Care Home: Beenstock House

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What the care home does well The care home provides care specifically for older people of the Orthodox Jewish faith. It is providing a service to ensure the religious and cultural needs of these people are catered for in their daily lives. Kosher meals are provided by Jewish cooks and a variety of appropriate social activities are facilitated by volunteers from the local community and an art therapist. There are close links with the synagogue that is next door to Beenstock House and staff are respectful to people`s personal prayer times. Religious festivals are celebrated in keeping with the Jewish traditions and customs. Staff are very respectful to the people who live at the home and always address them using their title and name. People we spoke to during the visit were very happy at the home and relatives were pleased with the service provided. One relative said, "Obviously I would like to care for mother myself however I know I can go away feeling safe she is looked after by caring people." There is professional input provided by community nurses to ensure people`s health care needs are fully met including any necessary equipment. Medicines are well managed to ensure people receive what has been prescribed. Visiting professionals spoke positively about how the staff carried out any instructions. The internal and external premises are well maintained. The environment was spacious, very clean and comfortable. Each person has a large room with en suite shower and toilet facilities. People`s bedrooms are personalised with their own belongings, photographs and pictures. people who expressed a view were happy with their environment. One person said, "It is like home from home, I am very happy here." There are sufficient staff on duty to meet the needs of the people accommodated. Agency staff are used to keep the numbers of staff on duty to an acceptable level. What has improved since the last inspection? There have been a number of improvements since the last inspection. Since the last inspection the decision to appoint the deputy care manager as the care manager has been made. Improvements were seen in the detail provided in the pre admission assessments so staff had information about the person`s needs when they moved into the home. Some improvement were seen in the care plans and the risk assessments. Improvements have been made to some of the recruitment practices since the last inspection. Some more staff have had training in relation to the protection of vulnerable people from abuse and the manager has plans for more staff to undertake this. There is an ongoing programme of redecoration and changes have been made to make the environment more homely for the people living at Beenstock House. There is a record of any concerns or complaints made with a record of the action taken by the management. This shows that people`s complaints or concerns are taken seriously and are addressed. A sluicing disinfector has been ordered and planned for since the last inspection to reduce the risk of cross infection. There have been some improvements to a system for auditing the care plans, medicines, accident and incidents, complaints to make sure the good standard of care is maintained. A quality assurance survey has been developed and sent out since the last inspection. This has included the views of people at the home, relatives and their families, staff and other stakeholders to express their views of the service provided. A fire risk assessment that has been agreed with by the fire service has been put in place. The hot water temperatures are checked by staff before bathing a person. What the care home could do better: Areas identified for improvement during this visit include making the care plans more person centered and show clearly the detail of how a person likes and needs to be supported. Risk assessments should be signed and dated to show when they have been started from. There have been some staff who have attended training courses since the last inspection and this needs to continue to make sure more staff receive training. Staff spoken to were positive about the training they have done so far and found this valuable. The manager should submit her application to become Registered with the Commission. Key inspection report Care homes for older people Name: Address: Beenstock House 19-21 Northumberland Street Salford Gtr Manchester M7 4RP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Holt     Date: 1 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Beenstock House 19-21 Northumberland Street Salford Gtr Manchester M7 4RP 01617921515 01617921616 postmaster@beenstock.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Agudas Israel Housing Association Name of registered manager (if applicable) Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: A maximum of 15 older people (OP) requiring personal care only may be accommodated. One service user who is under the age of 65 requiring care by reason of physical disability (PD) may be accommodated. Should this service user no longer require the services offered by the home or reach the age of 65 then the place will revert to that of old age (OP). Date of last inspection Brief description of the care home Beenstock House is a care home registered to provide personal care for up to sixteen people. The home offers both long-term care and short-term respite care. The home was first registered on the 18th August 1999 and is owned by the Agudas Israel Housing Association and managed locally by Beenstock Home Management Company Care Homes for Older People Page 4 of 29 Over 65 15 0 0 1 1 6 0 2 2 0 0 9 Brief description of the care home Ltd. The home is is set in its own grounds in a residential area of Salford and is located next to a synagogue. The home offers a culturally specific service for Orthodox Jewish people. The residential home is integrated into a sheltered housing complex that comprises three floors, with sheltered flats on the ground and second floors, and the residential unit on the first floor. All bedrooms are single occupancy with en-suite facilities. Residents of the home and tenants from the flats share ground floor dining facilities. Ample car parking facilities are available and there are small well-maintained gardens and patio areas around the home. 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 visit was undertaken as part of a key inspection, which includes an analysis of the information received by the Commission in relation to the home prior to the visit. Before our visit we asked the manager to complete an Annual Quality Assurance Assessment (AQAA). This document gave them the opportunity to tell us what they do well, how they have improved since the last inspection in February 2009. People living at the home and staff were asked to complete survey forms to tell us what life is like at Beenstock House. We have received nine completed surveys from people who use the service and two surveys from staff. Comments from these surveys have been included in this report where possible. As part of this inspection an expert by experience assisted the inspector for part of the visit. The phrase expert by experience is used to describe people who have a Care Homes for Older People Page 6 of 29 knowledge of social care services. This person talked to a number of people about their experiences of daily life at Beenstock House. She completed a report after the inspection and where possible some of her comments and observations are included in this report. The visits took place over the course of 8 hours on Monday 11th and Monday 18th January 2010. The first visit was unannounced as they did not know we were going. During the course of the visits time was spent sitting and chatting with people who use the service, visitors to the home and staff on duty. During the visits we spoke to both the care manager and the general manager. Records were looked at in relation to the running of the home and health and safety and a partial tour of the premises was made. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? There have been a number of improvements since the last inspection. Since the last inspection the decision to appoint the deputy care manager as the care manager has been made. Improvements were seen in the detail provided in the pre admission assessments so staff had information about the persons needs when they moved into the home. Some improvement were seen in the care plans and the risk assessments. Improvements have been made to some of the recruitment practices since the last inspection. Some more staff have had training in relation to the protection of vulnerable people from abuse and the manager has plans for more staff to undertake this. There is an ongoing programme of redecoration and changes have been made to make the environment more homely for the people living at Beenstock House. There is a record of any concerns or complaints made with a record of the action taken Care Homes for Older People Page 8 of 29 by the management. This shows that peoples complaints or concerns are taken seriously and are addressed. A sluicing disinfector has been ordered and planned for since the last inspection to reduce the risk of cross infection. There have been some improvements to a system for auditing the care plans, medicines, accident and incidents, complaints to make sure the good standard of care is maintained. A quality assurance survey has been developed and sent out since the last inspection. This has included the views of people at the home, relatives and their families, staff and other stakeholders to express their views of the service provided. A fire risk assessment that has been agreed with by the fire service has been put in place. The hot water temperatures are checked by staff before bathing a person. 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 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. People are given information and have their needs assessed before deciding to move to Beenstock House, so they know their needs can be met. Evidence: Beenstock House is a large modern building situated in an area of Salford that is predominately populated with people of the Orthodox Jewish faith. There are 16 shelterd housing apartments on the ground and second floor and the registered care home is on the first floor. People who use the service are provided with information before the offer of a place is made. Information received from nine surveys showed that people had received enough information about the home before they moved in so they could decide if it was the right place for them. The manager stated they planned to develop a new brochure about the home during Care Homes for Older People Page 11 of 29 Evidence: the next twelve months to give more information about the services the home offers. In the AQAA the manager stated they can provide intermediate care, when appropriate, liasing with the Council services to provide rehabilitation. One person said, We already knew about the home because it is talked about in a positive way within our local community. My father came here for respite care first and so we already knew about the care provided. Referrals for places at the home come from Orthodox Jewish communities in the North of England as there are very few homes that cater specifically for their specific religious and cultural needs. A look at three pre admission assessments for people who were currently accommodated showed the home had gathered information about these peoples long and short term needs and the information was used to start the care plan. The manager knew the needs of the people accommodated well. Prospective people and their relatives were encouraged to visit the home and to join in activities before making a decision to move into the home. 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. People have their health, personal and social care needs met in a way that meets their needs for privacy and dignity. Evidence: The previous inspection report told us they were going to introduce a new care planning system that had an individual folder for each person. A new system of care planning had not yet been introduced since the last inspection however a care plan was available for each person. The manager stated she had reviewed the care plans and made improvements. The format for the care plans included an assessment, identified a persons need or a problem, then showed a goal with care instructions for the staff. Care plans included photographs of the person. As noted at the last inspection the people were treated as individuals with their personal needs and individual personalities. Staff always spoke to people in their preferred way. From discussions with staff, it was clear they knew each person well and were aware of their individual likes and dislikes. Staff were heard talking to people in a pleasant manner and one person was seen to be very patient in her dealings with Care Homes for Older People Page 13 of 29 Evidence: a person with poor mobility. Improvements were seen in the record keeping to enable staff to monitor the persons health and progress. Records included a persons weight and comments were seen if there were changes in this. Some shortfalls were identified, for example. The care plan for a person with diabetes stated the staff, should maintain acceptable blood sugars. There was no specific guidance for the staff and there were no risk assessments around the management of this persons diabetes for the staff. We discussed the need to make the care plan more person centered around the needs of the individual person. The instructions for the staff should show how they can give support where needed in line with the persons likes and dislikes. There were some examples of where a more person centered way of recording had been used, Keep eye contact and speak clealryand facial expression that can show relaxed and frown to show discomfort. Care plans included input from the GPs and any instructions or advice was recorded from other visiting health professionals. A GP visiting the service at the time of the visit was complimentary about the way staff carried out any instructions and the way they communicated with him about peoples needs. Before the inspection we sent surveys to people living at the home to ask their views of the home. Of the nine people who responded, people said there was always someone they could speak to informally if they were not happy. In response to the question, Do you receive the care and support you need? Seven people said always and two stated usually. One person added, The staff care well for the people in their management in every way. The evaluations were not always detailed to reflect any changes in care over the previous month. Risk assessments were in place in relation to nutrition, falls, pressure ulcers. These were not always fully completed, dated and reviewed so it was not always possible to tell how accurate and up to date the information was. Following a requirement made at the last inspection in relation to the risk assessment and management of bed rails. Two sets of bed rails were seen in place and both were fitted with protective covers. There were some shortfalls in the information looked at around the decision as to whether bed rails were appropriate for the individual. During the visit we looked at the management of medication to make sure people were given their medicines properly. As part of this we looked at a sample of medication administration records(MARS) and the accompanying medicines for each Care Homes for Older People Page 14 of 29 Evidence: person. A registerd nurse took the lead for the adminstration of medication and we found that medicines were given as prescribed. The MAR charts were clealry recorded. A sample of controlled drugs showed these were stored and recorded appropriately. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People found the lifestyle they experienced in the home, matched their expectations and preferences. Evidence: Beenstock House caters for the needs of older people from the Orthodox Jewish Community and provides support to ensure peoples religious and cultural lifestyle can be maintained when they are no longer fully independent. The home has a team of social/volunteers, led by an organiser who provide one to one chats and activities for people living at the home. Each person receives a personal programme of activities every week. On the day of this visit some people were pleased to see the plates they had painted recently which had just been glazed. Examples of art work were on display and one person stated Even though I do not really like to mix, I do enjoy the art class. The enthusiasm and interest the art therapist inspired in people at the home was clear from the work people had produced and were pleased with. In order to remind people when the classes started, the intercom system announced when activities were due to commence and people were seen to gather for a singing class which they said they enjoyed. People who expressed a view told the Expert by experience that they enjoyed the activities provided but also enjoyed having the choice to read quietly or to go out visiting others in the local community with support Care Homes for Older People Page 16 of 29 Evidence: as needed. People living in the home and the tenants of the apartments use the large dining room on the ground floor at mealtimes. People who prefer to dine in the privacy of their own room can if they wish. There is always a Jewish cook to provide kosher meals and strict dietary requirements are respected. People who expressed a view were pleased with the food provided and with the flexibility to meet their needs. The Expert by Experience enjoyed a meal with some people living at the home. The following observations were made, All staff serving food wore aprons and caps. A three course meal, with choice was offered to each person from the menu on display. Fruit juice and water was offered during the meal and a hot drink and fresh fruit was offered at the end of the meal. The food was well presented and was very tasty. After the meal, the opportunity for silent prayers was offered to individuals. The Expert by Experience made the following comments; she stated that all the people living at the home were pleasantly groomed and they said there was a nice atmosphere in the home. Some people said they had a choice of when they wished to go to bed and get up. Two people mentioned they would sometimes like more of a lie in but added they could take afternoon naps when they felt like. One person added, I do not think you can find a better place to live in and I appreciate it even more with the weather we have had. Another person said, There is nothing to be ashamed of here, it is like home from home, I can sum it up in two words, very good. Relatives and friends can visit at any time during the day and a policy regarding visiting was available. A room is available for relatives to stay overnight as necessary. There is a library in the building and people are assisted to visit the synagogue which is a very short walk away. Visitors spoken to during the inspection were positive about the care provided and the way their relative, friends were cared for. 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. People were confident their concerns and complaints would be taken seriously and people feel listened to. Evidence: A complaints procedure is available and a copy of this is on display. People spoken to said they were very happy with the home and they did not feel they anything to complain about. One person said, I would talk to the manager and get any issues sorted out before they became big. Following a requirement made at the last inspection, a log of complaints had been made available. This included the action taken by the manager to resolve and address any issues raised. All nine people who returned surveys said they knew how to make a complaint and any concerns were always responded to appropriately. A number of staff have received safeguarding training since a requirement made at the last inspection for this to be addressed. Staff spoken to were aware of the local procedures and of the action to take in the event of an allegation of abuse. The manager said she would address the shortfalls in staff training particularly in relation to the night staff. The homes induction also included information about the definitions of abuse and the course action for staff to take. Since the last inspection there has been one adult safeguarding investigation. This led Care Homes for Older People Page 18 of 29 Evidence: to a thermostatic control being placed on the one hot water outlet we were told did not have one. Water temperatures did not feel too hot to touch at the time of this visit. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean, homely, spacious, well equipped, pleasant surroundings. Evidence: The internal and external premises was clealry well maintained. Although covered in snow during this visit, people did comment how they have enjoyed spending time in the garden areas during better weather. A sitting area with lockable gates to allow people access to the outside is provided. Each person has a spacious bedroom with en suite facilities. The manager told us that they organise each persons room according to their wishes and do allow people to bring in personal items extra as long as it complies with the fire safety regualtions. The Expert by Experience made the following comments; The bedrooms are spacious and well lit. Rooms have an en suite shower/toliet facility which enables the persons privacy and dignity. An added feature is a curtain, a short distance from the door which can be drawn for added privacy when the door is left open, as required by the person who occupies the room. In relation to the cleanliness of the home, the Expert by Experience stated that All areas of the home were very clean. The home was clean, tidy and odour free on both of these visits. People who could express a view said they liked their bedrooms and the environment generally. People were pleased to have their personal possessions Care Homes for Older People Page 20 of 29 Evidence: around them and most people had photographs and pictures in their bedrooms. All the doors are linked to the fire alarm system so they can be left open if the person wishes but will close automatically if the fire alarm is activated. The CCTV monitors the exterior of the building and the entrance area and a separate CCTV shows the communal areas inside the home. This does not include pepoles individual rooms and does not therefore invade a persons need for privacy. A recommendation was made at the last inspection for this to be addressed however the service feel this provides extra security and surveillance. Plans for improvement during the next twelve months include the possibility of a 21 person lift, this would allow people greater freedom of movement around the home and may lead to extra office and storage space. Procedures were in place for infection control practices and 70 of staff undertook infection control training in the last twelve months. 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. People who live at Beenstock are supported by appropriately recruited staff so they are safe. Improvements to staff training were being made to improve the staffs skills and knowledge. Evidence: The numbers and skill mix of staff were sufficient to meet the needs of the people living at the home on the days of this inspection. Staff were supported by the manager, administrator, maintenance, housekeeping, catering, laundry and activities organiser. A receptionist is on duty during office hours and an administrator is the warden for the apartments and manages the catering and housekeeping staff. The home provides a domiciliary care service for people who live in the apartments on the ground and second floors. This additional care and support is provided by staff on the first floor, the care home. The manager has reviewed how staffs time is allocated to named people, however she needs to monitor the time staff are needed to provide this service as there is the potential for this time to be taken away from the people living in the care home. Of the nine surveys we received before the inspection, six people said the staff were always available when they needed them, three people said usually. Three people commented that more staff to allocate more time with each person would be Care Homes for Older People Page 22 of 29 Evidence: something the home could do better. Staff spoken to did state they felt they were alwaysdoing tasks however they liked being kept busy. One staff member who returned a survey wrote, The residents here are well looked after, more so than any other home, it keeps up its standards. The staffing levels should be monitored in light of the comments made. Comments made in relation to the staff were positive, one person said, The staff are kind and always helpful. Another person added, They are patient and kind, I couldnt ask for better. Pre inspection information supplied by the manager showed that 33 of the care staff had completed NVQ level 2 or above in health and social care. Staff spoken to were keen to learn and develop and this should be encouraged to make sure staff have the skills and competencies to care for older people. We were told that two staff completed NVQ level 3 and a further two staff achieved NVQ level 2 in health and social care. A requirement was made at the last inspection for further staff training to be addressed, the manager stated that some staff had received training through the Salford Training Partnership. Examples of other study days or training that had been undertaken by some of the staff was moving and handling, diabetes, dementia awareness, equality and diversity, health and safety and first aid. Other training materials used include the use of videos and plans were being made for staff to undergo training in dementia care. Staff spoken to said they thought the training was quite good and the staff were keen to learn and develop themselves. We discussed that the manager should update the training records so that she has an up to date record to show clearly when all staff have completed mandatory training and any other courses they have attended. Overall training had improved since the last inspection and the manager stated she was committed to continue to improve this. The way in which staff are recruited was looked at by reviewing the files of three staff who had been recruited most recently. Each staff file showed detailed application forms, documents to prove their identity, written references. Evidence that POVA (Protection of Vulnerable Adults and CRB (Criminal Records Bureau) checks were carried out were held on file. Some files had photocopies of photographs rather than a recent passport sized photograph. A recommendation was made to hold an up to date photograph of the staff member on the persons file. 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. People and their relatives were confident that the home was run in the best interests of people who live there and that their safety and welfare was promoted. Evidence: Since the last inspection a decision has now been made to appoint the Deputy Care Manager, who is a registered nurse as the Care Home manager. The care manager is supported by homes general manager, who is based in the building and is the warden for the apartments. Staff said the care manager was supportive, she listened to their needs and she knew the needs of the people living at the home well. The service is considering plans to provide nursing care as well as personal care for the people living at the home. This would allow people to be cared for by the staff, in the same environment if their dependency needs changed. One of the relatives spoken to during the visit said, The nurse manager was very approachable and was always available to talk to if necessary. We have been told she will submit her application to be registered with the Commission within the next few weeks. This will provide stability and leadership for the service. Care Homes for Older People Page 24 of 29 Evidence: There has been an improvement in the quality monitoring system used in the home since the last inspection. Questionnaires were sent out in august 2009 to residents, relatives and professionals. There was a record made of areas where change has happened by listening to the views of people who use the service. The manager and care manager stated there are also informal quality monitoring processes being carried out on a daily basis. This involved talking and listening to people and their visitors on a daily basis to gain their views about the service. Some of the services maintenance records were seen which included the fire safety records. A fire risk assessment was in place and the manager stated this had been reviewed by the fire officer at a recent visit. The manager said a list was available of staff who attended a fire drill but this was not seen during this visit. Copies of the bath temperature records held in the bathrooms were looked at to show the staff are checking these and keeping the water within a safe temperature. The self assessment showed there were equipment and health and safety checks being carried out on a regular basis. A discussion with the care manager highlighted the need for her to establish a good system for the risk assessments and care plans, involving other staff members and then to monitor and audit these on a regular basis so she is confident the care practices promote the health, safety and welfare of the people accommodated. Accident records were held on individual sheets. We asked the manager about her monitoring of any accidents/incidents and whether any changes to practice or to the persons risk assessment or care plan was carried out as a result of the accidents/injuries. We recommended that a written note is made following accident records being reviewed. There was evidence of records in place for some people who were seen by the local voluntary paramedics who can access medical backup as needed and provide a service on a 24 hour basis. All interactions between the manager and the staff and people who use the service were seen to be appropriate and professional. We were told that as noted at the last inspection no personal spending money is kept at the home on behalf of people who live there. All people living at the home have either a family member or an advocate to help them with finances. Services such as hairdressing or chiropody can be billed to the relative or advocate. The manager had a system in place for the staff supervisions and appraisals and some Care Homes for Older People Page 25 of 29 Evidence: records were seen in relation to this. This system needs to be fully developed to show that each staff member receives regular supervisions/appraisals. Two staff spoken to said they had received supervising to discuss their care practice, and personal development. A tour of the home highlighted one concern in relation to the extended length of the call bell cords. We discussed the potential risk to people due to the extended length and the manager assured us this would be addressed. Care Homes for Older People Page 26 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 27 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 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 7 That care plans and risk assessments are dated, include the persons name and record that families and carers have been involved in the care planning. In relation to the risk assessments for the use of bed rails, there should be clear assessment information around the decision as to whether bed rails are appropriate for the individual. 2 7 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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