2 Page 7 Staff supervision needs to take place more regularly to ensure that consistent professional guidance is provided to staff. This will further improve the care provided to people living in the home. 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. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3, People using the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is clear information informing people about the service to enable them to decide if their individual needs can be met. The manager is more able to establish if the staff can meet these needs given the further training that has been undertaken. People’s needs are assessed as part of the admission process. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 10 EVIDENCE: The statement of purpose and service user guide were both inspected. They are both in a user – friendly format and were clearly written in both English and Greek. The service user guide has been updated. The statement of Purpose has been reviewed and updated. We looked at the records of four people’s files that had moved into the home. They all contained assessments as part of the information prepared by the home. Information provided by an appropriate care professional if the person is placed by social services. The assessments contained all the information required. Staff have now undertaken dementia training which assists them to appropriately support the people living in the home. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health care needs are being carried out in a way they prefer and require. People do have access to health care professions. However it is not possible to confirm that people’s physical and emotional needs are being fully met as recording of health care information is not fully effective and consistent. Medication recording is not being carried out consistently in line with procedures. EVIDENCE: Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 12 The care plans for people living in the home were inspected. They did identify the areas were care and support were needed. They covered areas such as, physical wellbeing, mobility and dexterity, communication, personal safety, medical history, medication, mental health and cognition and religious observance. However a discussion took place with the manager who is working to ensure that care plans are more person centred and include identified goals for each person based on their individual needs and wishes. The care plans needs to ensure that for example when it refers to people needing assistance to wash, dress and refers to oral hygiene and skin care that the care plan specifies how the person would like this support to be provided. When the care plans state that encouragement is needed the information needs to provide clearer guidance in relation to how and in what form this should take place. Were the care plans indicate that people’s dignity and privacy must be respected clear guidance needs to be included in the care plan to evidence how people’s privacy and dignity will be respected. This will ensure people have the opportunity for personal development. The manager has updated a number of care plans but further work is required in this area. The people’s documents inspected indicated that areas of risk were assessed. They included moving and handling, in relation to transferring turning in bed, toileting, risk of falls, the documents indicate how many staff are needed to ensure that identified risks to people are minimised. The manager is working hard to ensure that all risk assessments are reviewed and updated. At the time of the inspection nobody living in the home had pressure sores. The health care records for identified people were inspected. They indicated that people are receiving regular input from healthcare professionals including General Practioners, opticians, chiropodists and the district nurse. People were being referred to specialist healthcare when needed. People had been assisted to attend the diabetic clinic. The acting manager and another staff member have now received training from the district nurse in relation to those people that have diabetes and how they need to be supported. However not all of the people had a record that they had seen the dentist. The dental hygienist had also visited the day before the inspection and this had not been recorded to evidence that the appointment had taken place. The record of people’s weight was also not being effectively recorded for a number of people living in the home. This does not ensure that people’s health care needs are being monitored in a professional manner. The health information must be clear, well organised and evidence clear outcomes of appointments. This will ensure that updated information is available to staff that monitor people’s health care needs to ensure they are met. A hairdresser visits the home and it was observed that the people living in the home were well dressed and their hair was well kept. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 13 The medication and medication administration records were inspected. Not all of the medication had been signed for on the medication administration record but had been administered. This does not protect the health and wellbeing of the people living in the home as procedures were not followed on this occasion. An air conditioning unit has been obtained to ensure that medicines are stored within the licensed temperature range to maintain their therapeutic effect. A guide to medication had been purchased and was available for staff to use. The home has obtained copies of professional guidance provided by the Care Quality Commission and the Pharmaceutical Society. The homes medication procedure includes details of how to deal with medication errors, what to do if a person is self medicating and retaining medication after the death of a person. This supports good practice. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, People using the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from an approach which encourages and supports them to take up opportunities for activities both in the home and in the community. Daily activity plans are used to plan both community and individual activities on an individual basis. The meals are balanced and nutritious and reflect people’s cultural wishes. EVIDENCE: On the day of the inspection the inspector spoke with the activity co-ordinator who works in the home five days per week and has a clear programme of activities. The activity co-ordinator and acting manager confirmed that on the two other days that this person does not work that the care staff arrange the activities. These include large group activities and other small group activities. The group activities include ball games, bean ball bags, puzzles, gentle exercise, religious activities and cooking. This particular activity was observed Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 15 on the day of the inspection and a group of people were getting a great deal of enjoyment from making a coconut cake to have with their tea that day. Individual activities recorded on the activity schedule included swimming, music and dance, gardening and a walk to the market. One the day of the inspection it was observed that one identified person went out with assistance for a walk. The activity co-ordinator arranges trips out once a fortnight including, going to restaurants, visiting places of interest and shopping. This provides people with the opportunity to socialise within the community. The activities reflect the culture of the people living in the home, including baking, named days. On the day of the inspection the provider took the time to show the inspector a book that had been obtained which very much reflects the culture of the people that live in the home their way of life and history. The provider was going to copy the photo’s and place them on the walls of the home to bring the people living in the home pleasure and assist them to remember their past. A number of activities are provided within the home people can watch Cypriot television, listen to Cypriot music, read newspapers and socialise together. On the day of the inspection the inspector was provided with evidence in the form of pictures in relation to a number of birthday parties that had taken place very recently. It was observed that a number of staff speak to people that live in the home in Greek. The manager explained that a number of staff speak Greek and were staff do not speak Greek they have learnt some basic vocabulary to improve the means by which they communicate with the people living in the home. This makes them feel valued. People’s religious wishes are respected and people can practice their religion if they wish. On the day of the inspection the inspector noted evidence that the priest from the church visits the home and conducts ceremonies for the main festivals. He was visiting the home to celebrate Christmas and notices informed families of the planned dates and times and they were invited. This promotes the people’s spiritual wellbeing. People living in the home have contact with their family and friends. There were many visits observed taking place throughout the whole day. It was obvious that relatives were made welcome and felt relaxed in the home. This assists to promote people’s emotional wellbeing. One of the relatives spoken to privately commented, when discussing their relative ‘they are happy here and the food is varied’. ‘Another relative confirmed, ‘you can visit when you want to’. The home employs a cook and during the inspection lunch was being prepared. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 16 The home has a four week rolling menu and indicated that it provides a mixture of both English and Greek food for example, Stafato, beef stew served with rice, Fassolia, (haricot beans) with potatoes, carrots celery, cooked in tomato sauce served with sardines or cod and chips peas and potatoes. There were also a range of sweets such as rice pudding, Home made apple crumble. The inspector sampled the food which was well presented tasty and consisted of good quality produce. One relative spoken with privately commented, ‘the food is very good the same standard that would be provided at home’. The lunchtime was observed. People who are able to eat independently sit in the dining room. Those people that need support from staff to eat their meal remain in the lounge. The staffing levels have increased and as a result the meal was observed to be relaxed. People were seated in appropriately before meals left the kitchen which meant the meals remained hot. The acting manager informed the inspector that senior staff are more aware of who staff need to support during meal times. The provider and manager discussed with the inspector that during the allocations meeting in the morning it could be recorded the staff on duty and who they are going to support at meal times rather than just be a verbal discussion. The manager and provider agreed to implement this to ensure that this improvement in meal times continues. The kitchen was clean and tidy. The fridge and freezer was inspected and this was found to be clean and hygienic. The food identified was labelled and stored appropriately. There were colour coded chopping boards to prevent cross contamination during the preparation of food. This promotes the health and wellbeing of the people living in the home. The chief had a good understanding of the preferences of the people living in the home. I was informed that the meat is obtained from the local butcher, fresh fruit and vegetables are obtained on a daily basis by the provider who was completing this task at the time when the inspection started. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to access an appropriate complaints procedure. Complaints are being addressed and recorded appropriately. Staff have undertaken appropriate training and know how to recognise abuse. The home is informing the commission and relevant professionals of significant events in a timely manner. EVIDENCE: A copy of the homes complaints procedure is displayed in the hall and staff office. The complaints book was investigated and seven complaints had been made since the time of the last inspection. The information had been documented clearly in the complaints book and had been responded to appropriately. The information had been signed and dated. The inspector was pleased by the clear improvement noted in this area. The acting manager confirmed that the complaints procedure is evidenced in the service user guide and people are provided with a copy of the complaints Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 18 procedure when they move into the home. The complaints procedure is also available in Greek. This promotes the rights of the people living in the home. All of the people’s relatives spoken with individually confirmed they knew how to make a complaint if they wanted to and were happy to speak to the manager or staff members if they had concerns. The home had a copy of the adult protection guidance issued by the London Borough of Enfield, the local authority the home is situated in. This ensures that clear guidance is available to the staff team should they need it. The home also has its own Adult Protection Policy and Procedure. The policy was clear in relation to the stages a complaint will undertake and states that a complaint will be acknowledged in writing within seven days and investigated and responded to within twenty eight days. This document assists the people living in the home and their families to feel that their wellbeing will be promoted and protected. The inspector was provided with information to evidence that some staff had undertaken adult protection training. The acting manager confirmed that a number of staff (six) still require training in this identified area. The manager confirmed that all staff will all complete this training. (Please refer to the staffing section.) This training will ensure that staff have up to date knowledge and skills in relation to abuse. This assists the staff to protect people from potential abuse. The acting manager informed the inspector that the personal finances of the people living in the home are managed by their relatives. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26, People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are provided with an attractive and well maintained home that is clean. There was a slight odour in one identified bedroom which was being acted on appropriately. EVIDENCE: Autumn Gardens opened in April 2007. The home is spacious and comfortable. We undertook a tour of the home accompanied by the homes acting manager. All areas of the home including people’s personal bedrooms and communal areas were inspected. All areas of the home have been furnished and decorated to a high standard. The home encourages people to personalise their rooms with their own personal mementos, such as photographs, ornaments and small items of furniture. This makes people feel valued. The bedrooms all Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 20 have en-suite facilities and some have a shower also. This assists to ensure that people’s privacy and dignity is respected as they have their own identified areas were their personal care can be carried out in private. There are three separate comfortable lounges which provide people with a pleasant comfortable place for people to relax and socialise. There is a large well equipped kitchen which means that the cook can effectively cooked and prepare the meals for the people living in the home. On the day of the inspection one identified bedroom had an odour. The inspector did note that on the day of the inspection the carpet had been cleaned and was still in the process of drying. A discussion took place with the manager and provider and it was acknowledged that due to this identified person’s behaviours and needs that the floor covering should be replaced with a floor material that is washable and more suitable in relation to this person’s identified needs. This will prevent the odour being contained within the flooring. The provider and manager agreed to ensure that the flooring was replaced as a priority and responded positively to the suggestion made. At the time of completing the report the inspector was informed that floor specialists had been contacted and their advice was being sought. There were no other areas within the home were an odour was identified. The home was maintained to a good standard. All of the people living in the home have some degree of dementia and all the rooms are numbered to help people find their way around. A number of people living in the home are at risk of wandering and the home has the front door secured with a key pad. The stairwells at night are protected by doors, which have a high handle to prevent people from wandering onto the stairs. Some people are able to open these doors. Therefore there are staff located on every floor which was not previously the case. The laundry room was seen and was also clean. All of the equipment was working effectively. The people living in the home have their own identified baskets were their clothes are stored in the laundry room. People’s clothes are also labelled to ensure that once they are washed they are returned to the correct person. The home employs four domestic staff and one of these was observed working on the day of the inspection. There is a garden which has plants, flowers and garden furniture which means that people are provided with a nice area to sit in and relax in the summer. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are adequate to enable staff to support people living in the home in a safe dignified manner. Staff have received training in numerous areas. However some further training is still required for some identified staff to ensure they have the knowledge and skills to met people’s needs. The people living in the home are not fully protected by the homes recruitment procedures. EVIDENCE: The home has a staff team in place. The staff rota was seen. There were adequate numbers of staff on shift to meet the needs of the people living in the home. The staffing levels had increased at the time of the last inspection which benefits the people living in the home who have high care needs and complex behaviours. The home also has a finance administrator. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 22 A number of staff had started their National Vocational Qualification (NVQ) level 2 and 3 and 4 information is clearly documented on people’s files to evidence this. This indicates that the home is working towards ensuring that fifty percent of the staff team have undertaken their NVQ. This ensures that good practice is being followed. The staff folders showed evidence of an induction process that was being undertaken using a comprehensive checklist prepared by the home. Staff files indicated that staff had undertaken training in a number of areas that included adult protection, manual handling, infection control, first aid, fire safety, medication, health and safety and dementia care. Further training had been booked in relation to a two day mental health training session, defusing violent challenging and aggressive behaviour, health and safety in the workplace, responding when dementia progresses, mood disorders, working with depression, cognitive behaviour therapy, healthier food and special diets. The inspector was pleased to see the efforts being made in relation to training. However some staff need to undertake training in first aid, Protection of vulnerable adults, manual handling and infection control. The home has carried out in house pressure care training which needs to be recorded on the staff training records. A discussion took place with the provider and acting manager and it was acknowledged that the home could organise further pressure care training with identified professionals that have a good relationship with the home. This will ensure that people living in the home have the necessary training and skills to meet the needs of the people living in the home. The acting manager has started to complete a staff team training analysis and is continuing to develop this. This will further assist the home to provide a clear list of which staff have completed certain areas of training. The manager and the inspector discussed the fact that the staff files need to be more organised. The manager agreed to undertake this task. The staff recruitment policies and procedures and relevant documentation was inspected and indicated that recruitment procedures were in place. The staff files contained criminal records bureau checks (CRB) (a number had only one reference) birth certificates and a copy of the person’s passport. It was confirmed that two staff references and a staff photograph need to be on file. The manager needs to obtain these documents to ensure that people living in the home are fully protected from potential abuse. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, 36, 38, People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home benefit from having the service run by a willing and hard working acting manager. The home needs a permanent registered manager supported by a permanent deputy manager to ensure the home continues to progress and develop and ensure a good service is provided to the people living in the home. Supervision needs to take place regularly as supervision is not taking place consistently which does not ensure staff are effectively supported. EVIDENCE: The acting manager who was the deputy manager is currently making their application for registration and is managing the home. The deputy manager’s role is vacant. The manager is currently undertaking the Registered Manager’s Award. The manager was very knowledgeable with regard to the identified Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 24 people living in the home which assists to ensure their needs are met. A recommendation is made that a deputy manager is appointed as soon as possible as a stable management team needs to be in post to continue to ensure the home progresses. The manager has developed a Quality Assurance Questionnaire and the views of service users and their relatives had been sought. The results have been summarized in the updated service user guide. The manager of one of the other homes within the organisation has started Quality Assurance visits. The Care Quality Commission is sent regulation 37 notifications of incident forms. This is a legal requirement in place to try to ensure that professional practice is followed. The acting manager explained that the families manage the finances of the people living in the home. The home holds some cash for people to spend for example on chiropody or hair dressing. The cash is held in the safe and each person’s money is held in a separate pouch. This was inspected at the time of the previous inspection and found to be in order. The staff supervision records were inspected and some staff were receiving supervision. However the staff supervision needs to take place more regularly at least six times per year. The staff must also receive an annual appraisal. The manager must ensure this task is completed to ensure that staff are supported to work with people living in the home in a consistent way. This will assist staff in relation to their own personal development. This benefits the people living in the home as the quality of care is improved and they feel valued. A discussion took place with the provider and acting manager and it is strongly recommended by the inspector that staff including the manager attend some training in relation to supervision. A range of health and safety information was inspected that included a gas certificate, electrical installation certificate, portable appliance testing certificate, that would be due for renewal next month, fire evacuation procedures and servicing and testing of the home’s fire fighting equipment. The home has a fire risk assessment. The home also has a current public liability insurance certificate. All of the records were found to be in order. This indicates that the home takes health and safety seriously which promotes the health and safety of the people living and working in the home. . Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 2 X 3 Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Timescale for action The registered Person must 10/02/10 ensure that care plans are fully detailed and contain goals for each person based on their needs, specify what support is required and how it will be provided. Care plans must be kept up to date. This will ensure that up to date and guidance is available to staff to ensure people’s individual needs can be met. The Registered Person must 15/01/10 ensure that risk assessments are reviewed and updated. This will ensure that all risks are minimised. This will promote the health and wellbeing of the people living in the home. The Registered Person must 26/12/09 ensure that all health care appointments take place. All health care recording such as dental appointments and weight charts must be clearly recorded. This will ensure that professional practice is being followed and evidence that people’s health is being monitored. DS0000069167.V378749.R01.S.doc Version 5.3 Page 27 Requirement 2. OP7 13 3. OP8 13 Autumn Gardens 4. OP9 13 5. OP18 13 The Registered Person must 20/12/09 ensure that all medication is effectively signed for on the medication administration record. This will ensure that professional practice is followed with regard to the administration and recording of medication and safeguards people’s health and wellbeing. The Registered Person must 25/01/10 ensure that the remaining staff have received training on safeguarding vulnerable adults including understanding whistle blowing. This is to ensure all staff can recognise and respond appropriately to allegations of abuse. The Registered Person must 28/01/10 ensure all staff have the correct recruitment checks in place including two references and a photograph. This is regarded as professional practice and protects the people living in the home from potential abuse. The Registered Person must 10/02/10 ensure that the remaining staff undertake mandatory training including manual handling, first aid and infection control. This will ensure that staff have the knowledge and skills to meet the needs of the people living in the home. The Registered Person must 28/12/09 ensure that supervision for all staff takes place at least six times per year. It must be detailed and clearly recorded. This will ensure that staff are assisted to provide consistent care to the people living in the home. DS0000069167.V378749.R01.S.doc Version 5.3 Page 28 6. OP29 19 7. OP30 18(1) 8. OP36 18 Autumn Gardens RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP31 OP36 Good Practice Recommendations The provider is strongly advised that the deputy manager makes the application for registration in time for the new registration process under the Care Quality Commission. The manager and senior staff should attend supervision training. Autumn Gardens DS0000069167.V378749.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.london@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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