Care Home: Autumn House

What the care home does well The home has a comprehensive pre-admission procedure, which ensures that the home should be able to meet the needs of people admitted. Additional comments from people who live at the home included `I love being here, I love them all (staff)`, `treat elderly people with respect and employ really good staff` and `create a loving caring, friendly atmosphere for vulnerable people no longer able to cope at home`. All evidence indicates that people`s personal care needs are met. People stated in comment cards that they were happy living at the home and felt that their needs were met. External health and social care professionals commented on the good continuity of care and staff having good knowledge of service users. They also identified that the home did well with `personalised care, alerting GP to concerns and good end of life care`. The home provides a range of activities, both individual and in groups. Care staff or external professionals provide activities. People are offered choice and decisions are respected. People receive a balanced diet with choice and special diets catered for. The home employs appropriate numbers of care staff that ensure that people`s needs are met. Staff receive the necessary training including NVQ`s and training specific to the needs of the people living at the home. All but one member of the care staff had an National Vocational Qualification (NVQ) in care at the time of the inspection visit. Comment cards from service users included lots of additional comments about staff including `the staff are lovely, they look after us all well`, `the girls work really hard and do a wonderful job` and `I think they do everything well, the staff are all kind and they help everyone`. Comment cards from staff included lots of comments about how happy they are working at the home stating `Autumn House is a lovely place to work and the atmosphere is always friendly and welcoming`, `all staff are cheerful and work well as a team` and `I enjoy my job and work in a lovely caring environment with professional colleagues`. The home works well with external professionals to manage the various needs of the people who live at the home. An external professional stated `a challenging client group managed well`. What has improved since the last inspection? The home has continued to maintain and improve the homes environment with various communal rooms and bedrooms redecorated and new carpets or flooring provided. The registered manager now has an administrator to assist her in aspects of the homes administration giving her more time to focus on care issues. Three requirements were made following the previous inspection. These have all been complied with. The home has reoganised the way that medication is managed in the home and this is now being administered as prescribed by health professionals with full records maintained. Staff have all had medication training provided by the new pharmacist who supplies medication to the home. The home is now following the correct reporting procedures for safeguarding and continues to work with external professionals to ensure that people are safe and do not present a risk to themselves or others. The home is now sending relevant notifications to the commission of incidents in the home which may have had an adverse effect on people who live at the home. The registered manager has also implemented a supervision system that provides staff with bi-monthly supervision and annual appraisals. What the care home could do better: One requirement is made following this inspection. The registered person must ensure that all pre-employment checks are completed prior to staff commencing work at the home. At a minimum this must include two written references and a POVA first check that a persons name is not on the list of people who should not be working with vulnerable adults whilst waiting for the return of the full CRB. Key inspection report Care homes for older people Name: Address: Autumn House 21 - 27 Avenue Road Sandown Isle Of Wight PO36 8BN     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: Janet Ktomi     Date: 1 4 0 9 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 32 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 32 Information about the care home Name of care home: Address: Autumn House 21 - 27 Avenue Road Sandown Isle Of Wight PO36 8BN 01983402125 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: office@autumnhousecare.demon.co.uk Mrs Janet Holmes care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 44. The registered person may provide the following category/ies of service only: Care home only - (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 (OP) Dementia (DE) Physical disability (PD). Date of last inspection Brief description of the care home Autumn House is a large period property situated in a busy part of Sandown. The property has been extended in recent years and provides accommodation on the ground and first floors for up to 44 older people and is registered to provide care for up to 44 older people with dementia. The first floor can be accessed via a passenger lift and the addition of ramps, during the extension, has improved access for those residents who are not fully mobile. There is limited parking in the street and staff park Care Homes for Older People Page 4 of 32 Over 65 0 44 0 44 0 44 2 3 0 9 2 0 0 8 Brief description of the care home in the courtyard area of the building, which restricts off road parking for visitors. There is a small area of garden to the rear of the property, with a terraced seating area. The home can provide daycare and short stay/respite accommodation. The home is owned by registered provider Mrs Janet Holmes and managed by registered manager Mrs Janice Ioannou. Care Homes for Older People Page 5 of 32 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 home was previously inspected on the 23rd October 2008. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 14th September 2009. All core standards and a number of additional standards were assessed. Compliance with the three requirements made following the previous inspection in September 2008 was also assessed. The visit to the home was undertaken by one inspector and lasted approximately seven hours commencing at 9.45 am and being completed at 4.30 pm. The inspector was able to spend time with the registered manager, provider and staff on duty. The inspector was provided with free access to all areas of the home, documentation requested and people who live at the home. Care Homes for Older People Page 6 of 32 Prior to the inspection visit the registered provider completed the homes Annual Quality Assurance Assessment (AQAA) and information from this is included in this report. Information was also gained from the homes service file containing notifications of incidents in the home. Surveys were sent to the home for distribution prior to the inspection visit. Nine were received from people who live at the home, ten from people who work at the home and eight from external health and social care professionals. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The home has continued to maintain and improve the homes environment with various communal rooms and bedrooms redecorated and new carpets or flooring provided. The registered manager now has an administrator to assist her in aspects of the homes administration giving her more time to focus on care issues. Three requirements were made following the previous inspection. These have all been complied with. The home has reoganised the way that medication is managed in the home and this is now being administered as prescribed by health professionals with full records Care Homes for Older People Page 8 of 32 maintained. Staff have all had medication training provided by the new pharmacist who supplies medication to the home. The home is now following the correct reporting procedures for safeguarding and continues to work with external professionals to ensure that people are safe and do not present a risk to themselves or others. The home is now sending relevant notifications to the commission of incidents in the home which may have had an adverse effect on people who live at the home. The registered manager has also implemented a supervision system that provides staff with bi-monthly supervision and annual appraisals. 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 32 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 32 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. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable as the home does not provide intermediate care. Evidence: The registered manager explained the homes admission procedure and the preadmission assessments for two people admitted shortly before the inspection visit were viewed. The inspector discussed admissions with care staff and information in surveys received is also considered. Due to age related memory loss it was not possible to discuss the admission process with the people who live at the home. The registered manager stated that if an initial inquiry from either social services or from a persons family indicates that the home would be able to meet the persons Care Homes for Older People Page 11 of 32 Evidence: needs the registered manager will arrange to visit the person, either at their home or in hospital. A comprehensive pre-admission assessment is completed including where possible members of the persons family and professionals involved in their care. Care manager assessments and hospital discharge information was also seen in care plans viewed. The person is provided with information about the home and where practicable is invited to visit the home before making a decision as to whether to move in on an initial trial basis. When the person is unable to visit the home a relative is invited to view the available room and facilities at the home. The home has an assessment tool that covers all the relevant areas necessary for the home to decide if it is able to meet a prospective persons needs. The registered manager stated that she will also visit and if necessary reassess people who have been admitted to hospital before they are discharged back to the home to ensure that their needs can continue to be met. The registered manager showed the inspector the information provided to service users or their families prior to admission. This contained information about the home including the service users guide and other information that may be helpful to prospective residents. Surveys were received from nine people who live at the home, eight stated had received enough information before admission and one stated unable to remember as had been an emergency admission. Discussions with care staff confirmed that they felt that they had enough information about new people admitted to the home and that they had the necessary training to meet peoples needs. Three care managers completed surveys and all stated that assessment arrangements ensure that accurate information is gathered and the right service is planned for people. The home provides all people with a copy of the terms and conditions of residency. This was viewed and although one aspect required updating this provided relevant essential information in a straightforward format. People living at Autumn House tend to be long term, however the home has one bedroom that is contracted to the local social services to provide respite/short stays. The registered manager stated that the same admission procedures would be used for respite or short stay admissions as for long-term admissions. The home would also Care Homes for Older People Page 12 of 32 Evidence: consider respite/short stay accommodation for private people if a suitable room were available and the same pre-admission procedures would be followed. The home does not provide dedicated accommodation for intermediate care or specialist facilities for rehabilitation. Care Homes for Older People Page 13 of 32 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. Peoples health, personal and social care needs are set out in an individual plan of care that states how individual needs should be met. Medication is correctly stored administered safely and full records are maintained. People are treated with respect and their dignity preserved. Evidence: Four care plans were viewed, two for people admitted to the home shortly before the inspection visit and the others for people who have been living at the home for a longer time. The inspector discussed with staff, visitors and people who live at the home how care needs are met. Surveys completed by health and social care professionals, service users and staff are considered. Manual handling practices in communal areas were observed during the inspection visit. The home has a computerised care planning system with information also printed out and held in service user files. A selection of these were viewed. People have a detailed plan of care that related to the persons assessment. The care plans are individualised and person centered being written in plain language providing sufficient information as Care Homes for Older People Page 14 of 32 Evidence: to how needs should be met. Plans are reviewed on an as needed or monthly basis with reminders provided by the computer when reviews are due. Photographs were seen in care plans. Care plans contained relevant risk assessments and management plans including nutrition, falls and any individual risks such as those resulting from memory loss. The home monitors peoples weight on a monthly basis with records seen. The home has equipment suitable to weigh all service users. Care staff spoken with said that communication about peoples needs was good. Care staff also stated that they felt they had sufficient time and training to ensure they were able to meet peoples personal and health needs. Eight health or social care professionals completed surveys. Four stated always, three usually and one sometimes that peoples social and health care needs were properly monitored, reviewed and met by the home. The same responses were received to the question asking if the care service sought advice and acted upon it to meet peoples social and health care needs and improve their well being. Care plans viewed contained individual manual handling assessments. Manual handling equipment was viewed in the home and care staff stated that they had received manual handling training and this was recorded on the homes training matrix. During the inspection visit staff were observed using manual handling equipment (belt and turntable) in communal areas. The procedures observed were appropriate and full explanations were given to service users throughout the procedure. Social and health professionals stated in comment cards that they felt that staff treated people who live at the home with dignity and respect. Although it was not possible to have an in depth conversation with the people who live at the home, those able responded that the staff were nice and observations of staff interactions indicated that people are treated with respect and their right to dignity maintained. Privacy and dignity are included in the homes induction training. With the exception of one room that may be used as a twin room if specifically required all bedrooms are for single occupation providing privacy for personal care. All bedroom doors are lockable with an individual electronic key fob opening system that has eliminated problems of people entering other peoples bedrooms. Care staff confirmed that they had sufficient time to meet peoples needs and discussions indicated that they had a good understanding of individual peoples needs and how these should be met. Care staff have received training to meet the specific Care Homes for Older People Page 15 of 32 Evidence: needs of people. Following the previous inspection in September 2008 a requirement was made that the registered person must ensure that all medication is administered as prescribed and that medication administration record sheets must be fully completed with no gaps. The registered manager explained the procedures the home has taken to ensure that medication is now administered correctly. The home has changed the pharmacy that supplies its medication and now has two medication trolleys divided between the people who live at the home. Medication is now dispensed into blister packs that only hold one tablet each (previously all tablets to be administered at a specific time were in one blister). One of the homes two deputy managers is responsible for medication and they and the registered manager undertake a weekly check on the medication administration records to ensure no gaps are left. The registered manager showed the inspector the trolleys and the medication administration records. These indicated that medication is stored and administered correctly. The home has the necessary storage facilities for medication that must be kept at cooler temperatures and for controlled medications. Medication administration records had been fully completed with no gaps. Care plans contained information as to when individual as required medication should be administered with a copy of this held with the medication administration records. No concerns in respect of medication were raised in by health or social care professionals in surveys they completed. At the time of the inspection visit nobody was self administering his or her medication. Care staff confirmed that they have undertaken medication training. The requirement in respect of the safe handling of medication has therefore been met. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit peoples individual needs. Family and friends are able to visit. People receive a balanced diet in pleasing surroundings at times convenient to them. Evidence: The inspector spent time talking with people in the homes lounges and observed part of the lunchtime and teatime meals and afternoon activity organised by staff. Information about social activities was viewed in care plans. Care staff and the cook also discussed activities and meals. Comment cards from service users, staff and external professionals are also considered as is the AQAA completed by the registered manager. The routines for daily living and activities made available are flexible and varied to suit peoples individual needs. People living in the home are able to spend their time in the home where they wish, people were seen sitting in all of the homes three lounges. People were also seen moving around the home as they wished. The home has a small pleasant courtyard style rear garden which has been provided with a solid shelter for people who smoke. The rear garden has level access. Care Homes for Older People Page 17 of 32 Evidence: Care plans contained individual information such as times people like to get up and go to bed. Most of the people living at Autumn House have age related memory loss and care plans contained life history information and recorded peoples likes and dislikes. People confirmed to the inspector that they are given choice over their meals and the inspector was shown the menu choice forms completed for the day of the unannounced visit. People were seen eating different meals. Bedrooms seen contained personal items brought into the home. Care plans and assessments include information about leisure activities, hobbies and interests, catering and religious needs. The inspector observed activities during the day of the unannounced inspection visit. The home has visiting entertainers and activity providers and organises monthly minibus outings and ad hoc walks to the nearby shops and seafront. Care staff confirmed that they had time for activities. A notice board outside the small dining room adjacent to the lift contained a rundown of forthcoming activities and events. The home organises themed days with a recent one to remember the start of world war two. Photographs of this and other themed days and activities were displayed on notice boards around the home. Service users also added comments about activities stating stating I like the singing and dancing the best and I like singing especially ABBA. The home has an alternative therapy suite and provides massage, aromatherapy and Reiki to service users at no additional charge. The home also has a fully equipped hair dressing room on the ground floor. External health and social care professionals added comments about what the home does well including good activities for people and involves them to the best of their abilities, the service goes a long way to promote activities in the home. They promote social inclusion but give the person the right of choice. Care staff also commented on the activities in their comment cards stating there is an extensive activities program provided for the benefit of the residents, including themed days with meals to correspond. Information about religious needs is included in care plans and the registered manager stated that she has contact details and would arrange visits from appropriate ministers and clergy if this were requested or identified as a need. The home does not have a private room for visitors however the home does have a dining room that is not used outside of meal times which could offer a degree of Care Homes for Older People Page 18 of 32 Evidence: privacy for visitors. Peoples choice about receiving visitors is respected and one care plan contained a note that the service user had requested not to receive visits from a particular relative. People were observed visiting during the inspection and the visitors book evidenced that people are able to visit at any reasonable time. The home has two separate dining rooms. Most people were seen to have chosen to have their lunchtime meal at the dining tables. People living at the home able to respond informed the inspector that they had enjoyed their lunch. The inspector was present for the main lunchtime meal and lighter teatime meal. People were seen to be eating the meal and most of the plates emptied. Care staff were seen assisting one person in a non obtrusive manner. Equipment to promote independence such as lipped plates and adapted cutlery was available. Drinks and snacks are also available throughout the day with people confirming this as well as the inspector observing people being given morning and afternoon hot drinks, fresh fruit and biscuits. The need for special diets or supplements as well as peoples likes and dislikes is recorded pre-admission. Discussions with the cook and food supplies seen indicated that where possible fresh vegetables are used and fruit is available. The cook was aware of the dietary needs of people. At the previous inspection it was identified that when meals are liquidized all parts of the meal (meat, potatoes and vegetables) were liquidized together. The cook stated that this practice has now discontinued and when meals are required in an altered format, the various parts of the meal are liquidized individually and identifiable on the plate. Care staff stated that people are provided with a supper at about 7pm and those who are still up in the lounge are provided with a hot drink and biscuit at 9pm. Service user comment cards contained additional positive comments about the food provided at the home. Added comments included the food is good, good food, food is well presented. Care Homes for Older People Page 19 of 32 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 and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. Evidence: The home has a clear complaints policy and procedure and a copy is in the service users guide and further information on display in the homes entrance hallway. Discussions with staff confirmed they were aware of what to do if a person or their relative complained or raised an issue. The manager identified in the homes AQAA that the home had received no complaints in the past year. This was confirmed during the inspection visit to the home. All nine service users who completed comment cards stated that they knew how to make a complaint and who to talk to if they were unhappy. External health and social care professionals stated in comment cards that the home had responded appropriately if they had raised concerns about the service. The registered manager stated that should a complaint be received she would follow the complaints policy and procedure and that the provider would be kept informed. The home has a policy and procedure relating to safeguarding adults and ensuring that people are not at risk of abuse. Care staff have safeguarding adults training as part of their induction. Discussions with care staff indicated they had an understanding of safeguarding and what they should do if they suspected abuse may have occurred. Care Homes for Older People Page 20 of 32 Evidence: Following the previous key inspection in September 2008 the home was required to ensure that safeguarding procedures are followed in all instances. The home has informed the commission and local safeguarding team of incidents that have occurred (generally between people who live at the home) where people have been placed at risk of abuse. Discussions with the registered manager and social services professionals since the previous inspection have identified that the home has reported incidents and that the home has taken appropriate action to protect people including seeking and taking the advice of external professionals. The requirement in respect of ensuring correct reporting procedures for safeguarding has therefore been met. The homes policies and procedures in respect of peoples personal finances should ensure that people are not at risk of abuse. The homes recruitment procedures are discussed within the staffing section of this report, however a person commenced working at the home before all the necessary pre-employment checks had been completed which may have placed people at risk. Care Homes for Older People Page 21 of 32 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 clean, safe, well maintained home that meets their individual and collective needs. Evidence: The inspector viewed the home with the registered manager and viewed records related to services such as gas and electric and fire safety equipment. The inspector also discussed the homes environment with care staff. Service user comment cards and the AQAA completed by the registered manager are also considered. The home is four older houses that have been linked and extended to provide the current home. All bedrooms are for single use although one could be used as a twin room if specifically requested. Most bedrooms have en suite facilities others are equipped with a wash basin. Bedrooms seen are well maintained and the home has a program of redecoration and replacement of carpets and soft furnishings. Over the past year most communal areas have been redecorated with new wood flooring in dining rooms and new carpets in various communal rooms and some bedrooms. Bedrooms had personal items belonging to the person whose room it is. The home has fitted electronic locks operated by key fobs to all bedroom doors which has eliminated problems of people entering another persons bedroom. Bedroom doors cannot be locked to prevent people exiting their bedrooms. The home has also eliminated the risks posed by the homes two flights of stairs by placing doors at the bottom and top Care Homes for Older People Page 22 of 32 Evidence: of stair cases which are operated by number codes. In the event of the fire alarms sounding all doors (including bedrooms and stairs) unlock automatically. The home has a shaft lift and all parts of the home are accessible to people with mobility needs. The home has the necessary moving and handling equipment and baths are fitted with hoists. The home has three lounges and two dining rooms. People were observed moving freely about the home with corridors being fitted with grab rails to aid mobility. The home also has an alternative therapy suite and hairdressing room. The home was clean and tidy throughout and there were no unpleasant odors. At the time of the visit the home was comfortably warm throughout. No concerns about the homes environment were raised in any comment cards received from staff, service users or external health or social care professionals. People who live at the home confirmed that the home is always warm and clean. The home employs housekeeping staff. The laundry was visited and is appropriate and fit for purpose with machines capable of washing to disinfection standards. The home now employs a specific member of staff to undertake laundry. This ensures care staff can concentrate on care duties and the manager stated that there have been fewer problems with laundry. Members of staff spoken with confirmed that they had access to all the necessary equipment to prevent cross infection such as disposable gloves and aprons, supplies of which were seen during the visit to the home. Substances hazardous to health (COSHH) were stored securely. Certificates seen confirmed that the homes services such as gas and electricity have been checked and serviced as appropriate. Portable electrical appliances are regularly checked. The home has contracted with an external fire equipment service who undertake weekly checks of the homes fire detection equipment. The records for this were viewed and confirmed that the necessary checks are undertaken on all the homes fire equipment. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs appropriate numbers of care staff to ensure that the needs of people living at the home are met. Staff receive the necessary training. The home must ensure that all pre-employment checks are undertaken before staff commence working at the home so that people are not placed at risk. Evidence: All comments from people who live at the home, and in surveys received from health and social care professionals were positive about care staff. Care staff were positive about working at the home and additional comments in staff surveys received included all staff are cheerful and work well as a team, I love working here and we are a great team and Autumn House is lovely place to work and the atmosphere is always friendly and welcoming. Duty rotas were seen during the visit to the home. The home provides additional staff at busier times with one person commencing work at 6am and another remaining on duty until 11pm to support the two awake and one sleep-in night staff. The home also employs a cook, kitchen assistant, housekeepers, laundry, administration and maintenance staff. During the inspectors visit staff on duty corresponded to those on the duty rota. Care staff stated that they generally have sufficient time to meet peoples needs and throughout the inspection care staff appeared to have time to meet peoples needs. Care Homes for Older People Page 24 of 32 Evidence: The home has a very consistent staff team with only one new carer having been required since the previous inspection. With the exception of the new staff member staff spoken with had all been working at the home for at least a year and many for much longer. The registered manager described the homes recruitment procedures and the records relating to the one new member of care staff were viewed. The records seen evidenced that the staff member had commenced working in the home before any of the pre-employment checks had been received. The registered manager stated that verbal references had been sought prior to the position being offered and person commencing work however there was no record of this. The Protection of Vulnerable Adults (POVA) and Criminal records checks had not been received until the person had been working at the home for three weeks. The registered person stated that the staff member was never left alone and was always with a senior carer. The carer confirmed that she had completed the forms for the police record checks on the first day that she worked at the home. She also stated that she had worked with another carer until the checks had returned. The failure to ensure that preemployment checks have been satisfactorily returned before a new person commences work at the home places service users at risk. The home must ensure that all pre employment checks are completed before a person commences working in the home. The registered manager provided training and qualification information during the inspection and on the AQAA. The manager stated that all but the newest member of staff has an NVQ. This includes staff with a level 3 and two staff with a level 4 qualification. Staff on duty confirmed that they had care qualifications and the one who did not stated that once she had completed the common induction standards she was due to commence an NVQ. Care staff stated that they felt they had the necessary skills to meet peoples needs and were not expected to undertake activities for which they had not been trained. Care staff stated that they have lots of training. Additional comments on surveys included Autumn House is always good at providing training to enable staff to have a good understanding of our client group, and Autumn House has helped me to gain qualifications and further my career. The inspector viewed the training matrix which records training staff have undertaken and allows monitoring of when updates are due. The home has purchased a training system and supplements this with other courses when a need is identified. A staff member informed the inspector that she is to undertake the train the trainer for manual handling in October 2009. Discussions with care staff confirmed the information on the training matrix and that all mandatory training had occurred. The registered manager stated that care staff have been booked on one day dementia courses at the local college throughout autumn. Care Homes for Older People Page 25 of 32 Evidence: The district nurse provides additional training and is due to do falls refresher training for staff in September and October. An in house induction is used for all new staff and supports the more detailed skills for care induction workbooks they complete during their first six weeks of employment at the home. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is in the process of completing the Leadership and Management Award and has undertaken other relevant training. Peoples financial interests are safeguarded. Records are well maintained. The health, safety and welfare of people and staff are promoted, and the home is now notifying to the commission and social services of incidents. All requirements from the previous inspection have been met. Evidence: Mrs Janice Ioannou was registered by the commission as the homes registered manager in August 2008. The registered manager is aware of the need to achieve an NVQ level 4 in care and a management qualification. The registered manager stated that she has commenced the leadership and management award and anticipated completing this by December 2009. The manager stated that she has undertaken other relevant training including Mental Capacity Act, risk assessment and in relation to the new medication systems in use at the home. The manager is aware that she will need to gain an NVQ level 4 or similar qualification in care and stated she would look Care Homes for Older People Page 27 of 32 Evidence: at options in this respect once she has completed the management qualification. Care staff were clear that they felt able to discuss any issue/concerns with the manager or provider who is often at the home. Following the previous inspection three requirements were made and these have been complied with. One requirement is made following this inspection in connection with pre-employment checks on new staff. The registered manager has undertaken formal quality assurance work including questionnaires to people who live at the home. The homes administrator is now responsible for collating these and showed the inspector completed questionnaires, most were very positive. Key workers complete a monthly room check questionnaire with service users or their relatives which covers a range of quality assurance questions. Completed forms were seen in care plans viewed. Care workers stated that if issues arise during the monthly checks that they are unable to resolve these would be passed onto the registered manager for action. The homes registered provider completed the AQAA. The inspector discussed the AQAA with the registered manager and provider and identified areas where additional information should have been provided. The home does not become the appointee for, or involved in the personal finances of people who live at the home. Any additional expenses such as for hairdressing or chiropody are invoiced to the person responsible for paying the persons bill. The inspector was shown completed invoices and these clearly showed what extra services were being charged for. It was identified in the previous report that staff were not receiving regular supervision. The manager stated in the AQAA that staff are now receiving bi-monthly supervision and records to confirm this were viewed during the inspection visit. Staff stated on surveys and to the inspector that they receive regular supervision and that they are able to approach the manager at any time if they had need of support or advice. Various records identified in the relevant outcome group of this report were viewed during the inspectors visit. All records were appropriately stored with access only available to people who should have access. The home has taken steps to address safety issues such as having secure doors fitted to the staircases and the provision of mattress movement detectors. The home is well Care Homes for Older People Page 28 of 32 Evidence: maintained and clean, with staff having relevant training to meet peoples needs. The home ensures that there are weekly checks of the fire detection equipment. Portable Electrical Appliance Tests (PAT), electrical wiring and gas certificates were seen. The local environmental health department has awarded the home four stars (maximum being five stars) for food hygiene. Accident reports were seen in care plan files and the manager undertakes a monthly audit of the accidents in the home. Following the previous inspection the home was required to ensure that notifications are sent to the commission of incidents which may have an adverse effect on people living at the home. This requirement has been complied with and the home are sending notification when incidents occur. Information would indicate that the home aims to learn from any incidents and where possible prevent reoccurance. Care Homes for Older People Page 29 of 32 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 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person must ensure that all preemployment checks are completed before people commence working in the home. So that people are safe. 01/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 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. 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