Care Home: Bannow Retirement Home

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What the care home does well People are happy living at the home. There comments included `general care and welfare is very good. I am satisfied with things as they are at present. I have been here for X years and have been well looked after and comfortable`. `I am happy with all management and the staff`. `Meals, accommodation and facilities (in the home)` are good. `Its all pretty good. I can`t think of anything` they can do better. `They are always there to help us. Very satisfied. They make you feel at home`. `Its excellent, very happy, cosy and staff are fantastic`. Relatives spoken with were satisfied with the care and support received by their family member. Their comments included `it absolutely excellent`. `X is treated as an individual here which is what really matters`. `Its well furnished, big and impressed with the manager`. `I find everyone very helpful, Angela (the manager) is very helpful and I am made welcome when I visit`. Staff are happy working at the home. Their comments included `I feel Bannow is one of the best homes that I have visited. Not because I work here but because I have a relative in one which I think needs to follow Bannows policies and ways. The home and management work well including all staff`. When asked what the home does well comments included `we work as a team and also as individuals working with clients`. `Everything`. `Activities, care planning, medication`. `Ways of entertaining residents with music, games and talking`. `The home makes sure residents have got all needed facilities. The residents health and well-being is well looked after`. `Bannow is a well run friendly establishment, staff are very caring, residents are happy and well looked after`. `We have a lovely home which has a great feel about it`. What has improved since the last inspection? Pre-admission assessments now contain clearer information in relation to how those who suffering from dementia are affected. People now benefit from medication being stored more securely, further staff training has taken place and some signage has been implemented around the home for those who suffer from dementia. A review of staffing has taken place to ensure sufficient staff are on duty to meet peoples needs. Recruitment practises are more robust but still need further improvement and audits by management are taking place to drive up standards of care. The home has completed considerable work on the environment to aid peoples safety and improve the environment such as work to the gas pipe, fitted some low temperature radiator covers, the rear garden is now secure so people can wander safely, refurbished the laundry, redecoration of bedrooms, repairing of communal carpets and some new flooring and created two new ensuite single bedrooms on the ground floor. What the care home could do better: Requirements are made in relation to recruitment and medication as these must be improved to ensure peoples safety and shortfalls in these areas were highlighted at the previous inspection. Suggestions for good practise improvements have also been made through the body of this report. Key inspection report Care homes for older people Name: Address: Bannow Retirement Home Quarry Hill St Leonard on Sea East Sussex TN38 0HG     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: Sally Gill     Date: 2 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Bannow Retirement Home Quarry Hill St Leonard on Sea East Sussex TN38 0HG 01424433021 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bannow Retirement Home Ltd Name of registered manager (if applicable) Ms Angela White Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home Aaron Manor is registered to provide accommodation for up to 26 older people who may or may not be suffering from dementia. Angela Hayes is the registered manager and is in day to day control of the home. The owner also owns two nursing homes in the South East. Care Homes for Older People Page 4 of 31 Over 65 0 26 26 0 0 8 0 1 2 0 0 9 Brief description of the care home The premise is a detached grade two listed property on a steep hill. The property has a level secure rear garden with lawn, greenhouse, flower gardens, established shrubs and path. Accommodation is on three floors. All bedrooms are currently singles and are situated on the ground, first and second floors. All bedrooms have ensuite facilities. People have the use of two assisted bathrooms and an assisted shower room. The home has a spacious drawing room, lounge, a dining room, library and smaller quiet room in addition to other seating areas. The home has a passenger lift and is suitable for wheelchair users. The home is approximately 200 yards from the nearest bus stop which will take you into the town centre and all its amenities including train station approximately ten minutes away. There is limited car parking to the front of the home. The staff compliment consists of a manager, head of care, senior carers and carers plus ancillary staff. Care staff work a rota that includes a minimum of three staff on duty during the day and two on waking duty at night. At the time of the visit current fees charged ranged from £455.00 to £646.00 per week. Additional costs would include toiletries, hairdressing, newspapers and magazines. Previous inspection reports are available from the home or can be viewed and downloaded from www.cqc.org.uk Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The previous inspection took place on 8th January 2009. This inspection was carried out over a period of time and concluded with an unannounced visit to the home between 09.15am and 5pm. The manager and staff assisted during the visit. People that live in the home, relatives and staff were spoken with. Observations were made throughout the day. Twenty-five people were living at the home on the day of the visit. Surveys were sent to the home for the manager to distribute to people living there, staff and health and social care professionals. Eight were returned from people living at the home, three of which were completed with staff help. Seven surveys were received back from staff. All surveys received were positive about the care and support received. Care Homes for Older People Page 6 of 31 The care of three people was tracked to help gain evidence as to what its like to live at Bannow Retirement Home. Various records were viewed during the inspection and a part tour of the home undertaken. The home sent their annual quality assurance assessment (AQAA) to the Commission within the required timescale. The AQAA is a self-assessment picture of how the manager thinks they are doing against the national minimum standards. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Requirements are made in relation to recruitment and medication as these must be Care Homes for Older People Page 8 of 31 improved to ensure peoples safety and shortfalls in these areas were highlighted at the previous inspection. Suggestions for good practise improvements have also been made through the body of this report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives may benefit if information provided about the home and it services was thoroughly reviewed. People are able to make a decision based on the information that this home is right for them and can meet their assessed needs. Evidence: People and their representatives have the information they need to make an informed decision about the home. Most people surveyed indicated they did receive enough information about the home prior to moving in, one indicated they didnt know. The manager told us a reduce statement of purpose and brochure is sent out when the home receive an initial enquiry. Once the individual has decided to move in a service user (residents) guide is sent out. The manager told us information can be produced in large print on request. People who may use the service and their representatives may benefit if information provided is thoroughly reviewed. Copies of the statement of purpose and service user guide were obtained. The statement of purpose is in a Care Homes for Older People Page 11 of 31 Evidence: written format and was last reviewed in November 2009. Some information must be reviewed as it is not quite accurate such as providing intermediate care and contacting the Commission if senior staff on call are not available. This document is fifty-three pages long which for any person to read and digest is a onerous task. Information is often repeated. For good practise this document should be reviewed to ensure it contains simply the information required under schedule 1 of the regulations which would be much more reader friendly. The service user guide (residents guide)is also in a written format. Some information listed in the standards for good practise is missing such as the relevant qualifications and experience of the provider, manager and staff and peoples views of the home. This document is thirty-two pages long which again should be reviewed to be more concise and reader friendly. Good practise would be for the statement of purpose and the service user guide not to contain complete policies but a brief description of the listed items or procedure to inform the reader in plain English. A statement of purpose was displayed in the front hallway but this was neither the full document or the reduce document sent out on enquiry. People are protected by terms and condition and also a contract. A copy of the terms and conditions and contract was obtained. Information is repeated in both documents and the name of the Commission needs updating so again these documents would benefit from review. Documents seen did not specified the individuals room number and should for good practise. Most people surveyed indicated they have received written information about the homes terms and conditions or contract, one indicated they had not and another stated they did not know. The manager told us people that live in the home and relatives have been advised that contracts signed under the previous owners are still relevant as the agreement is with Bannow Retirement Home not the owners. Peoples needs are assessed prior to receiving a service. The pre-admission assessments for four people who had recently moved in were examined. For two of the people these assessments were undertaken over the phone by speaking to professionals and family. In these cases the homes assessment information was brief with some sections were blank. Some information had been written on scraps of paper but not transferred to the assessment form. The home had obtained information from professionals involved in the individuals care including in one case a copy of the local authorities assessment who were funding the care. The third admission was an emergency admission and therefore the assessment was undertaken on arrival. A fourth assessment was examined where the manager had visited the person in their own environment. This contained good detail and gave a picture of the individuals skills and abilities and what help they would need. Once the assessment is completed and a judgement made that the home can meet the individuals needs a confirmation Care Homes for Older People Page 12 of 31 Evidence: letter is sent with a service user (residents) guide. The manager told us since the last inspection she has reviewed the format of the assessment. This is to ensure information is recorded for those suffering with dementia and how this impacts on their day to day life. People and their representatives have the opportunity to visit the home prior to moving in. Relatives spoken with confirmed they and their family member were able to visit the home prior to the move in. One said they had looked at several but liked this the best and choose it for the building, furnishings and feel of place. Intermediate care is not provided but short term care can be vacancies allowing. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. Further improvements in care planning and medication systems would benefit people. The principles of respect, dignity and privacy are put into practise. Evidence: Peoples health, personal and social care needs are set out in an individual care plan. Three were viewed. They contained sufficient information to inform staff about peoples needs. Some information sections were blank which is confusing as to whether they are not relevant or information has just not been recorded. Good practise would be to make this clear. Care plans generally evidenced reviews are undertaken monthly by the key worker. Signatures of individuals evidenced their involvement in care plans. Where people do not have the capacity to review their care plan and the home involve family or representatives it would be good practise to evidence this. Relatives/representatives spoken with felt the home meets the care needs of their family member and the home keeps them well informed. Most people surveyed indicated they always receive the care and support they need, one indicated usually. No care plan examined contained a photograph of the individual which is good Care Homes for Older People Page 14 of 31 Evidence: practise. The home is also required by legislation to hold a photograph of each person living in the home. Care plans contain risk assessments which detail a safe system of work to follow where there is deem a risk and these had been regularly reviewed. According to daily notes one individual had flooded their ensuite floor twice and this had not triggered a risk assessment which would be good practise. Such a risk assessment should be in place for all individuals who suffer dementia as this is an obvious risk. A general environment risk assessment is in place for individuals however information recorded in relation to windows is not accurate and should be reviewed. The manager told us all individuals now have a risk assessment for skin integrity and nutrition in place. The manager also told us she is working on a new format care plan which will give better information about peoples capacity to make decisions and will be in a more user friendly format. Reference is made in current care plans to Deprivation of Liberty assessments and a copy of the authorisation is contained within the care plan folder. Peoples health care needs are met. People and relatives spoken with confirmed that when they are ill a doctor is called. Records and discussions evidenced access to doctors, district nurse, Community Psychiatric Nurse, dentist, opticians, hospital appointments and chiropodist. One chart in the care plan is to record details of health appointments/input however although people see a chiropodist regularly this was often blank. In another case the manager told us the individual had seen an optician and had new glasses just prior to moving in but this information was not recorded. People are weighed regularly and have opportunities to undertake light exercises. People could be better protected by the medication systems. Care plans contain a list of medication. However not all medication had a start date and some had been crossed through rather than entering an end date. Not all creams were recorded on the list and the manager told us not all temporary medications such as antibiotics were entered on the list in the care plan. Good practise would ensure this list is able to give a details of current and historical medication taken by the individual including start and end dates. Since the last inspection the chemist supplying the medication has changed. Stocks of some medication are high and good practise would be to reduce these stocks. Some creams were stored in the fridge and do not need to be. One bottle of eye drops was opened and nearly finished but had not been dated upon opening. This was raised at the last inspection. The key to the medication trolley is now stored securely. The Medication Administration Record (MAR) charts were examined and showed appropriate use of signatures and codes. Medication was logged into the home appropriately. No handwritten entries were signed, dated or witnessed. This was also raised at the previous inspection. Where the home has responsibility for the individuals medication and medication is not kept in the medication secure storage Care Homes for Older People Page 15 of 31 Evidence: a risk assessment must be undertaken. Such medications should be clearly audited on the MAR chart when handed over including quantities. Quality auditing should be strengthened to ensure shortfalls are picked and addressed so they are not repeated. Due to the fact that previous shortfalls have not been addressed a requirement is now made. Staff that give medications have received training and further refresher training has taken place during 2009. People feel they are treated with respect and their right to privacy is upheld. People spoken with confirmed staff are kind and caring. All rooms have ensuite facilities. The manager told us eleven people have keys to their rooms. One said I sometimes lock my room and this is respected. Observations throughout the day showed staff to interact well with people using a kind and sensitive approach. Some signage has been introduced into the home to aid those suffering from dementia although further work would reflect good practise. The home is aware this is an area for improvement. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life and most are satisfied with the social activities. People enjoy the meals provided. Evidence: People have opportunities for social and recreational activities. A programme of activities is displayed in written format. Records and discussions confirmed recent activities have included daily newspaper reading, gentle exercises, music, television, films, beetle drive, music and dancing, manicures, games such as connect 4, snakes and ladders, Scrabble and hangman and reminiscence. Several people have a daily newspaper delivered. Some people prefer to spend time alone in their room and have their own hobbies and pastimes. One relative felt that activities is an area where the home could improve further particularly one to one activities. They felt further staff training in this area may benefit people living in the home. The home should keep under review the range of activities taking place to ensure they are appropriate and everyone living at the home benefits from them. A mobile shop has recently been started where people can buy small items such as toiletries or sweets. A music entertainer visits the home twice a month. People look forward to the hairdresser coming who visits three times a fortnight. A local vicar visits regularly to Care Homes for Older People Page 17 of 31 Evidence: give people communion. Some people are able to go out independently and there is the use of a seven seater car to take people into town shopping or out for an afternoon. One staff member surveyed commented the home has recently purchased a new car (mini bus). A recent outing was undertaken to Northiam to a tea rooms. All rooms are fitted with a telephone and one individual felt this helped them stay in contact with friends outside the home. Peoples choices are respected and they are able to spend time joining activities or time alone. One person spoken with said the time goes very quickly here. Everyone spoken with said routines are flexible and they can choose how to spend time, get up and go to bed as they wish. Visitors confirmed they are made welcome. Several visitors were seen spending time in the home and all were made welcome with a tray of tea. One group of relatives confirmed the atmosphere is always calm and relaxed. People have a choice of meals, which are very much enjoyed. A eight-week menu is in place. People are asked their choice the previous day and a written menu is usually displayed outside the dining room. The manager told us she is planning to introduce picture menus as well. The dining room is a pleasant room and tables are laid with linen table clothes and napkins and fresh flowers. Breakfast is cereals, toast and fruit juice which is mostly served on trays in peoples rooms. People are encouraged to come down for an aperitif prior to lunch. Lunch which is the main meal is a three course meal. To start there is a fruit juice or a starter followed by three choices of the main meal and a choice of two deserts. Supper is sandwiches or two choices of a light meal followed by something sweet. On the day of the visit lunch was fruit juice or pate and toast, fish and parsley sauce or roast chicken with potatoes and three vegetables. Vegetables were served at the table after asking the individual their choice. The meal looked appetising and well presented. People said they had enough food and it was excellent, good or very good. One person said the food is very good you would go a long way to beat it. Special diets can be catered for such as low cholesterol. Tea and coffees when served in rooms are presented nicely on individual trays. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their relatives feel confident any concerns would be addressed. People feel safe living in the home and are protected from abuse. Evidence: People felt confident any concerns would be addressed. There is a written complaints procedure in place although this was not seen displayed in the home but is included in the documents situated in the front hallway. People spoken with confirmed who they would speak to should they have a concern. One person said they had previously raised concerns and these had been resolved. People surveyed said they there is someone they can speak to if they are not happy. Most people surveyed indicated they know how to make a formal complaint although two did not. Most people surveyed indicated staff always listen and act on what they say, one person indicated usually. Regular residents meetings are held where people are able to voice their concerns. The AQAA indicated five complaints had been received since the last inspection. Records of these were not examined. The AQAA indicated that none were upheld. The Commission received information on occasion which resulted in safeguarding alerts being made. Information was found to be either unsubstantiated or appropriate management action was taken when the home became aware of the allegations. People are protected from abuse. The home has policies and procedures in place in relation to safeguarding people and a whistle-blowing policy. Most staff have received safeguarding training and further training has taken place during 2009. Care Homes for Older People Page 19 of 31 Evidence: The AQAA stated that behavioural guidelines are now in place where people exhibit aggressive behaviour and require intervention. These were not examined. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy living in the comfortable and pleasant period surroundings and are benefiting from ongoing improvements. Evidence: People live in home which is comfortable, homely and benefits from period features. The home is a large grade two listed building over four floors with a garden. The home is approximately ten minutes car journey from the town centre and all its amenities and is situated on a hill. A part tour of the home was undertaken and the garden briefly viewed. During the tour of the home it was noted that minor areas of carpet in the communal areas and on the stairs are worn, two chairs in the bathrooms are wooden which is not particularly hygienic and a bathroom was a bit bare and could benefit from pictures to make it more homely. Generally the home is well maintained. The manager told us since the last inspection sections of the carpets in communal areas have been repaired. Twelve radiators have now been covered and there are approximately another twenty to be done. The manager told us work on radiators has begun in those rooms where individuals who may be at most risk from a hot radiator. The laundry has been completed refurbished and has a new washing machine with sluice facility and new flooring. Five bedrooms have been redecorated and two new bedrooms have been created with ensuite toilet and wash hand basins. New flooring has been fitted in the hall outside the library. The rear garden has been made secure. Care Homes for Older People Page 21 of 31 Evidence: Confirmation was received from the manager following the inspection that the final twenty radiators will be covered with low tempreture surfaces by February 2010. People benefit from pleasant, large communal areas and a good space to wander as they please. On the ground floor people have access to a large drawing room, lounge with piano, well stocked library, small quiet room which could be used for visitors or meals and large pleasant dining room. In addition there are other quiet seating areas around the home and a hairdressing salon on the second floor. There is a shaft lift to the first and second floor. The garden is well maintained with a lawn area, established shrubs and flower gardens, flower pots, greenhouse and a level path. The manager told us there is a vegetable plot which is used in the summer. There is also a very large summerhouse which is being refurbished as living accommodation for the owner. People have sufficient bathrooms and toilets. All bedrooms have an ensuite with a toilet and wash hand basin. In addition one has a shower and nineteen have a bath. There are also two assisted bathrooms and an assisted shower room as well as addition toilets. People spoken with were happy with their rooms. Bedrooms are situated on the ground, first and second floors. Currently all rooms are used as singles. Bedrooms vary in size. Those seen were all personalised with knick knacks, photographs and personal furniture. Comments about bedrooms included it small but adequate and its fantasic, large lovely room with plenty of room for X to move about in. Peoples opinion were mixed about the heating of the home. One said I find it too warm and put a towel over my radiator. Another said it could be a bit warmer first thing in the morning. On the day of the visit the home was comfortably warm. People spoken with confirmed there is always plenty of hot water. The home is clean, pleasant and generally hygienic. On the day of the visit the home was clean in all areas visited. One relative said it is always spotless. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are generally trained and skilled to support people and the smooth running of the home. Good numbers are qualified. Recruitment practises need to be strengthened further. Evidence: Most people feel there are sufficient staff on duty. People surveyed indicated there is always or usually staff available when they need them. The manager told us in addition to herself there are three staff on duty through the day 8am to 8pm and two waking staff on duty at night. The manager told us since the last inspection the senior on duty is now out on the floor in the mornings. She has also had agreement from the owner to have an additional member of staff on duty 8am to 12 noon so this should shortly be implemented. Ancillary staff include a chef, kitchen assistants, laundry, domestics and a maintenance person. One person spoken with said staff were very good, nobody I could fault and they are good at covering other tasks such as cleaning to ensure a full service. Another said for the most part staff are good but been so many changes. The AQAA states actual staff turnover is low. Another said staff are fantastic they pop in all the time. Relatives said staff have good attitudes, one in particular a new girl X gets on with well but they all seem very nice. Most staff surveyed indicated there is usually enough staff on duty to meet the needs of people, one felt there sometimes is. Although staffing levels have been reviewed good practise would be to record this using a risk assessment tool based on peoples Care Homes for Older People Page 23 of 31 Evidence: assessed needs and keep it under review. People receive care from staff that are qualified. Records showed that there is a care staff team of twenty two in addition to the manager of which fifteen have obtained a National Vocational Qualification (NVQ) level 2 or above and five are currently undertaking it. This is commendable. People are not fully protected by the recruitment procedures. Two newly recruited staff files were examined. Staff surveyed indicated the employer carried appropriate checks before they started work. Staff had completed an application form and references, Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks had been obtained. However these again as at the previous inspection evidenced shortfalls in a robust recruitment process. Both application forms evidenced gaps in their history but there was no written explanation of these as required by legislation. This was raised at the previous inspection. For one employee although two references had been obtained this was not from their current/last employer. A positive CRB had been received but there was no evidence on file this had been discussed with the employee and a judgement made that this did not constitute a risk to people living in the home. This was also raised at the previous inspection. The manager told us some of the previous gaps highlighted at the last inspection in recruitment files such as CRB checks have now been obtained. Although there is still work outstanding to ensure all files contain the full information as per the regulations which must be completed. A further requirement is made in relation to the above recruitment shortfalls. People receive support from a generally trained staff team. The manager told us all staff undertake an induction which would include shadowing experienced staff and completing a skills analysis. Staff then go onto completing a Skills for Care induction and undertake mandatory training. Good practise would be to complete the Skills for Care induction within twelve weeks of starting employment. Staff surveyed indicated their induction mostly or very well covered everything they needed to know. A copy of the training matrix was obtained once updated by the manager who also advised on the refresher training frequency. Further staff training has taken place during 2009 in all mandatory subjects. The majority of care staff are trained in fire, medication, moving and handling, safeguarding, first aid, infection control and food hygiene. However there is some slippage on all subjects where staff have refresher training and one staff member according to records has attended very little training. The manager told us a fire course was taking place the following day. The majority of staff have undertaken training in dementia and the manager told us this is either four units of distance learning or four hours training by a training organisation. The AQAA states Care Homes for Older People Page 24 of 31 Evidence: more specialist training is planned. Staff surveyed indicated they are given training appropriate to their role. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect. It has quality assurance systems in place. Outcomes for people could be improved if quality monitoring systems were strengthened. Evidence: People live in a home which has a relaxed and calm atmosphere. The manager has obtained her Registered Manager Award (RMA) and NVQ level 4 in care. In addition she has undertaken dementia mapping and mandatory training and is an NVQ assessor. She has fifteen years experience in care and has been in this position for fifteen months. Both people living in the home and relatives spoke highly of the manager and she displayed a good rapport with individuals, relatives and staff. The organisation undertakes an annual quality assurance survey which is sent to people who live in the home, their relatives and staff. The last one was completed in September 2009. For people living in the home all responses ranged from good to excellent. Relatives and professional responses were again positive. Results were Care Homes for Older People Page 26 of 31 Evidence: analysed and people received feedback. The home returned their AQAA within the required timescale. It gave a good picture of the home. The provider undertakes monthly visits to the home to check the quality of care provided. The reports relating to these visits were viewed which showed records are examined and people and staff spoken with. The manager also undertakes a monthly audit of various activities within the home and has a development plan in place. Whilst it is acknowledge that on the whole requirements made at the previous inspection have been met it is disappointing that some shortfalls raised at the previous inspection are again highlighted during this visit such recruitment, risk assessment, medication and staff supervision. Quality monitoring systems must be strengthened to ensure shortfalls are picked and appropriated management action taken to resolve any shortfalls and continue to improve outcomes for people living at the home. The home does not hold any monies on behalf or people living in the home. Staff receive supervision although there is some slippage on good practise timescales. Records examined indicated one staff member had received two supervision sessions since June 2009. Another had received none since August 2009, the manager told us she felt this staff member had received a supervision but there were no records and it had not been entered on the supervision matrix. Frequency of staff supervision was an issue at the last inspection and must be addressed by management. Staff surveyed indicated they get enough support from their manager and meet with them to discuss working regularly or often. Peoples health, safety and welfare is promoted. Information in the AQAA indicates that the home has serviced equipment appropriately. Some equipment and certificates were examined and were in order. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In particular Handwritten entries on the MAR charts shall be signed, dated and witnessed. Medicines outside of the monitored dosage system shall be dated upon opening. A risk assessment shall undertaken where medicines are not stored securely. There shall be a clear audit trail of all medicines brought into the care home. 23/12/2009 Care Homes for Older People Page 29 of 31 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 To ensure medication systems are robust to protect service users 2 29 19 The registered person shall 23/02/2010 operate a robust recruitment procedure. In particular Information must be held in relation to each staff member working at the care home as per schedule 2 a full employment history must be obtained including a written explanation of any gaps prior to employment where a positive CRB is received there must be written evidence of the judgement that service users are not at risk by employing the staff member To protect 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 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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