Care Home: Avenue Care (Fareham) Limited

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What the care home does well The home provides a homely and welcoming environment and all of the service users spoken to told us that the homes` staff provide an excellent service. Comments received include: `They create a homely and comfortable environment and treat residents and relatives with respect`. `I am happy with the care provided by the Avenue`. `The staff are so friendly and there is always a warm welcome to the home`. `All the staff demonstrate a caring attitude to all the residents`. `I would recommend the home to anyone looking for a safe, well run and friendly home`. `They cater for individual needs and the home is so homely`. `The staff look after us well and see that we are clean and happy`. `There is nothing I can think of to make it better`. Records show that the home liaises with health care professionals regarding residents` medical and health needs. Residents and their relatives are provided with a copy of the complaints procedure and are aware of what to do if they have a complaint or any issues. The home`s routines were flexible and it promotes the right of residents to make choices for themselves and exercise personal autonomy as far as was reasonably possible. Residents were positive about the food which the home provides. Staff were recruited properly ensuring that residents` safety and welfare was given proper consideration. The service has a commitment to staff training and development to ensure that staff are able to fulfil their roles and responsibilities and meet residents` needs. There is a stable staff team who were observed to be interacting well with the service users and were noted to be good humoured and sensitive to the needs of those people who were confused. The home is a pleasant environment and service users are able to choose the colours and fixtures and fittings for their bedrooms. The home is well maintained and kept to a high standard of cleanliness. What has improved since the last inspection? The manager has replaced the washing machines with commercial machines which has negated the need for the general laundry to be contracted out. The menus have been updated and have been influenced by what the service users` surveys and what the service users say they like to eat. Staffing levels have increased for both care and housekeeping staff. Staff have a training programme provided by an outside training company and various training is made available to staff. What the care home could do better: The care plans must be person centred and reflect the individual care needs of the service user, as identified through risk assessments. Care plans must describe how the service user wish their needs to be met. A requirement has been made that `as needed` (PRN) protocols must be in place so that such medication is administered consistently in accordance with the written guidelines. A requirement has been made that all cleaning materials should be stored safely when not in use and should not be left unattended, putting service users at risk. If possible, a more detailed social history about the service user should be recorded to enable activities to be planned in relation to service users` past recreational hobbies and preferences. Records should be maintained by the person co-ordinating the daily activities of all activities and outings that take place. The record should also state who has participated and the level of their participation to evidence that service user are being offered stimulation and an opportunity to go out into the community if they so choose. The mangement hopes to provide a more extended activities programme in the coming year. It is recommended that personal toiletries be stored in the service users` room and not in bathrooms so as to avoid them being used communally, which may put people at risk of cross infection. Key inspection report Care homes for older people Name: Address: Avenue Care (Fareham) Limited 36 The Avenue Fareham Hampshire PO14 1NY     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: Janette Everitt     Date: 1 2 0 1 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 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: Avenue Care (Fareham) Limited 36 The Avenue Fareham Hampshire PO14 1NY 0000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Avenue Care (Fareham) Limited care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 24 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission ot the home are within the following category: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Avenue Rest Home provides residential care for up to 24 older persons, including some with dementia and mental disorder. The home is near to the town of Fareham, with a bus stop outside. The building is a detached property with car parking to the front and garden to the rear. There are two stairlifts and a passenger lift. Maintenance and decoration of the home is of a high standard. There are three lounges plus a Care Homes for Older People Page 4 of 32 24 24 0 Over 65 0 0 24 Brief description of the care home conservatory, which opens onto the rear garden. home manager. For information on fees contact the 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 site inspection visit to Avenue Care (Fareham) Limited which was unannounced, took place on the 12th January 2010. The registered manager Mr Press assisted us throughout the visit. For the purpose of this report the person undertaking the inspection visit and being a representative of the Care Quality Commission (CQC), will be referred to as we throughout the report. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The manager had returned the Annual Quality Assurance Assessment (AQAA) to the CQC. The content provided evidence of how well the service is performing and achieving outcomes for the people using your service and stated improvements for the coming year the home wish to achieve. Care Homes for Older People Page 6 of 32 The focus of this visit to the home was to support the information stated in the AQAA and other information received by the CQC since the last fieldwork visit, which was 7th March 2008. The process for this visit included a tour of the premises, discussion with the manager, staff on duty and most of the residents were also spoken to during the visit. CQC survey forms were distributed for comments prior to the visit. Nine service users, two staff and four relatives surveys were returned to CQC. The comments made were very positive and indicated they were generally pleased with the service. Other surveys distributed to visiting health professionals were not received by CQC. Staff were observed interacting with the residents well. Polices and procedures were examined. Records, including residents care plans were also looked at as part of the inspection process. The home is registered to provide support for 24 service users and at the time of this visit there were 20 service users living at the home. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The manager has replaced the washing machines with commercial machines which has negated the need for the general laundry to be contracted out. The menus have been updated and have been influenced by what the service users surveys and what the service users say they like to eat. Staffing levels have increased for both care and housekeeping staff. Staff have a training programme provided by an outside training company and various Care Homes for Older People Page 8 of 32 training is made available to staff. 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. People have accurate assessments of their needs and are confident the home can support them. Evidence: A copy of the Statement of Purpose and Service User Guide is given to all prospective service users that provides information about the home and would help inform their decision about moving into the home. Prospective service users and relativies are encouraged to visit the home, stay for a period of time, before they make a decision about moving into the home. All prospective service users are assessed by the manager before a decision is made about them moving into the home. The pre-admission assessments are undertaken either in a clinical setting, where information about the person can be gained from nursing notes, or in the persons own home. If a propsective service user visits the Care Homes for Older People Page 11 of 32 Evidence: home, an assessment can be undertaken at that time. If social services have made the referral to the home, they will send a care needs assessment to the home for information to support the pre-admission assessment. The sample of care needs assessments seen by us gave us a clear picture of the persons needs at the time of assessment and covered all aspects of their activities of daily living as well as their emotional and recreational needs. The manager told us he is training a senior care worker to accompany him on these assessment to enable the prospective service user to meet another member of staff at this time. Relatives are invited to be involved in the pre-admission assessment to enable the home to gain as much information about the person as possible. Six relatives and eight service users returned surveys to CQC and the response indicated that the service users and their relatives had received appropriate information about the home and were invited to visit the home before a decision was made about the person moving into the home. The AQAA states that the home strives to make the transition from home to care home as smooth as possible and will assist in the arrangements to transport items of furniture and personal belongings to the home and arrange their room as they choose. At the time of this visit the manager was arranging with the maintenance person to collect a persons bed from their home the day they moved in. The manager told us that rooms will be decorated and re-carpeted to the persons choice before they move into the home. The manager stated that he wishes to improve on the admission assessment and to gain more information about the persons hopes and expectations as well as gaining a more in-depth profile of their past social history. Care Homes for Older People Page 12 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. The home has a plan of care to meet each residents health, personal and social care needs, however there needs to be a more person centred approach to care planning and strategies documented to manage identified risk. Service users medication is managed by the home but there are areas of practice that need to be reviewed to ensure people received their medication safely as required. Peoples right to privacy is respected and support is given in a way that maintains dignity. Evidence: Comments on surveys returned to CQC from service users and relatives told us that there is a high level of satisfaction with the service. Comments made on surveys said: They treat residents and relatives with respect. The home provides for individual needs discreetly. The home maintains consistent records and medical notes which are communicated to relatives when needed. A very friendly home that caters for individual needs very well. The home demonstrates professional care, concern and Care Homes for Older People Page 13 of 32 Evidence: love as a family. Good staff and very friendly. The staff show a caring attitude to all residents and it is a safe, well run home. Service users are assessed when they are admitted to the home and care plans are formulated from the identified needs and problems. A sample of two service user care planning documentation was viewed. The care planning system records a good deal of information about the service user but information is fragmented and is not easily followed for audit purposes. Care plans did not consistently detail how a person wished their needs to be met. Risk assessments for one service user for tissue viability and nutrition had been undertaken and a level of risk identified. Care plans had not been written to detail how the risks were to be managed to ensure that the person received appropriate care and their identified healthcare needs were met. The service users are monitored regularly for weight, blood pressure and pulse and this is recorded separately in the care planning system. The daily records are detailed and much of what happens is documented on a day to day basis in the daily notes but not in a care plan and therefore care plans are not evaluated when there is a change in that persons condition. A service user had a fall and this was documented in the daily notes which said they were seen by a GP and treatment prescribed. There was no care plan documented about what effect the fall had on the person or how effective the prescribed treatment had been. A record of this accident could not be checked in the accident book as it was not available at this time. The manager told us that it was at his home as he was undertaking an audit of records. The accident book should not be removed from the registered premises so that it is available for use at all times. The care planning system should be reviewed to ensure that the records identify needs and problems, record an action or strategy to manage that need and be evaluated to record the outcome and how effective the planned actions have been. The care planning system was discussed with the manager. He stated in the AQAA that the home needs to continue to improve the care planning to reflect a more person centred approach to assessment and care and that the improvements needed in the coming year were to further enhance the care plans so that they are relevant and reflect the individuals care requirements. Care Homes for Older People Page 14 of 32 Evidence: As acknowledged by the manager the care planning system needs to be more person centred with more detail about how the service users needs are to be met in a way they wish them to be met, as currently the system does not inform effective and safe care delivery. The care plans are being reviewed monthly. The manager told us that all service users have had a mental capacity assessment undertaken. The service users religious preferences and food likes and dislikes are recorded on the assessment and their wishes in the event of death is also recorded. Service users health care needs are met. The home reports to have good relationships with the primary health team and the GP, community psychiatric nurse, dentist, optician and chiropodist visit the home when requested. The AQAA said that the district nurse will supply the home with equipment to promote good skin integrity and give advice. All records of visits from other professionals and actions prescribed from those visits is documented in the care plans and was seen by us. The home had a clear medication policy and procedure. All care staff have received training in administration and management of medication which is accredited training given by the supplying pharmacist. Staff told us that they have received medication training from the pharmacist. The home uses a monitored dosage system. We were advised by the manager that the home manages the residents medication but if service users choose to keep their own medication, this is acceptable within a risk management framework. All controlled medication was being stored and recorded appropriately. The medication of two residents was checked against the records and the medication held and found to be accurate. The medication administration records (MAR) were viewed. These were completed appropriately. For service users who had been prescribed medication on an as needed (PRN) basis, protocols had not been written so that such medication is administered consistently in accordance with the guidelines, especially for the service users unable to request medication. The manager told us that most service users are able to verbalise if they need PRN medication. It will be a requirement that such protocols be part of the care planning. We also identified on the MAR chart that a prescribed medication had been transcribed Care Homes for Older People Page 15 of 32 Evidence: by a staff member onto the MAR chart but this had not been signed and countersigned to evidence that this had been checked for correct transcription. For safe practice this will be recommended. The home does not have a specific fridge for medication as there is limited room in the office. Medication that is required to be stored below a certain temperature is stored in the domestic fridge in the kitchen in a locked container that only staff who have received medication training have access to. Fridge temperatures are monitored daily and recorded. The medication trolley and storage cupboards were viewed and were clean and tidy with no evidence of over stocking of medication. The medication that is no longer needed is returned to the supplying pharmacist who signs to say they have received this back. There was no record of the returns on the day of this visit. The manager told us that the returns book was with the pharmacist. There should be a record of all returned medication in the home. It was clear from observations on the day that staff have a respect for all residents privacy. Staff were observed to knock on a residents door and waited for a verbal response from the occupant before going in. All shared rooms had screens and all doors had appropriate locks. Comments on surveys said they always knock on my door. 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. Service users preferred routines for their daily activities of living are recorded in their care plans. Recreational activities are available but there is no system for recording peoples interests and participation in events and therefore the service cannot evaluate and ensure that people are enjoying the range of social opportunities they would like. Visitors are made welcome and people receive a choice of fresh, home cooked meals. Evidence: The AQAA told us that a range of activities take place in the home on a regular basis and that there is entertainment in the home by way of singing and music. Parties are held for special occasions like birthdays and at the festive times of the year. The home does record some social history about the persons past life on the initial assessment form but does not capture detailed information about the persons life and recreational past times. There was no evidence in documentation that activities are tailored around these. There is no formal activities programme arranged but care hours have increased in the afternoons and have been allocated specifically for carers to undertake activities with the service users. Care Homes for Older People Page 17 of 32 Evidence: The AQAA stated and the manager told us that a person visits the home every two weeks to undertake an exercise programme with the service users and she leaves a record of who has attended and participated in this class. A comment from a service user said I always enjoy the exercise session. Another person visits the home monthly to do reminiscence and other activities such as quizzes, bingo, board game and craft work, of which samples of the service users work were seen around the home. There were no specific care plans in service users documentation that detailed what social activity they enjoy and if they participate in such activities. There were no records in the home to document what activities had taken place each day and who had participated. This was discussed with the manager who assured us that activities do take place most days and said that he did not think it necessary to record the activities, but would do so in the future and record the outcome for the service users. The AQAA told us, and the manager confirmed that numerous outings take place during the year. These include trips to the Exbury Gardens, the New Forest and trips to the local seaside. There were photographs around the home of events and parties in the house that had taken place over the past year. The home had held a summer fete in the very lovely garden and photographs were displayed on the wall which showed the service users enjoying this event. The AQAA told us that the service users are encouraged to keep contact with the community and a highlight of the year is for residents to attend the local Brownie Pack Christmas party. Two of the residents had enjoyed attending the theatre this year and the manager told us that he endeavours to ensure that the service users are able to go out and enjoy local community events as they wish and he and other staff will transport them and assist them attending these. The manager told us in the AQAA that he has plans to organize more one to one trips to the local shops, liaise with the community groups to carry out talks and to develop the activities programme further in the coming year. Service users spoken to told us that they enjoy the activities. Nine surveys returned to CQC from the service users indicated that there is always some activity taking place for them to participate in if they wish to. Religious beliefs are respected and several of the residents are seen by the visiting clergy, who attends the home regularly. Care Homes for Older People Page 18 of 32 Evidence: The home has open visiting and the visitors book demonstrated that the home has regular visitors. The manager told us that some families are quite involved with the home and friends and relatives are welcome at any time and are invited to get involved with the activities and events that take place during the year. Comments on relatives surveys returned said: A very friendly homely place and staff are very king and caring. A very friendly welcome at the door and are always informed about mothers condition. Service users were observed to be wandering about the home freely and are able to go out into the garden in the better weather. Service users told us that they were able to choose the colour of their bedroom before they came to live at the home and were able to bring with them personal belongings and pieces of furniture. Rooms visited by us confirmed that each bedroom is very individual. The menus were viewed and are rotated every four weeks and were on display in the lounge. The menus demonstrated that the meals were wholesome and nutritious and that there was an alternative choice of food at mealtimes. Service users likes and dislikes were seen to be recorded in the assessment document. The cook told us that she is very familiar with the service users preferences and having worked at the home for some considerable time she was aware of what they liked to eat. The cook told us that residents enjoy the cakes she bakes most days. The AQAA told us that the home now provides a selection of supper foods at 2100. The lunchtime meal was observed and this appeared to be quite a social occasion with service users sitting together chatting. Some service users choose to eat in their rooms and this is respected, others were given assistance with their meals. Service users spoken with at the time told us that they had enjoyed their lunch and that the food was always good. The meal was observed to look well presented and wholesome. Surveys from relatives and service users commented: The food is nice. Good food. Individual needs are catered for. All service users are nutritionally assessed on admission to the home. There were no special diets being provided at the time of this visit. Service users weights are recorded monthly to identify any concerns. Care Homes for Older People Page 19 of 32 Evidence: Care Homes for Older People Page 20 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. Service users are protected by the policies and procedures of the home and staff training on safeguarding. Evidence: The AQAA said that the home has a clear complaints policy and procedure which is incorporated into the service user guide and the residents contract. The AQAA says that questionnaires distributed to service users told them that residents feel that they can complain or make requests without recrimination. The home has a complaints policy and procedure that is up to date and is incorporated into the Service User Guide. Information about advocacy services is also included in the Service User Guide, a copy of which is given to all service users. The manager maintains a complaints log but no complaints have been recorded by the home in the last year. No complaints have been received by CQCsince the last inspection. Service user spoken to and surveys received from service users and relatives indicated that they know who to talk to if they have concerns or make a formal complaint and that the manager would sort out any problem. Comments on surveys were very complimentary and said: Care Homes for Older People Page 21 of 32 Evidence: The manager keeps me well informed about my mother and I have no complaints. Relatives are pleased with the care and welfare of their relatives in the home. I cannot think of anything better the home could do. The home makes me feel secure and safe. I am happy with the care provided in the home. The home has policies and procedures in place to protect the service users from abuse. Staff records demonstrate that staff have received training in Safeguarding and the Mental Capacity Act. The protection of vulnerable adults training is also provided to new staff as part of their induction programme. The manager told us that the aim of the service is to have an open friendly home where residents and staff feel they are listened to. The manager told us and we evidenced that service users are provided with lockable storage space to ensure their personal belongings are safe. There are policies in place for the use of bed rails but the manager told us that there were no service users using them at the time of this visit. Care Homes for Older People Page 22 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 safe and well-maintained home that is homely, clean, pleasant and hygienic Evidence: The AQAA says that the home has a planned maintenance and redecoration programme and that as each room is vacated the person moving into it is able to choose colour and fixtures and fittings. At the time of this visit a gentleman was observed to be choosing a carpet for his room. The AQAA stated the planned programme for environmental improvements for the coming year. We looked around the home and visited a number of service users rooms. The home is well maintained and clean. All bedrooms have been decorated differently and to the service users choice of colour. It was observed that service users had personalised their bedrooms with their own belongings and pictures. Most of the rooms overlook the large gardens front and back. At the time of this visit the ground was covered with snow but the service users were enjoying watching the birds feeding. They told us that in the summer the garden is lovely and they enjoy sitting out under the very large tree close to the house. The home employs a maintenance person to undertake general repairs and maintenance. Care Homes for Older People Page 23 of 32 Evidence: The home is well appointed and has three lounge areas with dining areas incorporated. The communal areas are very homely and service users told us they are happy with their environment. Comments made on surveys received from service users said: The home is comfortable, homely environment. A very friendly, homely place. I would recommend this home to anyone. The home is always clean and much thought is given to make the home and rooms homely. I have an excellent room. The home employs separate house keeping staff seven days a week to maintain the cleanliness of the home. A house keeper was spoken with. She has worked at the home for many years and said that she now undertakes all the laundry and lays the tables at mealtimes. The home has an infection control policy in place and staff receive training in the principles of infection control. It was observed when looking around the home that the bathrooms and toilets have hand washing facilities but do not have disposable towels available for drying hands. This was discussed with the manager as to the risk of spread of infection using cloth towels. It was also observed that service users toiletries were left in the bathroom. These should be stored in the service users room for whom they belong so as to avoid a risk of infection if they were to be used communally. An observation on looking around the home was that the house keeper had left the container that held the cleaning materials on a table in the lounge, unattended whilst they were in another room. This was identified by us as a safety risk and the substances were removed immediately. Care Homes for Older People Page 24 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. Service users receive appropriate and safe support from a mixed skilled staff group who have received training. Service users are protected by the robust recruitment practices of the home Evidence: The AQAA told us that the staff rotas show a good skill mix of staff on duty every day with one senior member on each shift. At the time of this visit there were twenty service users in residence, two of which were men. The staff on duty throughout the day consisted of 3 care staff, the registered manager and the responsible individual, who is in the home most days during the week. Three housekeeping staff and a cook are also in the home each day. Two awake staff are on duty throughout the night. At the time of this visit there was evidence to suggest that sufficient staff were on duty to meet the current service users needs as staff were observed to be giving time to service users and call bells were answered promptly and staff were generally relaxed and familiar with the service users daily routines. Observations throughout the day demonstrated that the service users and staff had good relationships and that staff were aware and understood the service users needs. Surveys returned from service users and relatives indicate that service users in Care Homes for Older People Page 25 of 32 Evidence: general always receive the care and support they need. The AQAA stated that the home continues to have a long standing and experienced work force with 10 of the 13 care staff qualified to National Vocational Qualification (NVQ) level 2 and about 4 staff trained to NVQ level 3. The manager said that he anticipates achieving 100 per cent of staff trained to NVQ level 2 within the year. The home has a contract with a training supplier who supplies a number of training sessions per year for each member of staff. Staff training certificates evidenced that training received by staff included the mandatory training in health and safety, moving and handling, mental health and first aid. Food handling and hygiene training has been completed by all staff. Dementia training has been delivered to all staff by the community psychiatric nurse as well as the Mental Capacity Act training. Staff are paid for training sessions attended by them. The induction programme is based on the Skills for Care induction programme. There was evidence in the records of regular staff supervision and yearly appraisal and the manager told us that it is at these meetings training needs are discussed and planned. A sample of two staff recruitment files was viewed. These demonstrated good recruitment practice. The files were well organised and contained the Criminal Record Bureau (CRB), the Protection of Vulnerable Adults (POVA) checks, an application form, two references and the necessary identification documents. Staff surveys returned to CQC and staff spoken to at the time of this visit said: The home does well with training the staff. We always have updated training and many other courses are available if required. We are always offered plenty of training. 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. People have confidence in the care home because it is well managed. The environment is safe for people and appropriate health and safety practices are carried out. Evidence: The registered manager has appropriate qualifications and has managed the home for 13 years. The home has a friendly open atmosphere and is run in the best interests of the service users. The staff surveys and surveys received from relatives and service users told us that the manager is thought highly of and is always available to talk to. He was observe to have good rapport with the service users and that good relationships exist between he and the staff. Comments on surveys said: The manager responds to concerns and queries quickly, The manager selects staff that personal qualities are fitting. The manager and his staff are kind, professional and caring. The manager is always communicating with me about my relative. The manager is easy to talk to if you have any problems or worries. Care Homes for Older People Page 27 of 32 Evidence: The AQAA stated that the home has two quality assurance folders which assess the service they provide. This includes complaints, feedback questionnaires to stakeholders, risk assessments, medication, health and safety audit, recruitment audit and accident monitoring. The home has a quality assurance system in place and surveys are distributed to service users, relatives and other stakeholders. The questionnaires distributed this year have been sent out but the returns have not yet been analysed and reported on. The outcome from the previous consultation, that fed into the annual development plan, lead to action being taken that resulted in the service users having more home baked cakes, support bars fitted in the toilets and easier access made to the back garden by way of a fitted ramp. The manager told us that staff meetings do take place but are not recorded. Policy and procedures are reviewed yearly. The record of accidents is audited but could not be seen at this visit. The manager was in the process of auditing and some records were at his home. The manager advised us that the home does not become involved with any service users monies. A sample of servicing certificates was viewed for systems and equipment. These were observed to be current. The fire risk assessment and fire log were viewed. These demonstrated that the home tests their fire safety equipment at appropriate intervals and that staff have received fire training in recent months. We identified that a box of cleaning materials were left unattended by the housekeeper on the table in one of the lounges whilst she was out of the room. We had to draw this to the services attention so that they could be removed. This put service users at risk and staff must ensure that all cleaning chemicals are kept in a secure environment when not in use and must not be left unattended when being used. There was evidence in the training files that staff receive all health and safety mandatory training annually. Care Homes for Older People Page 28 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 29 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 7 15 The care plans must be 31/03/2010 person centred and reflect the individual care needs of the service user, as identified through risk assessments. Care plans must describe how the service user wishes those needs to be met. Care plans must describe what and how care should be delivered to meet the needs of the service user, taking into consideration the wishes of the service user in how they wish that care to be delivered. Care plans should be written to guide staff on how identified risks must be managed. 2 9 13 Care plans should be written 31/03/2010 stating protocols for when as needed (PRN) medications should be administered. Page 30 of 32 Care Homes for Older People 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 Protocols must be written for when PRN medications should be administered to ensure they are administered consistently by staff in accordance with the written guidelines. 3 38 13 Cleaning chemicals must not 28/02/2010 be left unattended and must be stored in a locked environement when not in use. All cleaning materials must be kept in a locked environment when not being supervised to ensure the safety of the service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 It is recommended that prescribed medication that is transcribed by a staff member onto the MAR chart should be signed and countersigned as evidence of correct transcription. It is recommended that a record of the activities that take place in the home daily is recorded to document who has participated in activities, their level of participation and those who choose not to participate. It is recommended that personal toiletries be stored in the service users room and not in bathrooms so as to avoid them being used communally. 2 12 3 26 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). 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