Care Home: Autumn Lodge

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What the care home does well The home has an assessment process which enables the manager to decide whether the home can meet the needs of the individual. The ones we saw on this occasion were completed and were used to inform the care plan. The home has care plans which describe the needs of the individual and what they are able to do independently. The plans describe the support staff have to give. When we spoke with people using the service they told us they were happy with the activities that are available for them. They enjoy the newsletter about the home. Daily routines in the home were flexible and people who use the service being encouraged to make choices for themselves and exercise personal autonomy as far as was reasonably possible. A variety of social and leisure activities have been planned and residents have a choice of whether to participate in these or not. People who live at the home were generally positive about the food that the home provided and the condition of the accommodation that they occupied. The home is regularly maintained and is comfortable with pleasant furnishing. Staff have undertaken training in mandatory areas and other areas for example caring for people with confusion and management of medication. We saw that new staff had been recruited and that the home had carried out checks to protect people who use the service. New staff have begun induction training in working at the home. Staff have received updated training in many areas such as moving and handling. People who use the service are consulted about the home and what they would like whilst they live there. What has improved since the last inspection? This is the first inspection for this service under new ownership. There are no outstanding issues from previous visits. What the care home could do better: Requirements have been made for the home with regard to the management, administration and recording of medication. Key inspection report Care homes for older people Name: Address: Autumn Lodge 172 Aldwick Road Bognor Regis W Sussex PO21 2YQ     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: Val Sevier     Date: 0 1 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Autumn Lodge 172 Aldwick Road Bognor Regis W Sussex PO21 2YQ 01243868242 01243867882 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Autumn Lodge Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 19. 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) Date of last inspection Brief description of the care home Autumn Lodge is a care home for older people in Bognor Regis very near the sea front and local shops. The accommodation is situated over two floors with stair and lift access. There 18 rooms some with ensuite facilities. The home is undergoing refurbishment by the new owners who have owned the home since July 2009. The responsible individual is Ms Sandra Daniells and the registered manager is Ms Penny 0 Over 65 19 Care Homes for Older People Page 4 of 29 Brief description of the care home Taylor. The current fees for the service and accommodation can be requested from the manager. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service 2 star. This means the people that use this service experience good quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 1st March 2010 between the hours of 10:15 and 3:30pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home, this is the first visit since the home was registered in July 2010 with new owners. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, Care Homes for Older People Page 6 of 29 any barriers to improvement to meeting the standards and how they feel the service is meeting the needs of people who live at the home. We met with the registered manager, responsible individual, a director of the home, two staff and there were four people who use the service involved in the inspection visit. We looked at three pre admission assessments, four care plans, medication records, staff files and training records and fire prevention testing and training records. We sent out ten surveys to people who use the service, ten staff and five professionals at the time of writing the report we have had ten surveys returned from people who use the service, eight staff surveys and two professionals. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 8 of 29 order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. Evidence: The AQAA for the home said:Each service user has an individualised pre admission assessment to ascertain whether the home can meet their needs. If not, an explanation will be given. Statement of purpose and service users guide which has recently been rewritten. Each service user is invited to visit the home and stay for a meal or weekend to help them make a decision, or if they are unable to visit the home a staff member usually the manager; will visit them within their own home or hospital. We welcome enquiries from any groups in society and pre assessment will determine whether we are able to meet their needs. Each service user is given a written contract setting out their rights and responsibilities. We give advanced notice of any changes regarding payment. Care Homes for Older People Page 11 of 29 Evidence: There have been several new admissions to the home since it was registered with new owners in July 2010. The home is moving to a computerised care plan and assessment system. The manager currently prints out an assessment and following the visit inputs the information onto the system. We were able to see where this had been carried out and see the paper copy completed at the time of the assessment. We saw that there was information on individual needs based on their present and past medical history for example, history of falls. The assessment offered choices and space for individual issues. For example needs assistance to get out of the chair with one person, needs encouragement as confidence lost due to falls. There were risk assessments, information on mood, sleep patterns, pain and physical health, current care providers and equipment that may be needed. In our surveys we ask what the service does well, a district nurse commented in this section that the home carries out assessment of patients prior to discharge. All surveys returned from people that use the service or their representative indicated that they had received enough information to help them decide that Autumn Lodge was the right home for them. They acknowledged that someone from the home had come to see their relative and they had been able to visit the home. One comment we received in a survey said the staff at the home have played a vital role in enabling my mother to make a successful transition from his home to living at Autumn Lodge. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans detail the needs of the individual and support staff are to give. The medication records and administration within the home are not consistently carried out in a safe manner to protect the people who use the service. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that:Each service user is supported to make their own decisions by having an individual care plan, which is evaluated every month and all staff are encouraged to use. These are now on a computer system and the staff receive training to use this. The care plans are person centred and printed off and signed by the resident and or their families. With the service users permission, we work with service user, family and carers in partnership in order to provide the best support for that individual. We train our care workers in giving choice to service users and encourage them to be self determining. The home operates a policy of knocking before entering a service users room to ensure privacy and respect. We encourage service users to discuss their end of life care if appropriate and involve relatives and Care Homes for Older People Page 13 of 29 Evidence: GP, district nurses. We support service users to manage their own health care, and we aim to identify any health problems so that they can be dealt with from a early stage. We have thorough care plans and risk assessments in place to identify those at risk of pressure area damage using Walsall community pressure ulcer risk calculator, manual handling risk assessments, risk of falls, and risks of malnutrition. Other individual risk assessments are carried out. Assessments are followed through with a plan of care, and outcomes regularly monitored and reviewed. Service users register with a GP of their own choice. A chiropodist is available every 6 weeks to the home. We employ a hairdresser. The home has a policy for the receipt, storage and handling, administration and disposal of medication and I ensure this is adhered to along with senior members of staff. The home is in regular contact with the local pharmacy who oversee the medication and ensure it is inspected and audited regularly. Call bell system to all areas of home which also records times of calls made for monitoring purposes Service users privacy and dignity is respected at all times. All service users are made aware of the complaints procedure. All staff follow induction and mandatory training. The home is currently moving to computerised care plans, we saw that when this is completed a copy is printed off and discussed with the person who is using the service and they sign it to say they understand and agree with it. Care staff can access the care plans via the computer in the office upstairs or on a lap top in the conservatory. Staff have their own individual log on and they record daily occurrences as needed on the lap top or computer. We looked at four care plans and saw plans to address individuals needs such as washing and dressing, bathing, stoma and catheter care. We saw that information was available for staff on how they would support individuals with their needs, individual strengths and abilities and what staff needed to do to support them. We saw risk assessments had been put in place with information on how staff could lessen those risks for example manual handling and falls. There were nutritional assessments being carried out by hand as the computer system doesnt calculate information unless it has three months worth of weight records for example. The manager said they will be completed by hand until the amount has been gathered for the computer system to use. We saw that the district nursing team was supporting the home with care of a catheter for example. We spoke with four individuals who use the service all are happy with the care and Care Homes for Older People Page 14 of 29 Evidence: support they receive. One has requested to remain at the home to end their days as they have a terminal illness. We saw that support has been arranged and the home is working with the individual concerned, their family the local hospice and oncology doctor to ensure their needs are met. The manager and deputy manager have recently completed a palliative care course. We looked at the medication storage and administration records. The medication trolley is attached to the wall by a chain in a downstairs corridor by the laundry. A small cupboard next to it contains stock medication. The home currently does not have anything stored as a controlled medication. This may change as we saw that one individual has been prescribed Buprenorphine patches as pain relief. The director told us that a controlled drugs storage cupboard had been delivered. The manager was advised to look at The Royal Pharmaceutical Guidelines regarding the fitting of this cabinet. The home had been visited the week before our visit by two pharmacists from the local chemist to carry out an audit. The home had not received the report at the time of our visit. We looked at the medication administration records (MAR) for 3rd February 2010 to the day of our visit. We saw that there were four gaps where medication was prescribed to be given and there was nothing to indicate if the medication had been offered, refused or destroyed. We saw that where there is a choice of dosage to be given for example one or two Paracetamol, there was not always a record of how many tablets had been given. Where a medication was as required there was no record of why it had been given and outcome for the individual. Where an individual is prescribed creams or lotions there was no record of whether this had been administered or not. The manager said that where an individual is prescribed a cream for example, there is a card in the individuals room for staff to sign to say they have administered it. There was no indication on the medication record sheets that this was the case. We saw that there were two examples of where staff had hand written medication for example Lactulose 10mls as required, there was no other information. We saw that two people had been given Lactulose on several occasions and one individual had been given Paracetamol, the individuals had not been prescribed these medications. The staff had recorded what they had given and when on the MAR sheets. The home does not have an approved list of homely remedies and guidelines. This was discussed with the manager. All surveys returned by staff indicated that they are given up to date information about the support they are to give people that live at the home. Surveys for people who use the service have been completed by their relative or advocate. One respondent said that that their friend is usually dressed well with make up and jewellery and that they seem happy. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home said that:We have an activities coordinator, organising activities on a daily basis, she also provides activities on a one to one basis, as well as in groups. Residents are given the opportunity to go out on organised outings, particularly in small groups as our activities coordinator is able to use the local Sammy bus which has been very successful. We have strong links with the community so that service users can access local activities and the community can be involved in the homes activities. We recently had a coffee morning and invited our local MP and Mayor. We have meetings with service users and their families and take all suggestions and where possible put these into practice We are able to make the routines of daily living as flexible as possible. This is also due to the fact that we are a smaller home and are able to be flexible over meal times etc We respect service users privacy and staff receive the necessary training in this Service users have their own private phones if requested We encourage service users to bring their own personal Care Homes for Older People Page 16 of 29 Evidence: items of furniture, and make every effort to accommodate these As well as offering three balanced meals a day, service users are able to request snack and drinks as often as they like, even throughout the night. We spoke with the cook who said that the home has a three week menu. She asks people what they would like each day and if they do not want what is on the menu then they can have whatever they would like. There was stew available on the day of our visit and milk pudding and she said two people had requested Veggie burgers which she cooked for them. People we spoke with said they enjoyed the food, although sometime there is too much for them and they have to remind staff what they like and how much. One of the people using the service told us that they liked the weekly cooked breakfast. We spoke with the activities coordinator who has been employed since the new owners took over the home. They work fourteen hours per week, there is a weekly Monday to Friday programme of activities. People we spoke with showed us the weekly programme that is given to them so they can choose what they would like to participate in, one person had highlighted their favourite events. There are also activities provided when the activities person is not at work by outside people for example chair music and movement, reminiscence, quizzes and crafts. The activity person said they offer group and one to one options and they are able to drive the community bus and take people out. One individual likes to read and the library regularly brings books to the home. One individual still uses their mobility scooter to go to the shops and brings back food items they would like to be cooked for their tea for example. Another person regularly goes out on their own to local facilities. The activities coordinator has started a quarterly newsletter about the home and the second was in progress. They said they try and involve people living in the home to make a contribution to the newsletter. people we spoke with siad they liked the newsletter. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process and the staff knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said:The home has a clear and accessible complaints procedure illustrating timescales and how the complaint is dealt with. All service users are informed of complaints procedure and would be fully supported by staff in making their complaint. We will keep a copy of any complaints made and what action was taken. The home operates a restraint policy of which all staff read and sign. Each service user is encourage to be self determining. We can provide service users with advocacy service information All staff are trained in protection of vulnerable adults and work to these regulations. Procedures are in place to respond to evidence of suspicion of neglect. We assist service users to vote if they choose to, many use the postal voting system, but we are able to assist by transporting them to a polling station. Call bell system to all areas of home which also records times of calls made for monitoring purposes. The home has a complaints procedure, people we spoke with said they knew how to complain and people who returned surveys said they were aware of the complaints procedure. The home uses the West Sussex safe guarding adults policy. We saw that the Care Homes for Older People Page 18 of 29 Evidence: manager had purchased information relating to the Mental capacity Act and guidance on Deprivation of Liberty. The AQAA said in plans for next twelve months: for staff to receive appropriate training. From the training matrix we saw that staff received safeguarding training in February and August 2009. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a pleasant and homely environment to live in which also has had adaptations to meet individual needs. Evidence: The AQAA for the home said:We have an external maintenance team who help to ensure Autumn Lodge is well maintained. As rooms become available, they are decorated, and re carpeted as necessary. A walk in shower has been installed in one bedroom at the relatives request and has proved very useful. Items of furniture may be replaced or repaired if damaged. We are undergoing total refurbishment of the home in all areas. We have brand new laundry facilities, now in the building, which is a huge improvement. We have completely redecorated, furnished and re carpeted our lounge dining room and conservatory. We have completely redecorated and refurbished, bedrooms six rooms. We will continue to work through the home decorating and refurbishing all areas. We offer service users a homely place in which to live with a family feel. The care home is maintained appropriately to reduce the risk of infection. The home provides infection control training to staff so that they are aware of the importance of prevention. A programme of routine maintenance works is kept within the home The home complies with the requirements from the local fire service. Communal space is available for all service users to access. We have a secluded back garden for service users to enjoy and a sunken garden to the front of the property with seating. Toilet and bathing facilities are available to meet the needs Care Homes for Older People Page 20 of 29 Evidence: of the service users. Grab rails are available as necessary We have a call bell system which monitors the number of bells and the times staff take to answer them. Autumn Lodge provides private accommodation for all service users and it is furnished to a comfortable standard. We looked around some of the home and we were able to see communal areas such as the dining room, lounge, conservatory, bedrooms and bathrooms. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures. The home has fish and a budgie. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home.. Individuals commented to us that they were happy with their accommodation those that had them liked having en suite facilities. They described small pieces of furniture that they had been able to bring. They liked the lounges where they could sit with others and chat, watch television, read or listen to music or just be quiet. Laundry facilities have just been refurbished, has new machines and is sited away from areas where food is prepared and stored. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current recruitment practices at the home do not always protect the people who use the service. It is unclear if staff have received all the mandatory training that is expected each year, although they have had training to help them meet specific individual needs. Evidence: The AQAA for the home said:As an organisation we recruit in a fair and open way ensuring we employ the right people for the job. We carry out employment checks on possible employees, including CRB, references and employment history We have at least 60 percent of our care staff trained to NVQ level 2 or above. The home displays a duty rota which clearly shows what staff are on duty at specific times. All staff receive induction training and regular updates. We ensure that all staff operate in a manner which promotes liberty, we enable service users to feel safe and secure whilst promoting their independence. The staffing structure at the home consists of the responsible individual, registered manager care staff, kitchen staff, and housekeeping. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. We looked at four staff files for people that have been employed since July 2009. For Care Homes for Older People Page 22 of 29 Evidence: three of them we saw that there were two references, there was evidence that a CRB had been carried out and they were dated before the employee commenced work at the home. We saw that the individuals had commenced and in some cases completed an induction process. The manager said they had received notification regarding the POVA check although this was not available. For the fourth person there was only one reference. The manager said that she had received a verbal reference however there was no record of this. Since the inspection visit we have been sent a copy of a reference that the home has received regarding this individual. One staff member did not have a CRB current to Autumn Lodge. The manager explained that as the person had received a CRB the same month as applying to and being accepted at Autumn Lodge they did not think one was necessary. The CRB the person had was related to their work with MIND. All staff information is kept at the home in locked drawer in the managers office. We saw a notice in the managers office about a talk on Strokes being offered 9th March 20101. The manager said that staff had undertaken dementia training with Northbrook college. The manager added information about first aid which staff had undertaken on 15th February 2010 whilst we were at the home, and she gave us a copy of that training information. Since the visit we have received an up to date record of the training received by staff at Autumn Lodge. We can see that since the beginning of 2009 to date staff have received training in manual handling, infection control, first aid, medicines, dementia nd food hygiene. The new staff undertake induction training which includes an introduction to the home for example fire procedures. The individual works through a pack on areas such as the home, safeguarding and their own personal development. We saw that the individual meets with the manager as needed before being signed off as completing the induction. Four surveys returned by staff state that there are usually enough staff on to meet individual needs and four surveys indicated that there were always enough staff. Seven surveys from people that use the service indicated that they receive the care they need and staff are always available when they need them, three surveys indicated that they usually receive the support they need and that staff are usually available when they need them. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures used to monitor and maintain the quality of the service provided for example mediaction records, staffrecruitment and fire safety do not always promote the safety and welfare of those living and working in the home. Evidence: The AQAA for the home said:All staff receive induction training and have yearly appraisals. The manager of the home has 25 years experience and holds the Registered Managers Award. The home has a clear and accountable management structure. We have updated policies and procedures. We analyse the quality of our service and document this. Satisfaction questionnaires are given to service users, relatives friends GPS etc. Service users are able to view their record. The manager has been at the home for some time and is due to leave at the end of March 2010 and a new manager has been appointed to start work mid March so that there will be a two week handover period. Care Homes for Older People Page 24 of 29 Evidence: We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. We saw that the manager has undertaken staff and resident meetings and resident and relatives meetings. The residents commented on food, staff, activities and the homes environment. The manager told us that the home does not manage or look after any personal money. The manager informed the commission in the AQAA that the servicing of all utilities and equipment used in the home has taken place. We looked at the records for fire safety training and monitoring of equipment we saw records that indicated that fire safety equipment and emergency lighting has been tested regularly up until 21st January 2010. The manager said that she had tested the system and equipment weekly and monthly up until that date. The director spoke with the maintenance person who is responsible for the test and they said that they had carried the tests out and recorded that they had done so. Following the visit we received copies of the records of the testing of the fire equipment and we could see that these had taken place up until the date of our inspection visit. We have also bveen sent copies of the fire training records since the inspection visit and these indicated that staf have had fire safety training. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 13 (2) The registered person must ensure that a record is kept of when and why a prescribed medication is not given. This will ensure that the individual receives the correct medication and helps to monitor their health. 01/05/2010 2 9 13 13 (2) 01/05/2010 The registered person must ensure that lotions and creams are administered at the times and in the amount that it has been prescribed, and that a record is kept. This will ensure that the individual receives the correct medication and helps to monitor their health. 3 9 13 13 (2) The registered person must ensure that a record is kept of the amount of medication 01/05/2010 Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action that is given where there is a variable dosage and why and when an as required medication is given and its effect. This will ensure that the individual receives the correct medication and helps to monitor their health. 4 9 13 13 (2) 01/05/2010 The registered person must ensure that medication is not given unless it is prescribed or is on the list of homely remedies which the GP has agreed. A record must be kept of the reasons a homely remedy is given and the outcome for the individual. This will ensure that the individual receives the correct medication and helps to monitor their health. 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 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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