Care Home: Beauchamp House

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What the care home does well Before anyone moved into the home the manager or senior staff visited them to assess what care they needed and to make sure that their needs could be properly met at Beauchamp House. Residents told us that the care at the home was good. One person told us, "I was very ill when I came here and they helped me to get better." The systems for managing medication were very well organised and helped to make sure that residents received their medicines as they should. Residents said they got on well with staff and several commented on their kindness and friendliness. One said, "I have never seen so many friendly people in one place." Another said, "I like it here because everyone is always smiling." Staff were observed treating people with respect and a resident said they were always polite and patient. Promoting privacy and dignity was important in the home and several of the senior staff were `dignity champions`. Staff encouraged people to make whatever choices they could about their daily lives. The routines in the home were very flexible and revolved around the people who lived there. A resident told us, "There are no more rules than necessary." One member of staff said, "We don`t really have any set routines, it depends on the residents." The manager made sure that new staff all had background checks before they started working at the home. This was to make sure that they were suitable to work with residents. Staff had training to help them to understand the needs of the people who use the service and to protect their health and safety. Over half of the care staff held an NVQ, which is a nationally recognised qualification in health and social care. What has improved since the last inspection? There were no requirements for improvement at the last key inspection. Following a safeguarding incident last year, the need for improvements in the admission process, care records and reporting serious incidents was identified. The service had acted upon the recommendations and had brought about changes in all these areas, which had helped to improve the safety of residents. What the care home could do better: Information about the home should be brought up to date to make sure that people thinking of moving in have accurate information to help them to make a decision. To ensure that staff have accurate information on which to base their care, care plans must be kept up to date and amended to show any changes in needs or care to be given. In order to meet their social and recreational needs, residents should have more opportunities to participate in group or one to one activities.The complaints procedure should be on display in the home so that it is accessible to residents and visitors. The staffing levels in the home should be monitored to ensure that there are always enough staff on duty to meet the health, personal and social care needs of the residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beauchamp House Proctor Road Chedgrave Norwich Norfolk NR14 6HN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Craig     Date: 1 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Beauchamp House Proctor Road Chedgrave Norwich Norfolk NR14 6HN 01508520755 01508528646 beauchamphouse@norfolk.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Norfolk County CouncilCommunity Care care home 43 Number of places (if applicable): Under 65 Over 65 7 36 dementia old age, not falling within any other category Additional conditions: 0 0 1. The registered person may provide the following category/ies of service only: Care Home only Code PC 2. The maximum number of service users who can be accommodated is: 43 There must be one member of staff on duty at all times with a recognised training in dementia awareness. Up to 36 older people may be accommodated. Up to 7 service users with dementia and over 65 years of age may be accommodated. Up to one (1) person under the age of 65 years may be accommodated in the Homeward Bound Unit. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category Code OP Dementia Code DE to service users of the following gender: Either Care Homes for Older People Page 4 of 29 Date of last inspection Brief description of the care home Beauchamp House is a Local Authority Home situated in the village of Chedgrave. The home can accommodate up to 43 older people in single rooms. There are no en-suite facilities but there are ample bathrooms and toilets close to bedrooms and communal rooms. Part of the garden is enclosed, and offers a discreet and safe environment for service users. There are ample parking facilities to the side of the premises. The home is supported by local GP surgeries and other health services. Information about the home is available on request and the latest inspection report is on display. The current fee is 391.28 pounds per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 21st June 2007. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 11th and 12th June 2009 and took a total of nine hours. The visit was conducted by one regulatory inspector. At the time of the visit there were thirty one residents in the home. We met with some of them and asked about their views of Beauchamp House. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and Care Homes for Older People Page 6 of 29 talked to staff about their care needs. We talked to the temporary manager, the service manager and other members of the staff team. We looked around the home and viewed a number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the care home does well: What has improved since the last inspection? What they could do better: Information about the home should be brought up to date to make sure that people thinking of moving in have accurate information to help them to make a decision. To ensure that staff have accurate information on which to base their care, care plans must be kept up to date and amended to show any changes in needs or care to be given. In order to meet their social and recreational needs, residents should have more opportunities to participate in group or one to one activities. Care Homes for Older People Page 8 of 29 The complaints procedure should be on display in the home so that it is accessible to residents and visitors. The staffing levels in the home should be monitored to ensure that there are always enough staff on duty to meet the health, personal and social care needs of the residents. 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 set out 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were not admitted to Beauchamp House unless their assessed needs could be met. Evidence: The annual quality assurance assessment (AQAA) indicated that the manager planned to improve the written information about the home. Both the statement of purpose and service users guide contained out of date information and needed to be reviewed. One person said he had received a copy of the service users guide when he moved in and knew where to get one if he needed it. Following a safeguarding investigation in 2008, the service had volunteered to restrict the number of admissions each month. This had helped staff to carry out a thorough admission process to ensure that residents were not admitted to Beauchamp House unless their needs had been assessed and they could be met at the home. It also Care Homes for Older People Page 11 of 29 Evidence: helped to give staff time to continue the assessment process and draw up care plans. The AQAA told us that the pre-admission assessment document had been updated to assist in this process. We saw some examples of completed pre-admission assessments, which provided clear information about the residents needs. One resident had been admitted as an emergency. Senior staff had been out to assess the person and the assessment had been built upon after their admission. Staff said they got enough information about new people from reading assessments and care plans and talking to senior staff. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs were met in the way they preferred and the systems for managing medication ensured that residents received their medication as it was prescribed. Evidence: We looked at the care records for three residents as part of the case tracking process and others to check specific issues. Each resident had a set of care plans and risk assessments to support them to meet their personal and health care needs. The plans were all person centred and included a care plan action sheet, which summarised the support the resident needed to meet their activities of living. These provided good information about the residents likes and dislikes, and how they wished to be cared for. Each resident had a copy of the plan in their room which, the staff told us, were good for agency staff to refer to. Risk assessments and management strategies were in place to help residents to retain their independence and take responsible risks. Residents, or their representatives, could be involved in care planning and reviews if Care Homes for Older People Page 13 of 29 Evidence: they wished to. Care plans also indicated whether the resident had capacity to agree to their care. There were a list of dates to show that care plans and associated records were reviewed. There were no evaluation notes to summarise the care given or show the residents progress towards meeting their goals. Most of the plans we saw had been added to or amended to show changes in the residents needs or care but some had not. For example, staff had carried out dementia care mapping with two of the residents we case tracked. There was a list of recommendations for care on both reports but these had not been added to the plans. Permanent staff we spoke to were aware of most of this information and had incorporated it into daily care but this would not be readily available to agency staff. This could result in people not receiving consistent and individual care. Residents on the dementia care unit had a set of supplementary plans. The plans were pre-printed and there was a separate plan and directions to cover each area of need that may be associated with dementia. Most of the plans we saw had been personalised and they gave a good description of the difficult behaviour of individual residents. However, some of the plans were focused on identifying behaviours and triggers rather than giving staff directions to help the resident to manage the behaviour. Residents had assessments to monitor risks to their health. The moving and handling assessments we saw were very thorough. Throughout the course of the visit we saw staff using appropriate equipment and techniques to transfer residents safely. Nutritional risk assessments were up to date and there was a plan in place to assist one resident to gain weight. Residents with a history of falls were monitored. However, the risk assessments we saw did not score the level of risk or identify specific risk factors. This meant that the strategies for reducing falls might not focus on the areas which most contributed to the risks. Residents said that staff looked after their health. One person said, We get very good care here, and another person told us, I was very ill when I came here and they helped me to get better. There was evidence that residents ongoing health care needs were monitored and records showed that they were referred to outside professionals whenever necessary. Some of the senior staff had been nominated as dignity champions. This meant that they took the lead in ensuring that the principles of promoting dignity and other core values were always practiced by staff. During the course of the day we heard staff speaking to residents with respect. A resident told us, The staff are very polite and Care Homes for Older People Page 14 of 29 Evidence: patient with everyone. We saw some good examples of staff and resident interactions. For example, a member of staff showed particular skill in reassuring a resident, with dementia, who was distressed by enabling him to talk about what was worrying him. The systems for managing medicines were very well organised. One resident administered all their own medicines. There was a risk assessment and staff carried out regular audits to ensure that the resident remained safe. There were safe systems for ordering and checking in medication. Staff who administered medicines had received training and policies and procedures were available in each of the medicine trolleys for easy reference. Medicines were stored safely, in a clean and tidy area. There was good stock control. Residents had lockable cabinets in their bedrooms to store creams. Care staff signed when they administered the creams. The records we saw were complete and up to date. Complete and accurate records of medicines recieved, administered, carried over and disposed of, ensured that there was a full audit trail to show that residents received their medication as it was prescribed. Staff carried out daily audits of medication that was not in the monitored dose system, which helped to quickly identify any errors. There was clear criteria to help staff to give medicines that were prescribed, when required. Staff also recorded the reason each time they administered this medication, which we thought was good practice. There was also a record of the exact time painkillers and antibiotics were given to ensure that there was a safe gap between doses. Some medication administration record charts were handwritten. These were not double signed to evidence that they had been checked to reduce the risk of transcribing errors. Controlled drugs were stored, recorded and administered safely and in accordance with the policy. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily life in the home matched most residents expectations. Evidence: Most of the residents we spoke to said they were happy with the home and the service. One resident told us, I felt at home straight away. Another said, It is wonderful, I like it because everyone is always smiling. The care records we looked at included information about the residents past social and family history. A member of staff said they looked at these to find out information about the resident and give them things to talk about. Another member of staff said that by using the information they had found out that one of the staff team came from the same area as the resident, which had helped them to form a bond. The residents we case tracked had a social care plan. However, there was very little information about the residents current interests or abilities and they were not used to plan an individual programme of activities or occupation. Two staff had been nominated to take a lead in organising an activity programme, in addition to their caring role. There was a weekly programme but this was not on Care Homes for Older People Page 16 of 29 Evidence: display in areas accessed by residents. Staff told us that hardly any of the planned sessions took place. The records of activities showed some one to one and small group activities but these were not every day and only involved a small number of residents. One of the residents we spoke to said, We have an odd party but there is nothing going on regularly. Another said, They have bingo once a week but I dont think there is anything else. We observed staff sitting and talking with residents when they had time but other care tasks took precedence. The annual quality assurance assessment (AQAA) indicated that one of the plans for the service was to improve the opportunities for staff and resident interaction. Staff told us that residents were able to take control and make choices about their day to day lives. Risk assessments were in place to support residents who made decisions that could adversely affect their health or safety. For example, decisions about medication. There was information throughout the care plans about residents likes, dislikes and preferences in all aspects of their daily lives. It was apparent that staff used this information when assisting residents. Staff also told us that this information helped them if they needed to make choices on behalf of residents who were not able to communicate. There were some staff led routines but generally these were flexible. A resident told us, There are no more rules than necessary. The flexibility of open visiting helped residents to maintain contact with their family and friends. Some residents went out regularly with their families. Others had less opportunities to make use of community facilities, although a resident told us that there were occasional outings. There were regular religious services held at the home for residents who wished to attend. One person told us that he felt that staff respected his spiritual beliefs. Residents did not have any involvement in menu planning, which was done centrally for all the county council services. The temporary manager said there were channels for residents and staff to be able to make suggestions for changes to the rotating menu. The majority of the residents we spoke to said they enjoyed the meals most of the time. One resident said, The food is first class. Another told us that most days she would give them 8 out of 10. However, staff told us that there had been some recent negative feedback about the food and this was confirmed in the minutes of the last residents meeting. The temporary manager told us that steps had been taken to address these issues. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were dealt with appropriately and procedures and training were in place to help to ensure that people were safeguarded from abuse. Evidence: Residents received a summary of the complaints procedure in their service users guide. It explained the first step of the process and gave contact details for the complaint to be taken further. However, there was no complaints procedure or leaflets on display in the home. This meant that people visiting the home would not have access to the procedure. Those residents we asked said they would feel able to talk to the staff if they were not happy about the service. One resident told us, I would not be frightened to make a complaint. Another said, I would feel comfortable talking to one of the senior staff. In the past year there had been eight complaints, relating to care practices and food. They had been investigated in accordance with the complaints procedure and all had been partially, or completely, upheld. Most of the responses showed that positive action had been taken to prevent recurrence of the issues. The AQAA told us that there had been four referrals to the adult protection team in the past year. Only one incident, which involved the potential abuse of one resident by another, had been accepted and investigated according to the safeguarding procedure. Care Homes for Older People Page 18 of 29 Evidence: It was apparent from discussion with senior staff and managers that the service had learnt from the incident. All recommendations from the investigation had been put into place. For example, one recommendation was to improve the way serious incidents were reported outside of office hours. A new procedure had been drawn up, which gave staff a very clear process to follow. Staff had also received updated safeguarding training and those we spoke to were all clear about their responsibility to report any suspected or actual abuse immediately. Changes had also been made to care documents and observation of residents, which should minimise the risk of similar incidents happening in the future. Senior staff had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards. This was due to be cascaded to other staff to to help them to understand the implications of the legislation with regard to care practices and the residents currently accommodated. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and well maintained and the standard of decor and furnishings provided people with a comfortable and homely place to live. Evidence: The home was split into five units. Each area had at least one lounge and a small dining area. There was a main dining room on the ground floor, which most residents used for their main meal. The dementia care unit was separated from the rest of the home by a key coded door, which protected residents on this unit from leaving the home unescorted. Residents could freely access the other four areas. From a tour of the building it was evident that the home was in a good state of repair. There was an on-site maintenance person who carried out small repairs. At the time of our visit work was being carried out to replace the staff call system. In addition to enhancing communication between staff and residents in their rooms, the new system incorporated several safety features. For example, it would alert staff when residents, who were at risk of falling, were up during the night. The AQQA told us that there had been some redecoration and renewal over the past year. For example, two bathrooms had been refurbished and overhead tracking had been installed to assist people who were not mobile. There was a plan to continue with Care Homes for Older People Page 20 of 29 Evidence: redecoration of the communal areas and upgrade other bathrooms. There were low surface temperature radiators throughout the building. Some of the ground floor windows on the dementia care unit had restricted opening, which provided safety and security for the residents. Other windows were not restricted but we did not see any assessments to show why these were not considered to pose a risk. All bedrooms were for single occupancy. There were no en suite facilities but there were ample toilet and bathing facilities on both floors. Most residents had personalised their rooms with ornaments and pictures of their taste. All the residents we asked said they liked their rooms. One told us they had been given a bigger room because of the equipment they needed. Another said, I am very happy with my room, there is plenty of space for my clothes. At the time of the visit the home was clean and free from offensive odours. Residents told us it was always like that. One said, They have made it very nice; very clean. The laundry was tidy and organised. We received two mixed comments about the laundry. One person told us it couldnt be faulted. Another said that they sometimes had to wait a long time for their clothes to be returned, which caused them some anxiety. The manager told us she would look into it. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures provided safeguards for residents and the level of staff training meant that staff had the knowledge and skills to meet peoples needs. Evidence: Staff were rostered to work on a specific unit for the duration of a shift. There were three staff on the dementia care unit throughout the day and one person at night. The other four units had one carer on each during the day and two to cover the four at night. The care staff were supported by the manager, care co-ordinators and senior care staff. The manager had some flexibility to roster an extra member of staff on a temporary basis should this be necessary. The staff we spoke to said that there were generally enough staff. However, they confirmed that residents, who needed two staff to assist them to move, sometimes had to wait until a member of staff from a neighbouring unit was free to help them. This also meant that units would be left unattended for periods of time. At night there were only two care staff to cover the four units and also to do any laundry that was left over from the day time. This meant that there would be occasions when there was only one member of staff available to cover the four units. The night staff on the dementia care unit remained on the unit. Residents had mixed views about the staffing levels. One told us how staff shortages impacted on the flexibility of routines. They Care Homes for Older People Page 22 of 29 Evidence: said they went to bed at 6.30 because that was the time staff could fit them in, otherwise they would have to wait until after all the staff had their breaks. Another said, They are very often short of staff, which means they are always in a hurry, sometimes I feel I am being rushed. Some of the other residents we asked said they had to wait for staff attention but others said they had not experienced staff shortages. We discussed these comments with the manager, who agreed to review the staffing levels by using the new staff call system, which could audit frequency of calls and waiting times. There was a high level of agency staff. The service were using the same agency and tried to book staff who had become familiar with the residents to assist with the continuity of care. The manager told us they were currently recruiting into a number of posts, including relief staff, which should resolve some of the difficulties. New staff were employed in accordance with the robust procedures of the county council. The manager told us that staff did not start work at the home until they had received satisfactory pre-employment checks, which helped to provide safeguards for residents. New staff completed a thorough induction training programme, which covered the standards of the national training organisation. The programme was delivered through a mix of taught sessions, self study and mentoring, which helped to make sure that staff had opportunities to discuss and clarify elements of the training. A member of staff said, The induction was very informative, it gives the essentials and then you carry on learning every day. The manager described a system that was being introduced to assess the induction training needs of staff who had already completed induction training or NVQ at other establishments. Staff told us they had mandatory training and there were good opportunities for other training relevant to their roles. The records showed that most staff had received refresher training in the safe working practice topics over the past year. Other courses included, dementia care courses of varying depth, palliative care and dealing with complex behavioural needs. One of the care co-ordinators took the lead on staff training and there was information about courses and articles of interest on display in staff areas. The AQAA told us that there had been improvements in NVQ training over the past year and over half of the care staff were qualified to NVQ level 2 or above. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was run in the best interests of the residents and their health and safety were promoted and protected. Evidence: Since the last key inspection the registered manager had left and the service had two temporary managers, one of whom was present during our visit. We were told that a new manager had been appointed and was due to start in August this year. Despite these instabilities, the robust management and administration systems of the county council were being followed. Staff and a resident told us that the home was, organised, and run really well. There were systems in place for monitoring the quality of the service. For example, the annual questionnaires were due to be collated and the results published in the next month. We were told that the action plan from last years results had been completed. The minutes from the last residents meeting showed that residents discussed issues Care Homes for Older People Page 24 of 29 Evidence: that were important to them and that these were acted upon by the manager and staff. The meetings were also used as a forum to keep residents up to date with any issues about the management of the home. For example, at the last meeting the manager discussed how she was trying to reduce the number of agency staff. There were a number of internal audits of procedures and systems. The AQAA told us that there were a number of Norfolk county council policies that had not been reviewed for some time and it was not clear whether they still reflected current best practice. Residents who were not able to manage their own finances were usually supported by their families or other representatives. A number of residents had small amounts of money held at the home for safekeeping. The manager had safe systems for recording money handled on behalf of residents. We checked a small sample of records and found them to be accurate and complete. Fire safety records were up to date and staff had received fire training. The AQAA told us that the maintenance of some of the equipment in the home was not up to date. During the visit we found that most of this had been carried out but the records relating to maintenance of the electrical circuits could not be located. The home had three recent power cuts, which had been investigated by the electricity supplier. The cause had been identified as an overload to one of the circuits. The manager was negotiating with upper management and the electricity supplier for major work to be carried out as soon as possible. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be kept up to date and amended to show any changes in needs or care to be given. To ensure that staff have accurate and up to date instructions and do not have to rely on verbal instructions. 31/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 1 9 12 16 Information about the home should be reviewed and brought up to date. Handwritten entries on MAR charts should be witnessed to reduce the risk of transcribing errors. There should be sufficient group or individual activities to meet residents social and recreational needs. The complaints procedure should be on display in the home to ensure that visitors to the home know how to make a complaint. Windows without restricted openings should be assessed Page 27 of 29 5 19 Care Homes for Older People with regard to any security risks they pose. 6 27 Staffing levels should be monitored to ensure that there are sufficient staff on duty at all times during the day and night, taking into account the layout of the building as well as the needs and dependencies of the residents. Policies and procedures should be reviewed so that staff can be sure that they reflect current practice. Certificates to evidence servicing and maintenance of equipment should be kept in the home. 7 8 37 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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