Care Home: Autumn Grange Care Home

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What the care home does well On entering the care home, the atmosphere is relaxed and friendly and we can see that staff maintain good relationships with people using the service and their relatives. People using the service speak highly of the staff and the care and support that they receive and they say they are satisfied with the life that they experience within the care home. Case files contain in depth information about people`s needs to make sure that staff have sufficient information to be able to support people appropriately. People are supported and enabled to access specialist services to maintain their health and wellbeing. People using the service feel that they are treated respectfully and that their privacy and dignity is upheld. Activities on offer are suited to people`s individual needs and contacts with the wider community are maintained. A wholesome and appealing diet is on offer and specialist diets are catered for. Staff continue to undertake compulsory and additional training and they are able to discuss people`s needs and how they support them in meeting these. What has improved since the last inspection? Plans of care are now in place for all identified needs and these are now more person centered to make sure that people receive support in their preferred way. These are also reviewed on a regular basis to ensure that people receive continuity of care. In depth information is in place in regard to people`s medical conditions to make sure that staff understand how these may affect people and to provide them with information so that they can support them appropriately. Each person now completes a questionnaire in respect of equality and diversity so that their personal preferences and diverse needs are fully recognised and met. Risk assessments are now in place for all identified risks to make sure that these are managed and reduced and people using the service are protected. The medication practices has improved to make sure that people are protected by these and they receive their medication as prescribed. Staff now maintain good working practices to make sure that people are protected from abuse and they receive a quality service. A hairdressing and sensory room has been installed so that people can make use of these.The recruitment and selection practice has been improved to make sure that people are protected from unsuitable people caring for them. The staffing numbers have been reassessed to make sure that sufficient numbers of staff are available to meet people`s needs. The management structure is now more settled and progress in regard to the general management of the service has improved. The quality assurance system has been further developed so that people can have a say in how the care home is run and managed. What the care home could do better: Ensure that handwritten entries on medication charts are signed by two members of staff to demonstrate that they have been checked as correct. Continue to monitor the room temperature where medication is stored in unit 3 and act accordingly if this exceeds the recommended temperature so that medication remains effective. Implement a risk assessment in regard to people using the service propping open fire doors in unit 3 so that they are protected from the risk of fire. Key inspection report Care homes for older people Name: Address: Autumn Grange Care Home 19-29 Herbert Road Sherwood Rise Nottingham NG5 1BS     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: Karmon Hawley     Date: 1 2 0 6 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 31 Information about the care home Name of care home: Address: Autumn Grange Care Home 19-29 Herbert Road Sherwood Rise Nottingham NG5 1BS 01158417475 01159620061 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sherwood Rise Ltd care home 76 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: for 76 service users at least 7 (seven) care assistants must be provided from 08:0020:00 Registered Manager must be full time and have full time supernumery hours of work That the identified bedroom to be only used for residents who by virtue of their needs are unable to use an ensuite facility. Three Senior Carers to be in charge, one on each unit (three in total) from 08:0020:00 Date of last inspection Brief description of the care home The home is located in a quiet residential area of Nottingham (Sherwood Rise) with access to local amenities. The city centre of Nottingham is about 1 mile away and there is a direct bus route to and from the city centre with a bus stop about 300m metres from the care home. A park and ride service is available, about 500 metres from the care home. The home is split into three units, two of which provide up to Care Homes for Older People Page 4 of 31 Over 65 51 25 0 0 0 2 1 0 2 0 0 8 Brief description of the care home fifty-one (51) places for people who may have a Dementia related illness (residential, non-nursing). The other unit provides personal care (residential care, non-nursing) for up to twenty-five (25) older people. There is a choice of lounges and combined dining room areas. The building is wheelchair accessible with adaptations and equipment appropriate to the needs of the service users. The garden area to the front of the premises has an enclosed safe garden to enable residents to access it safely. Parking is limited at the front of the building but there is more space available at the rear of the building itself as well on the road parking. The current basic weekly fees for the service is £336. The most recent inspection report can be found in the entrance hall. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One regulatory inspector conducted the unannounced visit over 1 day, including the lunchtime period. A review of all the information we have received about the home from the provider and the general public since the last inspection was considered in planning this visit and this helped decide what areas were looked at. The main method of inspection we use is called case tracking which involves selecting the care plans of 3 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Care Homes for Older People Page 6 of 31 The Director of Care, the acting manager, members of staff, relatives and people who use the service were spoken with as part of this visit. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. The provider provided us with an Annual Quality Assurance Assessment which is a document that outlines the services development over the last year and areas where they intend to make improvements. We used some of this information within this report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Plans of care are now in place for all identified needs and these are now more person centered to make sure that people receive support in their preferred way. These are also reviewed on a regular basis to ensure that people receive continuity of care. In depth information is in place in regard to peoples medical conditions to make sure that staff understand how these may affect people and to provide them with information so that they can support them appropriately. Each person now completes a questionnaire in respect of equality and diversity so that their personal preferences and diverse needs are fully recognised and met. Risk assessments are now in place for all identified risks to make sure that these are managed and reduced and people using the service are protected. The medication practices has improved to make sure that people are protected by these and they receive their medication as prescribed. Staff now maintain good working practices to make sure that people are protected from abuse and they receive a quality service. A hairdressing and sensory room has been installed so that people can make use of these. Care Homes for Older People Page 8 of 31 The recruitment and selection practice has been improved to make sure that people are protected from unsuitable people caring for them. The staffing numbers have been reassessed to make sure that sufficient numbers of staff are available to meet peoples needs. The management structure is now more settled and progress in regard to the general management of the service has improved. The quality assurance system has been further developed so that people can have a say in how the care home is run and managed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that their needs will be assessed and that staff can meet these before they make a decision to move into the care home. The service does not offer intermediate care. Evidence: The Director of Care or the acting manager visit people within the community to carry out a preadmission assessment. This is to make sure that staff are able to meet peoples needs before a decision to move into the care home is made. This process has developed since the previous inspection and the assessment now contains further information to enable a through assessment to take place. People who may wish to use the service and their relatives may visit and spend time at the care home to get a feel for what it would be like to live there before they make a decision to move in. Care Homes for Older People Page 11 of 31 Evidence: One person using the service tells us, my daughter looked around before I came to stay here, this was one of the cleanest and I must say they are always cleaning here. Staff spoken with say that they receive enough information about peoples needs when they move into the care home so that they can support them appropriately. The service does not offer intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that their preferences are respected and that their needs will be met. They are now protected by the medication practices and receive their medication as prescribed to maintain their health and wellbeing. Evidence: All case files have now been completed; working towards bringing these in line with person centred planning to ensure that people receive their care in their preferred way. Some plans of care do remain task focussed, nevertheless there is sufficient information within assessments to ensure that staff are aware of peoples personal needs and preferences. Plans of care are in place for peoples identified needs such as dementia care, diabetes and specific disabilities to ensure that their needs are met. There is sufficient information available for staff to be able to support people using the service appropriately. We can also see that following research there is in depth information within peoples case files in regard to their medical conditions so that staff are fully informed and can understand how conditions such as dementia and diabetes may Care Homes for Older People Page 13 of 31 Evidence: affect people and the support that they require. Peoples personal preferences are recorded and people now complete an equality and diversity questionnaire to ensure that any diverse needs are highlighted and catered for. We can see that this has been particularly useful in regard to those people who are of an ethnic minority in regard to special needs such as skin and hair care. There is now in depth information available in plans of care in regards to peoples cultural and religious needs, for example preferences in regard to a male or female carer, skin and hair care needs and dietary needs, to ensure staff have this information available and can therefore support people as needed. Plans of care highlight areas that people may be able to do for themselves as well as the areas that they may need support, so that independence is promoted and enhanced. Risk assessments are in place for highlighted risks such as falls and the safe use of bedrails to make sure that these are managed and people are protected. We can see that plans of care are evaluated and updated as peoples needs change to make sure that continuity of care is received and peoples needs are met. Staff say they can access plans of care at any time and they feel that peoples needs are met. They say that the key worker system is working well and this means that they are able to support people more effectively. They are able to discuss peoples individual needs such as diabetes and managing behaviour that may be challenging. People using the service tell us that they are happy with the help and support that they receive; it couldnt be better, they are so kind here, I dont need much help but they do help me to use the lift, and it is very nice here, I am well looked after. Relatives spoken with offer the following comments: the home is excellent we had a bad experience before this, it is really good, we are kept informed of things and my relative is very well looked after, and things are much better, staff pay more attention to detail and Paulette has sorted out my relatives medication and they are much better for this. Within plans of care we can see that people are supported to access specialist services such as the doctor, incontinence specialist and the dementia outreach team to make sure that their health care needs are met. Care Homes for Older People Page 14 of 31 Evidence: During the tour of the care home we can also see that specialist equipment such as beds, mattresses and cushions are in place. Staff spoken with are able to discuss why this special equipment is in place and the manual handling practices that they use to make sure that people do not get pressure sores. A member of staff has become a link nurse working with the incontinence specialist to make sure that up to date knowledge and practice is maintained within the care home. Staff spoken with say that people are supported to access specialist services as needed and that some people are now accessing these within the community if they are able. People using the service tell us I can see the doctor if I need to and I have had my glasses sorted out, and I get medical assistance when needed, I hurt my head so they phoned the ambulance. All staff who administer medication have been trained to do so and since the last inspection additional training has taken place and staff have been assessed as competent in their medication knowledge and skills by the Director of Care. There has been improvements in the overall management of mediation practice and compliance with the requirements set at the previous inspection has been achieved. Monthly audits also take place to make sure that good practice is maintained and the results of these audits show us that there have been no concerns. We can see that people are administered their medication as prescribed to ensure their health and wellbeing is maintained. Although some handwritten entries are not signed by two members of staff to show that these have been checked as correct, when we checked the prescription against the medication records these did match. Room temperatures are kept to monitor that medication is stored at the correct temperature so it maintains its effectiveness, however we did see that in unit three the temperature does on occasion exceed the recommended, therefore the Director of Care is going to look at solutions to manage this. Throughout the inspection we can see that staff maintain peoples dignity and they Care Homes for Older People Page 15 of 31 Evidence: treat them with respect. Staff spoken with are able to discuss how they maintain peoples dignity by way of knocking on peoples doors, covering them up when offering personal care and making sure that respect peoples choices. People using the service tell us that staff are kind and caring and that they feel respected. One person says that staff always knock on their door before they come in. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and enabled to live a life of their choosing, which satisfies their needs and to maintain contacts with people that are important to them. Evidence: People using the service are supported by staff to undertake various activities such as games, arts and crafts, reminiscence, trips out and dominoes. Activities take place as and when people wish to do these and there is no set time; these sometimes take place in a group or on an individual basis. Outside entertainers also visit the home on a regular basis and provide activities such as singing and dancing and movement to music. We can see photographs on display where people are enjoying a dance with staff when a rock and roll group visited the care home. Staff are also working with a local museum and galleries who are visiting the care home and bringing in things of interest which will aid reminiscence and discussion. A sensory room is now available for people to use if they wish and we can see that Care Homes for Older People Page 17 of 31 Evidence: this is beginning to be more popular. There is a wealth if information on display on the activities board, offering information about; avoiding empty day syndrome, reminders for families, if their relative is registered blind that staff can access large print items and services in community, that special cutlery can be made available for those people with arthritis and information about issues facing older lesbians, gay men and bisexuals. Staff feel that there are enough activities on offer for people using the service and that they now have more time to spend with people doing these, they say; the activities are a lot better there is more available, and most ladies like knitting, we have more time in the morning now for activities and there are various things on offer. Sitting talking to people is good as I find out more information about people which is interesting; I enjoy talking about the past. It is important to give people the opportunity to go out and maintain their old skills and hobbies, such as watering plants and doing the gardening. We let people do what they want. People using the service offer the following comments about the activities on offer and life within the care home; I enjoy the activities, it is just as I would want it, it is my home, it is ok here, I am settled, there is not much to do but I am past the party game side of things, I have no problems, it is ordinary sort of living to me, I am happy with what we do, I go to the stroke club I am settled here, I go out with my daughter, I go and have a manicure, and I often go out in the garden, it is very friendly and the atmosphere is relaxed, I have got everything I need, I couldnt praise it enough, there are activities but I tend not to join in I like to sit and watch. Staff say that the routine of the care home is flexible and people may spend their time as they wish and we saw people doing this throughout the day. Church services are held in house for those of a Catholic and Church of England denomination. Other people also attend places of worship within the community. The Director of Care states that if any other needs are expressed then attention will be paid to researching networks within the community to make sure that these are met. So that people can maintain contacts with people that are important to them there are no restrictions on visiting and visitors may be received in private. We can see that staff maintain good relationships with people using the service and they are made welcome when they visit. Care Homes for Older People Page 18 of 31 Evidence: People using the service say that their relatives are made welcome and they can go out with their families when they want. Relatives say; I feel welcome when I visit, staff now spend time with residents and visitors. I used to feel that I could come and go unnoticed before, and we are always made welcome and offered cups of tea, we can also make our own. Staff confirm that there are no restrictions on visiting and that people are made welcome. A wholesome and appealing diet is on offer to people using the service and special diets such as diabetic and cultural diets such as Afro Caribbean are catered for. Choices are available at each meal and there is plenty of variety. Three times a week for those people who wish to have an Afro Caribbean diet this is made available. One person goes out shopping with the Director of Care to pick up Afro Caribbean food. Before the lunch time meal was served we could see staff using a picture menu to assist people to choose what they would like to eat, so that they could look at the pictures and make an informed choice. Special aids have been purchased for those who need them, such as cutlery for people with arthritis and cups that are designed to prevent choking. People using the service say; the food is very good, I have sausage, bacon and toast for breakfast, I love it, I had fish, chips and peas for dinner which was nice; we get enough to eat, the food is good enough to eat, and the food is very good here. One member of staff says that there is now more choice in the food on offer and simple things such as fruit and cereals are now available. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience 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 are assured that their complaints will be listened to and acted upon and that they are protected from abuse. Evidence: There have been three complaints received since the previous inspection, in regard to a lack of choice in sandwich fillings, which was unfounded, staffs failure to recognise a damaged finger nail which caused pain to a person using the service and one in regard to the Director of Cares daughter visiting the care home. We can see that these have been investigated and responded to appropriately. Staff spoken with are able to discuss what they would do if they received a complaint to make sure that this is resolved. People using the service say, I would tell someone if I was unhappy as I am definitely outspoken, the staff are good at their jobs, I have no criticism of them, there are no funnies or nasties, everyone is so good, I can do more or less as I want, if I was unhappy I would tell someone, and I am really happy, I would say if there were problems but there is not, staff are very good and are approachable. Relatives say; the staff are very good and they are approachable and compassionate and I can always tell Paulette if there are any issues. Care Homes for Older People Page 20 of 31 Evidence: The majority of staff have been trained in safeguarding vulnerable people and when spoken with they are able to discuss their roles and responsibilities in making sure that people remain safe. They give very good accounts of what action they would take if they feel that abuse is occurring, however they are confident that good practices are maintained. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and well maintained environment. Evidence: The environment remains well maintained and we can see that repairs logged in the maintenance book are dealt with quickly. Staff spoken with confirm that this takes place. The gardens remain pleasant and we saw people sitting out on the day of the visit. The Director of Care has arranged for the purchase of new tables and chairs to make this more comfortable for people to use. The new hairdressing and sensory room have been completed for people to use and enjoy. Unit 1 and 2 have merged together which has proved beneficial for people using the service as staff are more readily available and people can talk to people that share the same interests as them. Specialist aids and adaptations are in place such as grab rails, specialist baths and wet rooms to ensure that the diverse needs of people are met. Care Homes for Older People Page 22 of 31 Evidence: All areas of the care home we saw are clean and tidy. Peoples rooms are personalised and people using the service say that their rooms are nice and tidy. One relative says that the staff are very accommodating as they changed the colour of the room so that it was more suited to their relatives tastes. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 are supported by sufficient numbers of staff who are knowledgeable in their jobs roles and the support that people require. Evidence: We can see that units 1 and 2 have been restructured and these are now joined. This means that there are more staff available to support people as needed. We can see that staff are continually present within communal areas and supporting people as needed. Staff spoken with say, the staff team get on well we could do with an extra one on in the mornings at times but otherwise it is ok, and it is better now the units have merged, people can have whatever they want. There are enough staff and there has been extra staff put on when peoples needs change and they need more care and support to make sure there are sufficient staff available to care for them. People using the service express no concerns about the staffing levels. So that staff are aware of their roles and responsibilities when they first start working at the care home they undertake an induction. We can see evidence of this occurring within staff files examined. Care Homes for Older People Page 24 of 31 Evidence: One member of staff confirms that all new staff undertake an induction; new staff have an induction, we work with them and they shadow senior staff for 2 to 3 weeks. Nine members of staff have attained the National Vocational Qualification (a nationally recognised work and theory based qualification designed to enhance peoples knowledge and skills in caring for people) level 2 and seven have attained level 3. One member of staff confirms that they have undertaken training in both level 2 and 3 and they say that this has helped them in their care delivery and making sure that they ask people what they want and respecting their wishes. Staff files examined show us a through recruitment and selection process is now taking place. All the required documentation such as references and identification have been obtained before anyone starts working at the care home to ensure that people using the service are protected from unsuitable people being employed. No one starts working at the care home now until a satisfactory Criminal Record Bureau check (a police check to see if an individual has a police caution or criminal record) has been received, again to make sure that people using the service are protected. One member of staff spoken with confirms they have undertaken a Criminal Record Bureau check. Since our previous inspection we can see that staff have continued to undertake compulsory training such as fire and safeguarding adults and additional training such as risk assessments and equality and diversity to ensure that they have the necessary knowledge and skills to support people using the service. The dementia outreach team, continue to work with staff at the care home in regard to developing their knowledge and skills in respect of supporting people with dementia. There are some deficits in compulsory training such as first aid and food hygiene; however we can see that arrangements have been made in regard to addressing these to ensure that all staff have attended. Staff say that they feel supported in their training and development; the training with the outreach team has opened my eyes to understand what people are going through, I feel supported in my training, and the training is at a good standard and I feel supported. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a care home that is well run and managed where they are enabled to have say about life within the care home to make sure that they are satisfied with this. Evidence: The previous acting manager has now become the Director of Care and a new acting manager has been in post for three weeks. The Director of Care is overseeing the general management of the service and is responsible for the quality monitoring. The new acting manager has previous experience in managing a care home and crisis management. She had completed the Registered Managers Award (a recognised work and theory based qualification designed to enhance management knowledge and skills) and she remains up to date in all other compulsory training. Staff feel that many improvements have been made over the last 6 months; there have been many improvements and we have been involved in the changes, if we do not understand anything we can ask the manager. The manager (Director of Care) is Care Homes for Older People Page 26 of 31 Evidence: approachable and we can ask her anything, and it has improved a lot, people are now happier and we get what we need for the residents. The manager (Director of Care) has made improvements and is approachable. One relative spoken with also confirms that improvements have been made over the last 6 months and that there is more consistency in care delivery and standards of care. People using the service are enabled to have a say about the way the care home is run and managed by way of meetings and questionnaires. A number of questionnaires have been returned from both residents and people using the service which are of a very positive nature in respect of the care received and life within the care home. We can see that a relatives meeting has been held and that people have been informed of the changes that have taken place within the service. The feedback during this meeting was that everyone feels that there is a big improvement and that communication is good and the new structure is working well. The minutes from the last staff meeting evidence that staff feel supported in their training and development and that quality issues and maintaining standards are discussed. All of this information is used in the workforce plan and the business planning for the year to demonstrate that peoples views are being considered. The Director of Care has now implemented monthly auditing systems which covers areas such as medication, care planning, catering and activities so that any areas of concern can be highlighted and addressed. People using the service may have their money kept in the care homes safe if they wish, which they can access at any time. We examined four peoples personal allowances and we can see that receipts are kept for all transactions and two members of staff sign for these. Regular audits of this money takes place and all accounts seen have the correct money in as stated on the accounting sheet. We can see accidents occurring within the service are minimal and if these do occur staff are acting appropriately to ensure that people receive the correct care and attention to ensure their wellbeing. The fire log book examined shows us that the systems are checked as required and Care Homes for Older People Page 27 of 31 Evidence: that some staff have undertaken training in fire safety. The fire risk assessment has been developed to pay particular attention to those people who have dementia care needs to ensure that they are protected. The Annual Quality Assurance Assessment that the service provided tells us that regular maintenance of services and equipment is taking place, we examined the electrical, gas and lift certificate during our inspection which confirms that this is happening. During the tour of the care home, we could see that in one persons bedroom that the window locks had been undone and the windows were open wide. The Director of Care immediately resolved this and is intending to complete a risk assessment in regard to this issue. Also several times when we went onto unit 3 we could see that the fire doors had been wedged open with a chair and a table. It transpires that this had in fact been done by a person using the service on both occasions, and the situation was remedied. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Continue to develop plans of care so that they are all person centered to make sure people receive care in their preferred way. Make sure that all handwritten entries on medication charts have been signed by two members of staff to show that these have been checked as correct. Monitor and act if the room temperature where medication is stored goes above the recommended to ensure that medication maintains its effectiveness. A risk assessment is completed in regard to people using the service propping open fire doors to make sure people remain protected from the risk of fire. 2 9 3 9 4 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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