Care Home: Bedford Park Care Centre

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What the care home does well Good information is available to people to help them decide if the home will suit their needs. Admissions to the home are well managed, ensuring that people`s needs are assessed and that people are made to feel welcome during the settling in period. All people spoken with or contacted were satisfied with the care provided at the home, many were more than satisfied. Improved care plans ensure that people`s health and personal care needs are met. The home works well with other health professionals to ensure people have access to good health services. People told us that their dignity and privacy was respected and that they were supported to be as independent as possible. People seen during an observation were being engaged by staff appropriately and this was being done with regard to their dignity and privacy. Staff were discreet in asking people if they wished to use the toilet and in giving support to moving and reposition. People were called by their name at the start of each interaction to help re-orientate those with memory problems, and keep them included in the conversation. Information on people`s communication needs and how this could be supported was detailed in their care files. The staff seen understood people`s needs well and demonstrated genuine affection in the support they delivered. People enjoy a flexible routine, which suits their needs and most people enjoy the social life and activities at the home. Families and friends are encouraged to visit regularly. People told us they enjoyed the food. People told us they felt confident that they could raise any concerns or complaints with the management and these would be dealt with satisfactorily. People living at the home are protected from abuse by well trained staff who have appropriate attitudes towards them; systems are in place to ensure that people`s financial affairs are protected. The home is well maintained. Communal areas are decorated and furnished to a good standard. People living at the home were very happy with the environment. Bedrooms have been personalised and people have been encouraged to bring furniture and personal effects in order to make their rooms feel homely. Staffing levels are good and people told us their needs were met. Staff feel well supported and most receive a good level of training, including regular updates in all health and safety related topics. New staff receive good induction training to ensure they can do their job safely. The management of the home is open and inclusive. Good systems are in place to ensure that people living at the home "have their say" and can influence the service provided. Health and safety of people living and working at the home is promoted, with systems in place to ensure good practice. What has improved since the last inspection? A substantial amount of work had gone into improving and updating care plans within the whole home. Since the last inspection procedures medication practice has much improved ensuring people get the correct medication at the correct times and it is securely stored. Increased staffing means that activities and social profiles are now improved and generally people feel safe and well cared for. Staff have also had more training and feel more confident in the work they do. Staff attitudes and morale has improved and this has impacted on the well being of the people they care for. The general environment has improved throughout the home, this is ongoing. The recruitment processes at the home are now more robust. Health & Safety issues identified at the last inspection have been completed, this includes window restictors and furniture being securely fitted. What the care home could do better: Some areas of the care plans seen were not completed fully. This included falls risk assessments, moving and handling assessments and social histories. Some lifestyle choice information was available in the personal preferences plan in the care files, however this was not consistently completed across the files sampled. In the laundry some systems need improving to prevent cross infection. Throughout the home in many bedrooms overlay mattresses are used this could pose a danger to people slipping from their beds and they should be removed. Although there was evidence of some environmental adaptation to support people with memory or communication problems, the home would benefit from more. The Registered person must be sure that all staff, in particular agency staff, has up to date training. A better system should be put into place for managing peoples monies. Key inspection report Care homes for older people Name: Address: Bedford Park Care Centre Pearn Road Mannamead Plymouth Devon PL3 5JF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Caroline Rowland-Lapwood     Date: 1 7 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Bedford Park Care Centre Pearn Road Mannamead Plymouth Devon PL3 5JF 01752770477 01752785090 manager.bedfordpark@aermid.com www.aermid.com Aermid Health Care Properties Ltd care home 104 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: DE(E) Maximum registered 39 service users Maximum of 104 service users accommodated at any one time OP Maximum registered 65 service users PD(E) Maximum registered 39 service users Registered for 65 years and over Date of last inspection Brief description of the care home Bedford Park Care Centre comprises of three separate units known as the Manadon Gardens (Nursing Unit), Compton Gardens and Pearn Gardens (Residential Unit). All units are laid out over two floors with wheelchair access via ramps or passenger lifts. Care Homes for Older People Page 4 of 32 Over 65 39 65 39 0 0 0 2 6 0 6 2 0 0 9 Brief description of the care home Bedford Park care centre is situated on the outskirts of Plymouth close to local amenities. Staff within Manadon Gardens provide 24 hour nursing care to a maximum of 38 people. Staff within Pearn Gardens provide personal care to a further 38 people and staff within the Compton Unit are able to provide personal care to a further 26 people. People with dementia are cared for in all units. The maximum number of people at the home should not exceed 104. Communal rooms are available in each unit and the home benefits from large landscaped gardens, which are accessible from Pearn Gardens. Manadon Gardens has a sheltered patio area and people within the Compton Unit are able to access both areas when staff are free to accompany them. The home is owned by Aermid Health Care Group PLC a national care home provider (www.aermid.com). The current weekly fees vary according to their needs and whether they require residential or nursing care. All people living in the home are issued with a contract breaking down the fees so people can see who is paying what. The last inspection report and Statement of Purpose are on display in the entrance foyer to each unit. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced inspection visit was carried out over a period of six hours. Three inspectors and a pharmacy inspector were present. To help us understand the experiences of people living at this home, we used the services of an expert by experience. These people have experience of using services, and they join some inspectors to help us get a good picture of the service from the viewpoint of the people who use it. Experts by experience can provide a unique contribution to the assessment of quality. On this occasion the expert by experience spoke with several people about the social activities and food at the home, he also had lunch in the dining room with several people and looked around the home. His observations and findings are contained within this report. During our visit we looked closely at the care planned and delivered to five people. The home provides care for people with a dementia related illness and some people do not have the capacity to communicate fully or understand the inspection process. We spent Care Homes for Older People Page 6 of 32 a period of two hours in the nursing support area of the home observing and recording the care being delivered, the activities and stimulation people received and how well staff were able to engage with the people there and support their needs. Some of these people had difficulties with communication or memory loss and so were unable to give us direct feedback verbally about their experience of being at the home A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. The outcome of the inspection was discussed with the manager. CQC surveys were sent to people living at the home and their relatives, and to staff and outside professionals. Completed surveys were received from 7 people living at the home; and 3 staff expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? A substantial amount of work had gone into improving and updating care plans within Care Homes for Older People Page 8 of 32 the whole home. Since the last inspection procedures medication practice has much improved ensuring people get the correct medication at the correct times and it is securely stored. Increased staffing means that activities and social profiles are now improved and generally people feel safe and well cared for. Staff have also had more training and feel more confident in the work they do. Staff attitudes and morale has improved and this has impacted on the well being of the people they care for. The general environment has improved throughout the home, this is ongoing. The recruitment processes at the home are now more robust. Health & Safety issues identified at the last inspection have been completed, this includes window restictors and furniture being securely fitted. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides good information to people, which enable them to make a choice about whether the home will suit their needs. Good systems are in place to ensure that peoples needs are assessed and can be met prior to moving into the home. Evidence: People spoken with during this visit told us they were happy living at the home, one said, Its fine here, it suits me well. The home uses an assessment as a way of getting information about peoples needs and preferences before they move to the home. This helps to ensure that individual needs can be met. We looked at three assessments, all gave good information about peoples abilities, needs, usual routines and preferences to enable staff to plan and deliver care appropriately. The home does not provide intermediate care. Care Homes for Older People Page 11 of 32 Evidence: Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an improved care planning system , which provides the staff team with the information needed to enable them to support people in a way they prefer,however more work needs to be done to ensure that all aspects of the care plan are completed. Peoples health needs are met and the management of medication is generally satisfactory. People feel they are treated with respect and that their privacy is upheld by caring staff. Evidence: Staff informed us that a substantial amount of work had gone into improving and updating care plans within the whole home. Staff also informed us that it is the ultimate plan was to make care plans more person centred, but this was working progress at the moment. Two care plans were inspected within Compton Gardens. One care plan was an old style care plan and one care plan had been changed and updated in line with the new structure of care plans. Both documents were well written and contained evidence of monthly reviews. Each care plan contained admission information, communication Care Homes for Older People Page 13 of 32 Evidence: with families, arrangements in the event of death, for medication history, financial details, involvement of health care professionals, and a full range of assessments. Each care plan contained a dependency profile which had been reviewed monthly and showed changes in the persons dependency. Care plans seen included plans for elimination, breathing, sleeping, communication, nutrition, eating, mobilisation, moving and handling, falls, hygiene, comfort, tissue viability, expressing sexuality, psychological issues, and skin assessment. The new care plans contained a life story highlighting significant events in the persons life. The new care plans also included a list of activities the person had been involved in. These included nail care, skittles, looking at a book, bingo, painting, and coffee afternoons. All documents seen on the Compton garden unit will well written, secure, dated, and signed with no evidence of gaps. Care plans also contained evidence that people are able to access health care services in the community. Where this is not possible healthcare is provided at the home by external health care professionals. Examples included district nurses, general practitioners, phlebotomist, podiatrists, and dentists, examples were also seen where people attended local hospitals and also had access to immunisation programmes. Records of monthly observations were performed to ensure peoples blood pressure, pulse and weight were monitored. Risk assessments were also present and included risk assessments for falls, skin assessment dependency, nutritional assessment is and observations. Two care plans within the Manadon unit were also inspected. Staff explained that all care plans on the Manadon unit had been updated with the new structure. Both care plans contained the above information and were also well written and contained evidence of a monthly review. Both care plans also highlighted the personal preferences of the person, however not all documents had been completed. Both care plans also contained paperwork for conducting life stories these also had not been completed.One persons file seen contained charts to detail behaviours that were challenging to staff and others. These should be regularly audited and proper protocols in place to manage behaviours consistently. Also some other areas of the care plans seen were not completed fully. This included falls risk assessments, moving and handling assessments and social histories. Staff were enthusiastic about the many changes that had occurred since the last inspection. One member of staff said the culture has changed, it still needs work but were getting there. Another member of staff said we have had a lot of new staff but its been really good. The plan to make care plans more person centred should continue. People seen during the observation were being engaged by staff appropriately and this was being done Care Homes for Older People Page 14 of 32 Evidence: with regard to their dignity and privacy. Staff were discreet in asking people if they wished to use the toilet and in giving support to moving and reposition. People were called by their name at the start of each interaction to help re-orientate those with memory problems, and keep them included in the conversation. Information on peoples communication needs and how this could be supported was detailed in their care files. The staff seen understood peoples needs well and demonstrated genuine affection in the support they delivered. People had varied opinions about the staff saying, Most are quite good but some are not so good, Some are better trained than others, Very nice people, Yes they seem to know what they are doing. The consensus was that the staff were helpful and gentle when giving assistance but Always very busy and pushed. The response to the call bells was said to be generally within 5 minutes or less except at night when, with fewer staff available it can take up to 15 minutes if they are busy. No one made any adverse comments about members of staff. There was no evidence of care being given other than behind closed doors. People appeared relaxed, clean and well groomed attired in freshly laundered clothes. We looked at arrangements for storing and giving medicines in the home. We checked the records that are held in the home for medicines given to people, and discussed how medicines are handled with the manager and other staff working in the home. Sometimes people can look after their own medicines, although there are no people doing this at the moment. We watched some medicines being given to people in the home and saw that they are given using a safe method. There have been improvements to the way medicines are handled in the home since the previous inspection. There are separate storage areas for medicines in each unit and we found that medicines are stored safely for the protection of people in the home. There are suitable arrangements for keeping controlled drugs and any medicines requiring cold-storage. Temperatures in the rooms and refrigerators are monitored which helps to show that the medicines are stored correctly, and will be safe and effective for people. We saw an oxygen cylinder stored in one unit, but no oxygen signs are in place. Most controlled drugs are correctly signed out of the register with two staff signatures, but we found two entries in the register where controlled drugs had not been signed out when they were destroyed or removed from the home. All controlled drugs destroyed or removed should be signed out of the register, by two members of staff Records are kept of medicines received into the home, and of any unwanted medicines Care Homes for Older People Page 15 of 32 Evidence: that are sent for destruction. Records are kept of medicines that are given to people, and new charts have been introduced to record creams and other external preparations that are applied. Records are generally well completed, although on one unit we found a medicine chart where two medicines are signed as both being given, despite a written warning on the chart that they should not be given together. We were informed that only one of the medicines is currently being given, but this shows that this medication chart was not being accurately kept. We looked at some care plans to see what information was recorded about peoples medicines and found that the plans contained information to help staff administer medication correctly to people, particularly when medication is prescribed to be given when required. This helps to show that people receive their medication in the way their doctor has intended for them. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines are flexible and people are supported to exercise control over their daily lives. Social activities meet some peoples expectations and preferences and people benefit from contact with their family and friends, which is encouraged and supported by the home. Meals at the home are enjoyed and provide a nutritious variety. Evidence: Bedford Park care centre has introduced a quarterly newsletter. The November issue contained information regarding the recent summer fete, the renaming ceremony of each unit, the fundraising events, a local trip out, a poem, and future announcements regarding the Christmas party regular shopping trips and planned purchase of sensory equipment. The newsletter also informed people regarding new staff within the unit and congratulated people on birthday celebrations. Posters were displayed reminding people and relatives about a forthcoming residents meeting. Discussion was also held on the activities provided and on making these more person centred. As an example in one unit the persons activity plan had been completed to show that they had been offered opportunities to take part in bingo and music Care Homes for Older People Page 17 of 32 Evidence: sessions but that they had consistently refused to participate. A more person centred approach would be to identify activities the person wished to undertake and support the person to access those. No one spoken to could recall trips out other than with relatives but the manager gave examples of shopping trips and visits to places of local interest using the Centres minibus which can take two wheelchairs and four passengers in addition to staff. There are two dedicated activity organisers (with another two currently being recruited) and their duties include one-to-one sessions as well as a wide range of group activities including, Movement to Music, Dominoes, Reminiscing, Armchair Darts, Singalongs, Quizzes and Bingo. The activity organisers also undertake individual Nail care and Hand massage. Outside entertainers also visit on a regular basis. Without exception people spoke well of the food. None could recall ever being specifically asked what their favourite meal was. Comments included, Food is good here although not like at home, Food pretty good, alternatives always available if I do not like the two main choices, Well looked after for food, Food satisfactory, Food very good and plenty of it, Seconds are always on offer, and Food very nice, cant grumble about it. On the day of the inspection the menu choice was either sausage casserole with mash potatoes and peas or ham, egg and chips. In fact several variations of these items and other alternatives were served. Pureed food was served in identifiable portions. The meals looked attractive, were tasty and hot. Dessert was a choice of an excellent Jam Sponge with custard, fresh fruit, yoghurt or ice cream. No one in the two dining rooms visited needed assistance with eating beyond having their food cut up. Staff serving meals checked the menu selected with the diners by taking around and showing sample plates of the two main meals. Carers checked with diners before removing plates. People chose where to eat their meals. All meals and cakes are freshly cooked on the premises and the fresh vegetables for the evening meal of beef stew were seen being prepared. The alternatives for the evening meals are various sandwiches or a variety of items on toast plus cake and dessert. According to the chef of 6 months standing, all meat, fish, vegetables and fresh fruit is purchased locally with dry goods being sourced from a national wholesaler. Most people said they followed a set routine which was of their own choice with some preferring to remain in their room most of the time or perhaps until lunchtime when they went to the dining room and then to a lounge for the afternoon. Others spent the day in a lounge. People said they choose their own time of retiring and rising with some enjoying breakfast in their bedroom whilst others regarded walking to the dining room as part of their daily exercise. The bathing regime was acceptable with some Care Homes for Older People Page 18 of 32 Evidence: having one and others two baths per week. Visitors are said to be made very welcome by the staff and are offered refreshments and meals. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their complaints will be listened to and staff understand the principles of adult protection, which helps to protect people from abuse. Evidence: All people responding with CQC surveys knew how to make a complaint and knew who to speak with should they have any concerns. Relatives were also aware of how to make a complaint. Records show that the home has received complaints since the last CQC inspection. These were dealt with in a professional way. The Commission has also received complaints about this service, they also have been dealt with in a professional and timely way. Training records showed that staff receive adult protection training to ensure they are aware of the issues and know who to raise any concerns with. Staff spoken with showed they had a good understanding of adult protection matters and understood their personal responsibility to report incidents of concern. The home has provided some in house training and is waiting for the local authority to provide some dates for more detailed training in adult protection. People spoken with confirmed that they were happy living at the home and all said they felt safe at the home. Care Homes for Older People Page 20 of 32 Evidence: Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a good standard of accommodation that is attractive, clean, homely and generally well maintained. The laundry is well organised though one area of its management could pose a risk of cross infection. Evidence: A full tour of the building was conducted. This showed that many areas of the home were subject to a planned refurbishment programme. Staff informed us that a substantial deposit had been made by the organisation to secure refurbishment throughout the home. On the day of inspection five new sluices had been delivered and were in the process of being fitted throughout the home. Staff from each unit gave us a tour of the building. Within Pearn Unit, the entire upper floor on one wing was not being utilised. This wing was in the process of being redecorated and had been fitted with new carpets throughout communal areas. Staff informed us that new divan beds had been purchased for this unit, and one highly low bed had been purchased for people with more severe mobility issues. Staff also informed us that since the manager had been replaced in Pearn unit many areas had been organised more efficiently. The entrance area of the unit had been tidied with new plants positioned to make the environment more welcoming. The lounge layout Care Homes for Older People Page 22 of 32 Evidence: had changed, providing a more domestic in style layout. New chairs had been purchased for the lounge area and further plans were discussed. The kitchen had also been subject to improvements. Broken equipment noted at the last inspection had been repaired, new equipment such as jugs cutlery and crockery had been purchased. Storage areas within the kitchen was tidier and more organised. The kitchen manager informed us that he had just completed his food safety level III training. He informed us that his course tutor visited the kitchen to perform an audit to ensure good practice. The kitchen was clean, tidy and well organised. Fresh fruit and vegetables were available and freezers and fridges were well stocked. The dining area within Pearn unit had also been tidied and repainted. Staff informed us that new flooring had been booked and the new tablecloths had proved popular with people who said it looked very nice. The Pearn unit also has a hairdresser who has a designated salon. This salon had been fitted with new flooring and new equipment. Storage areas within the home had improved and new store cupboards had been provided. Staff informed us that the managers office was now downstairs within the home and was located centrally within the Manadon unit. staff said this had proved popular with relatives and staff alike. The previous managers office was now being used as a secure archive room. A tour of the Manadon unit also highlighted improvements. Staff are keen to show that the new call bell system which is fully auditable and easy to use. The dining area within the Manadon unit had also been refitted with new flooring. New chairs and furniture and carpets had also been fitted in the lounge area. Staff showing us around Compton Gardens informed us that no improvements had been made within this unit to date. Staff informed us that new chairs had been purchased and had been placed within Compton Gardens lounge area, but these had been later removed on instruction from a director within the organisation. Staff within the Compton Gardens commented that of the they felt they were last on the list of improvements, and this hit home when the chairs had been removed. Staff were appreciative of all the changes that had been made to date, and said they felt valued because their workspace was being improved. Care Homes for Older People Page 23 of 32 Evidence: Although there was evidence of some environmental adaptation to support people with memory or communication problems, the home would benefit from more. The manager confirmed this was on their plan for the future. Current adaptation includes pictures on bathroom and toilet doors of what the room is for, and names on doors. In one room the bed comprised only an overlay pressure relieving mattress on a wooden bed with a slatted base. There was no mattress in place under this overlay as there should have been. Many of the beds had oversized overlay mattresses on, this is hazardous and they must be removed. In the laundry, although dispersible bags were being used for soiled linens, bed pads or clothing that had become wet with urine were left in open bags in the laundry area. This is also an area where clean clothes are stored waiting to be returned to peoples rooms. This presented an infection control risk. People spoke very highly of the laundry, which is sometimes returned the same day and always placed in the wardrobe or drawer by the laundress. Comments included, Laundry is now excellent, The laundry girls are very good, very special girls, and Laundry good. Our Expert by experience toured the building his observations were that the home was clean and free from unpleasant odours. The decor was in a good state of repair. Bedrooms had been personalised to a greater or lesser degree by the occupant. People said they were pleased with the standard of cleanliness with several complimenting the cleaners. A visitor said, The cleaners are terrific girls. The 3 entrance doors have coded keypads, visitor books and antiseptic hand gel. The garden is huge, wheel chair friendly and has several seating areas with views to distant Dartmoor. The area to the rear of the car park contains a large accumulation of discarded furniture and electrical items detracting from the otherwise well kept appearance of the site. Care Homes for Older People Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are sufficient to ensure that peoples needs are met in a timely way and experienced and friendly staff support people. Although people are protected by the general recruitment practices followed, these could be improved by ensuring outstanding requirements have been met. Permanent staff are well-trained, but improvements in systems would show that agency staff have up to date mandatory training. Evidence: One member of staff said staffing has been a real issue, weve had a lot of staff go, some have been told to go, and some did not like the changes. We have had a lot of agency and that caused some problems but they are getting new staff are all the time now so hopefully it will improve. Staff informed us that staffing levels had not been an issue in recent months, because the home had not been full. Staff did talk about high agency usage but also said that the same agency staff tended to work regularly. The agency used at the home provide a staff profile of training and identification of each member of staff that comes to the home. This information we were shown Care Homes for Older People Page 25 of 32 Evidence: indicated many of the staff profiles were out of date with mandatory training, which included moving and handling. A discussion was held with the manager regarding the importance of ensuring all staff, whether temporary or permanent have suitable training when working in the home. A discussion was held that the staff may have had updates in the training but the manager was informed that it was homes responsibility to ensure this is in place. Staff files had improved since the last inspection. The construction of staff files was more robust. Each member of staff had a separate folder containing relevant information including recruitment information and training information. Five staff files were inspected and showed that the majority of information was present in staff files. One file did not contain evidence of criminal records bureau check. Later discussion with the manager confirmed that this had been requested and received but mislaid somewhere within the home. Registered nurses employed provided information of having a current valid registration with the nursing and midwifery Council. All staff files contained an application form, two written references, forms of identification, health declarations, interview records and details of induction. Home office information was provided for staff who were from overseas. Not all staff files contained a photograph. Staff were overwhelmingly positive about the increasing training in recent months. Comments such as training has really taken off we are all trained out and we have training coming out of our ears at the moment. the majority of staff had received all mandatory training with the exception of one or two spoken to, who confirmed that training had been booked or was been booked in the near future. Discussion with one unit manager confirmed that is different training providers have now been sourced and a new training room has been provided. The unit manager informed us that the managers had attended training to ensure that the providers were delivering high-quality training for their staff. The manager provided a training matrix which highlighted some gaps in mandatory training but were in the process of being addressed with the new training providers. Everyone said that they had a good relationship with the staff commenting, Staff kind and gentle, I get on with the girls very well,they are very good, Girls are very good,as is the fellow we have sometimes, Lots of different ones now but they are all very good, and The girls are pretty good now. The perception was that there were not enough staff. A visitor comparing the present staff with past employees and management said, things are much better now. People said they were confident they could speak with the Unit Managers and the Registered Manager and they would listen and take any necessary action. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, with good systems in place to ensure that peoples views are sought and acted upon. Health and safety within the home is promoted meaning people live in a safe environment. Evidence: The manager (Carol Edwards) is professional and carries out her duties and responsibilities effectively. She has several years experience of running a registered care home. Staff were very complimentary about all managers in the home. Staff in Compton Gardens talked of the change of manager; they said is was not too much of an issue, because the new manager used to be a care superviser previously, and had the same work ethic and standards as the manager who had been popular within the unit. Staff said the new manager was proving to be popular. Staff within the Pearn unit were very complimentary about their new manager. One member of staff said she is really organised, very approachable and will soon let you Care Homes for Older People Page 27 of 32 Evidence: know if youre not doing anything right. Another member of staff said this new manager is there all the time and has even worked with us on the floor so we could get to know her. Staff in the Manadon unit informed us that they were aware a new unit manager had been recruited but had not started work yet. The manager of the home informed us that a unit manager with nursing qualifications in general nursing and mental health had been recruited for the Manadon unit and he was due to commence work in the very near future. All staff will complimentary about the overall manager of the home and said she had been supportive and introducing many great changes. The home has established quality assurance systems, which ensure that the service is managed and developed in the best interests of the people living there. Surveys are sent to people living in the home, relatives and outside professionals. The management team take the necessary action within agreed timescales to implement requirements identified in CQC inspection reports. The home looks after some peoples personal monies. Some people choose to look after their own money and are encouraged and supported to do so. A record is kept of any bills paid on behalf of people, such as hairdressing or chiropody etc.We looked at three accounts all were correct and were kept securely. These monies are only able to be accessed by the administrators and the manager, however when these people are not working the money is not assessable. This should be changed so that people are able to gain access to their money at all times. Staff told us they received regular supervision and support to help them do their jobs well. One staff member told us, Management give a lot of time & support to us. We have lots of information available & training. Health and safety at the home is managed well. The records we looked at showed that staff have received training and regular updates on all health and safety related topics. Records showed that staff had undertaken fire safety, first aid, manual handling, food hygiene, infection control, and health and safety training to ensure people work safely. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 29 19 The responsible person must 30/06/2009 ensure no staff work at the home until satisfactory checks and information is obtained the member of staff. This must include: a recent staff photograph. This will show that the recruitment procedure is robust and means that staff working with vulnerable adults have had a satisfactory checks performed. This will mean that people can be safe and looked after by people suitable to do so. Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be up to date and fully completed. This will ensure staff are aware of how to meet peoples needs at all times. 31/01/2010 2 19 13 All unnecessary risk to 28/02/2010 people living at the home must be identified as and far as possible eliminated; this refers to the use of over sized overlay mattresses. This will keep people free from the risk of slipping from their beds and risking injury. 3 26 13 Systems in the laundry must 31/01/2010 be improved to prevent any cross infection. This will keep people safe and well and away from cross infection. 4 30 18 The registered person shall ensure that all staff, 31/01/2010 Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action including temporary workers, employed within the care home have had up to date training training and appropriate to the work they are to perform. This must include mandatory training. This will mean that staff have the necessary information and training to care for people in a safe way and know how to respond in the event of emergencies. This will ensure people living at the home are cared for by people trained to do so. 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 9 9 29 All controlled drugs destroyed or removed should be signed out of the register, by two members of staff. Make sure formal oxygen warning signs are displayed where oxygen is kept in the home. The mislaid criminal records bureau check should either be located or repeated to show that satisfactory recruitment checks have been performed on all staff. Staff files should contain a recent photograph. Systems should be in place so that people can gain access to their money at all times. 4 5 29 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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