Care Home: Avondale Lodge Care Home

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What the care home does well The home provides a safe, well-maintained homely environment for the service users Assessments and care plans are detailed and inform the practices of the home to meet the needs of the service users. Service users` healthcare needs are provided for. Service users felt safe and secure and happy that staff could look after them properly and treated them with respect. Comments received on surveys said. `I have been completely happy with the care my friend receives in Avondale Lodge`. `I have visited at various times and have found everyone happy and well cared for`. `The home is lovely, clean and friendly and a joy to visit`. `In most cases the staff are very helpful. Some better than others`. `There is not much more the home could do to get better`. `The home gives me good food`. `I think it is a very good home`. `Well run home`. `I am happy in the home`. `The home does most things well`. `Because it is a small home the staff are always close by`. The home`s routines are flexible and promotes the right of service users to make choices for themselves and exercise personal autonomy as far as is reasonably possible. A well-balanced and varied diet is offered to service users. This can be adjusted to meet their own needs and requirements. We talked to staff and the surveys received from staff indicated that the home provides an appropriate training programme and staff feel supported by the manager and the more experienced staff. What has improved since the last inspection? The manager has introduced a new menu plan for more health eating that is based on service users preferences and needs. All service users` nutritional status is risk assessed. The manager has expanded the activities programme to include more varied activities like cake baking. New medication storage cupboards have been installed. What the care home could do better: The daily notes for service users could better describe how the service users have spent their days and evaluate the outcome of the planned care. Service users who wish to self medicate must be risk assessed to do so and have GP involvement in this decision. The home must provide lockable storage space in the service user`s bedroom to store all medication for those who choose to self medication. The fire integrity of the building must be risk assessed and checked at appropriate times.All information identified on Schedule 2 of the Care Home Regulations must be received before a person commences employment in the home. Key inspection report Care homes for older people Name: Address: Avondale Lodge Care Home Hythe Road Marchwood Southampton Hampshire SO40 4WT     The quality rating for this care home is:   one star adequate 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: 0 8 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Avondale Lodge Care Home Hythe Road Marchwood Southampton Hampshire SO40 4WT 02380666534 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Wendy Osman,Mr Gary John Osman Name of registered manager (if applicable) Mrs Meenu McCarthy Type of registration: Number of places registered: care home 14 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 14. 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: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP). Date of last inspection 14 14 0 Over 65 0 0 14 Care Homes for Older People Page 4 of 32 Brief description of the care home Avondale Lodge is a registered care home providing personal support and accommodation for up to fourteen older people including those with dementia or mental disorder. Avondale Lodge is situated in the village of Marchwood. The detached property is one of the oldest buildings in the village, and has a small front and rear garden, with parking to the rear of the home. Service users are accommodated in 12 single rooms and 1 double room. Nine of the single rooms and the double room have en-suite facilities. Bathrooms and toilets are situated near to rooms without en-suite facilities. Service users also have access to the lounge and dining area. Fees are available on request from the home. Fee does not include hairdressing, chiropody, and other personal items. 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: one star adequate 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 visit to Avondale Lodge, which was unannounced, was attended by one inspector. The registered manager, Mrs M McCarthy was on duty and assisted us throughout the visit. For the purpose of this report CQC will be referred to as we and us throughout. 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 within the stated timescales and the focus of this visit to the home was to support the information stated in this document and other information received by the CQC since the last visit, which was an key inspection on 11th October 2007. Documents and records were examined and staff working practices were observed where this was possible without being intrusive. The inspector spoke to a number of Care Homes for Older People Page 6 of 32 the residents and staff in order to obtain their perceptions of the service the home provides. Those spoken to were very happy and complimentary about the care and the home. Surveys had been distributed to service users,staff and visiting professionals. Eight (8) service user surveys, some of which were completed by relatives, and three (3) staff surveys were returned to the CQC. The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally service users were pleased with the care the home provides and staff were satisfied with their jobs. There were 13 service users in residence at the time of this visit. We were unable to communicate effectively with a small number of residents to gain their views of the service. There were no residents from an ethnic minority group. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The daily notes for service users could better describe how the service users have spent their days and evaluate the outcome of the planned care. Service users who wish to self medicate must be risk assessed to do so and have GP involvement in this decision. The home must provide lockable storage space in the service users bedroom to store all medication for those who choose to self medication. The fire integrity of the building must be risk assessed and checked at appropriate times. Care Homes for Older People Page 8 of 32 All information identified on Schedule 2 of the Care Home Regulations must be received before a person commences employment in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. 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. Service users are assessed prior to their moving into the home to ensure the home can met their needs. Evidence: The AQAA states that Avondale Lodge has an admission procedure and new service users are only admitted to the home following a full and thorough assessment by the home manager to ensure the home can meet their needs. The AQAA says the assessment is undertaken on a needs assessment basis and if possible with the involvement of a relative or representative. A sample of two service users care plans was viewed, one being for the most recently admitted resident. The pre-admission assessment tool was thorough and covered all aspects of care. The manager told us she undertakes all the pre-admission assessments and will visit the person in their own environment or in the clinical environment if they are in hospital. The manager said there is a great deal of family Care Homes for Older People Page 11 of 32 Evidence: involvement at the assessment time and that she receives care management assessment of needs from social services if they have assessed the client before referral. The service users surveys returned to CQC indicated that they had received sufficient information about the home and the terms and conditions of residency, prior to them making the decision to move into the home. This service does not offer intermediate care. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home now has systems in place to ensure the personal and healthcare needs of service users are fully met. The procedures for the safe management of medication are not consistently being adhered to. Service users privacy and dignity is upheld and promoted. Evidence: The AQAA states that each service user has a care plan revolving around their needs. All care plans are reviewed monthly. Risk assessments are carried out and reviewed monthly. The manager stated that as part of her improvement plan she would like each member of staff to read and sign the individual care plans to ensure they fully understand the plan and how to provide the care and support for each person. A sample of three service users care plans was viewed. Care plans are formulated from the pre-admission assessment and the initial assessment when the person moves into the home and are based around the persons needs. Care Homes for Older People Page 13 of 32 Evidence: The manager has reviewed all of the service users care plans since her appointment. Those viewed were very detailed and had been signed by the service user. The assessment covered all physical, psychological and social needs. The service user cognitive and mental state were also part of the assessment. Care plans were observed to being reviewed monthly and signed by the service user if possible as evidence of their involvement with the plans. Risk assessments are undertaken and care plans written to manage any risk. We identified in one persons care plan that they had been assessed as being high risk of falls, which tended to happen when they attempted to mobilise. The care plan did not describe how the person was to be moved and handled and the level of assistance needed for mobilisation. It was discussed by us that more detail should be recorded and a more specific care plan written for moving, handling and mobilisation. Daily notes are documented for each service user by the care staff on duty. The daily notes do not describe in detail how the persons needs had been met or how they had spent their day. It was discussed with the manager about encouraging staff to be more involved with the actual care planning, this then would give them more understanding of how to evaluate the care plan and describe the outcomes for the service user of the planned care. All care plans displayed a photograph of the service user on the front page of the care plan folder. Service users health care needs are met. The AQAA told us that the home actively promotes and maintains the service users health and ensures that each service user has access to health care services to meet their assessed needs. Service users are able to register with a GP of their choice. The AQAA stated that the chiropodist visits 8-10 weekly and the service users can have consultation with the dentist or optician either privately in the community, or when they visit the home annually. There were records in the care plans of when residents had consulted with a health care professional and the outcome of the visit. The manager said she was well supported by the primary health care team and described the support from the team recently when a service user became mentally very unwell and it needed the cooperation and assessments from all professionals to enable the service user to be placed in a safe environment. There was evidence in the care plans that the district nurse will attend the home to Care Homes for Older People Page 14 of 32 Evidence: undertake nursing duties like wound dressings and assessing peoples general health status. Service user surveys returned to CQC indicated that service users receive the medical care they need and this was confirmed when speaking to a resident. The AQAA says that the home has policies for the safe handling of medication and where appropriate service users are responsible for their medication, which is done within a risk assessment framework. The AQAA says the medication cupboard had been improved with allocated named boxes for each weeks medication. The manager requests the GP to review medication if she considers it necessary. The home has medication policy and procedures for the safe management of service users medication and also a copy of the guidelines for the management of medication in care homes There is a policy to encourage service users to manage and administer their own medication. However, at the time of this visit there was one person who was self-medicating their morning and night time medication. The manager could not show us that a risk assessment had been undertaken to ensure this person was safe to manage their own medication. There was no lockable storage space within their room to keep the medication safe from other service users. This was discussed with the manager as being unsafe practice and she was to ensure there was an assessment in place and lockable storage provided within the persons room. The manager co-ordinates the ordering, receiving and returns of medication. The home uses a monitored dosage system (MDS). We discussed with the manager the system for ordering medication and it was discussed that she checks the prescription sheet before it goes to the dispensing chemist to ensure that what is being delivered is what she has ordered and needs. There were records in a book of what every residents prescribed medication but there was no evidence of what was being ordered every month. There were records of what medication had been returned but this had not been signed by the receiving pharmacist. The manager was adviced that she should ensure the returned medication is signed for. The home is currently not administering or storing any controlled drugs. The home has no controlled drugs storage cupboard in place. We identified to the manager that the law had changed and that should the care home have any controlled drugs in the future they will need to install a controlled drugs cupboard in which to store controlled drugs, that meets the current regulations. Although the home does not have a specific medication trolley, medication was being stored in a safe environment appropriately. Care Homes for Older People Page 15 of 32 Evidence: We observed a carer undertaking the morning medication round following safe procedures. This was being undertaken by a carer who told us she had received training from the dispensing pharmacist. Training certificates and records evidence that all staff have received training in medication management and staff who are newly employed have been booked on a course imminently. We observed that residents were friendly with one another and chatted throughout the day. The staff were observed to interacted well with the service users and were overheard speaking to them in a respectful manner. Privacy screens were observed to be stored in double rooms to ensure service users privacy and staff knocked on bedrooms doors before being invited in. 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 are able to exercise choice over their lives, participate in social activities, receive visitors as they wish and enjoy a choice of meals taken in a relaxed atmosphere. Evidence: The AQAA received this year said that the home has improved over the last year and that more opportunities are made available for providing more stimulations and more appropriate physical activity for service users. The AQAA reports that the home would like to develop the activities programme further and this had been in response to the relatives questionnaire survey. The carers take on the role of organising and participating in activities for the service users. The manager has, in response to what relative and service users said in their surveys, expanded the activities programme to include cake baking once a week, which the manager told us they really enjoy and a weekly cheese and wine gathering, card games and reminiscence. An activities lady visits the home weekly to provide stimulation and physical activity. Care Homes for Older People Page 17 of 32 Evidence: Service users are encouraged to maintain contact with their families and the community. The visitors book showed that the home does have visitors most days and the manager said that there is a great deal of family support for the home and many of the residents are taken out by their relatives. The manager told us that a resident who used to attend a club once a week in the community, can no longer do so as transport cannot be supplied nor a person to accompany her. The manager told us she has tried all avenues to enable this lady to attend the club but it has been without success to date. The manager told us she does take one particular service user to the local shop quite regularly. Some social histories are recorded if the information is available and the service user is able to share the information. The home does not consistently record past social histories and recreational past times and the programme of activities is not arranged around service users specific preferences. The surveys returned from the service users indicated that there is always arranged activities that they can take part in. Service users spoken with were positive about the homes activities and how they spend their days. There were no specific records of what activities take place and who has participated. This was discussed with the manager that daily records or an activities folder should record the activities that take place and the level of service users participation. At the time of this visit most of the service users were sitting in the lounge area and the television was on, one service user was knitting. A carer did lead some activity in the afternoon for a period of time. Service users told us that they really enjoy sitting in the garden, which has a very pleasant sitting area. The manager told us that service users have choices of when they get up in the morning and go to bed at night. This are not recorded clearly in the care plans. The inspector observed that one resident was choosing to stay in bed most of the morning and the manager said this was her usual routine, she liked being on her own on her bed. She confirmed to the inspector that this was her choice. Other service users spoken to, said they could do as the wished and some said they liked to get up early. The inspector observed throughout the visit that service users where coming and going at their will and able to do as they wished. The service users rooms were pleasant and many of them have been individualised by the service user with their own belongings. The AQAA said that in the last three months the home has introduced a more health Care Homes for Older People Page 18 of 32 Evidence: balanced menu based on the likes and dislikes of the service users, this is a consequence of the manager distributing surveys to service users asking them their food preferences. The menu was viewed and demonstrated that the meals are planned on a four week basis with a choice at the main meal time. Service users said they liked the cooked breakfasts, the roast dinners and fish and chips. The manager anticipates changing the menu, in consultation with the service users, seasonally. The cook showed us the menu plan and said that the service users eat well and because it is such a small home, they can have what they like to eat. She and the manager arrange for food to be delivered and she orders whatever she needs without restriction. The lunchtime meal was observed and service users told us that they had enjoyed the meal and the trifle dessert. Nutritional assessments are undertaken on all service users with care plans recorded to manage any risks identified. Training records evidenced that all staff have undertaken the Food Handling and Hygiene training. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know that complaints will be taken serioulsy and acted upon and they are protected by staff awareness and training for the prevention of abuse. Evidence: The AQAA told us that the home has a clear, simple and accessible complaints policy which includes timescales for resolution. A complaint log is maintained to include the investigation and outcome from any complaint. The AQAA records that the home has received one complaint via CQC and this was dealt with by the manager and resolved promptly. The complaint log was viewed and this evidenced that just one complaint had been received in the past twelve months. The service users surveys and staff surveys returned to CQC indicated that service users and staff are aware of how to deal with complaints and who they should go to if a service or relatives wishes to complain. The manager told us that a suggestions book is kept in the reception area and relatives and service users are welcome to make comment in this book. There were no comments seen when the book was looked at by us. The AQAA states that all service users are protected from any physical, sexual, financial and emotional abuse. Care Homes for Older People Page 20 of 32 Evidence: To ensure service users are protected all newly recruited staff have Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA)clearance as part of the recruitment procedure. However, the was evidence that two references are not consistently received before the person commences employment. All staff are aware and have received training in Safeguarding Vulnerable Adults and the Deprivation of Liberty Safeguards. Information on abuse and safeguarding vulnerable adults is part of the induction programme. Staff surveys and staff spoken with said they would know what to do if they suspected or witnessed any form of abuse. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, safe and homely environment for those who live and visit there. However a fault on a fire door was identified as putting service users at risk. Evidence: On the day of this visit the home was clean, bright and homely. The physical appearance of the home demonstrates that care in taken in the upkeep of the environment. We visited most rooms and observed they were pleasantly decorated and had been made individual by personal belongings. Service users spoken with at the time of this visit said they were happy with their rooms. The garden and large patio area are very well maintained and the lounge area looks out onto the garden, for service users to enjoy. Many of the service users told us that they enjoyed sitting in the garden in the finer weather. The home has an infection control policy and procedures in place. Staff files evidence that training has been provided for infection control. Hand washing facilities with disposable towels are available and sanitising gel is also available in all areas of the home. Care Homes for Older People Page 22 of 32 Evidence: Protective clothing and disposable gloves are available for staff. The home employs a cook and a housekeeper. The manager monitors the cleanlines of the home as part of the quality assurance. Staff survey comments confirm that training is supplied and that they are aware of infection control principles. On walking around the building we observed that a fire door, which was a fire exit, was stuck and could not be opened. The manager called out an emergency contractor to rectify this. This is discussed further under health and safety in the Administration and Management section 7. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of staff meet service users needs. Service users are not fully protected by the recruitment practices of the home. Staff receive the training to do their jobs to ensure service users are in safe hands at all times Evidence: The staff rotas demonstrated that two carers are on duty all day and every day. The home employs a cleaner and a cook every day of the week. The manager is also on duty during the day for five days per week. There is one awake staff and one sleep-in staff on duty each night. Observation of practices at the time of this visit would indicate that sufficient staff were on duty to meet the needs of the 14 service users in residence at the time of this visit. The manager told us that she is on call if the staff need her at any time. The home employs a staff group from a mixed cultural background. A sample of three staff recruitment records were viewed by us. Two of the three examined only contained one written reference. It was discussed with the manager that two written references should be received before staff commence employment. The files contained the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) checks and had been received by the manager before the people commenced their employment. Care Homes for Older People Page 24 of 32 Evidence: The AQAA says that staff do receive a through induction whilst shadowing and within the 6 weeks of appointment. A sample of a completed initial induction programme for staff was viewed. The manager said this is undertaken before the staff member can commence duties and this is followed by an induction programme based on the Skills for Care standards. There was no evidence of these having been completed as the manager has not yet commenced new staff on this induction programme to date as most staff have achieved the NVQ level 2. Five of the nine carers have achieved NVQ level2 and above and currently there are a further two doing the NVQ level 2 and 2 undertaking level 3. The manager told us that she is committed to training the staff and that since her appointment staff have attended a number of training courses. We viewed a training matrix and this evidenced that all staff have undertaken mandatory training and nutrition in the elderly. The training records evidenced that most staff have undertaken dementia training to enable them to give appropriate care and meet the needs of the service users living in the home who have a dementia. The manager told us that she plans to book the staff on challenging behaviours training, following an incident in the home when a resident became very challenging and aggressive.The manager told us that she is preparing an individual training and development assessment for all staff as she undertakes their appraisals. Staff surveys comment that the training is available and that they are encouraged to undertake the training on offer. Training needs are identified through appraisal and supervision sessions, which now take place regularly and records of these were evidenced in the staff files. Staff spoken with at the home said that they were encouraged and supported by the registered manager to attend training courses and obtain qualifications. Care Homes for Older People Page 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interests of the service users, however the health, safety and welfare of the service users and staff were not fully protected at the time of this visit. Service users financial interests are safeguarded. Evidence: The AQAA was completed by the manager who stated that she makes sure the home is run in the best interests of the service users and ensures she discharges her responsibilities fully. The present manager has been in post for some months and is now registered with CQC. She is currently undertaking the Management and Leadership Award. She has some years experience working in the care industry. Her portfolio was viewed and evidenced that she has undertaken numerous training courses since she has been in post. Care Homes for Older People Page 26 of 32 Evidence: We did identify shortfalls in the recruitment practices of the home. In two of the three recruitment files viewed only one reference had been received beofre the person commenced employment. The manager has undertaken a quality assurance audit by distributing questionnaires to service users. relatives and visitors. She has also undertaken a food survey with service users to gain their opinion and preferences on food. The outcome of these surveys were seen and comments were very positive with most questions answered as good or excellent. If issues have been highlighted in these surveys, changes made and outcomes have been documented on the report. The manager told us that the proprietors visit the home approximately every two months but reports are not recorded and left in the home. The manager told us that she is able to make autonomous decisions about the management of the home on a day to day basis but she has easy access to the providers should she need to discuss any issues. She told us that she is not fully involved with the business planning and annual improvement plan but is asked for her opinions and would like to be more involved with the budgets in the coming year. The manager anticipates holding staff meetings every three months. She has held on meeting as a result of a complaint and the minutes were recorded and seen by us. The manager has reviewed policies and procedures since being in post. The home does hold small amounts of personal monies for service users. All monies are stored in separate containers. The monies are held in a secure environment and records and receipts are kept of all transactions. Records seen for a sample of two service users matched the amount that was held. The home has health and safety policies and procedures in place. The fire log was viewed and this evidenced that the fire alarms are tested weekly and emergency lighting monthly. The records evidenced that staff have undertaken fire training in March 2009. The training records demonstrated that staff have undertaken health and safety mandatory training. On touring the home is was observed that the fire door at the top of the back stairs was not functioning properly, the handle had malfunctioned and had stuck locked and this would put service users at risk if there was a fire. As discussed in standard 19, this was addressed at the time of this visit and the contractor attended the home to Care Homes for Older People Page 27 of 32 Evidence: identify the fault. The manager has subsequently spoken to CQC to inform us that the fire door is now functioning efficiently and the same contractors are undertaking a full fire risk assessment of the home imminently. A sample of servicing certificates was viewed for electrical equipment testing, lift, fire alarm system and were found to be current. The accident book was viewed and was observed to be recorded appropriately. The manager checks the accident records daily and makes comments if necessary and signs as evidence of her auditing these records. 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 9 13 Service users who choose to 30/11/2009 self-medicate must do so within a risk assessment framework to ensure their understanding and safety in managing their own medication. To ensure that the service user has the understanding and the physical capacity of complying with a medication programme independently. 2 9 17 The records of medications 30/11/2009 that are ordered and received into the home must be maintained. To ensure that all medications ordered and delivered are correct and what is currently prescribed and needed by individual service users. Care Homes for Older People Page 30 of 32 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 3 9 13 Lockable storage space must 30/11/2009 be provided for service users choosing to self-medicate and choosing to keep their medication in their rooms. To ensure that there is safe storage of medication and that there is no risk to other service users taking another persons medication. 4 29 19 Two written references must 30/11/2009 be received by the home in respect of an applicant before they commence employment. To ensure that service users are protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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