Care Home: Belmont Lodge Care Centre

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What the care home does well Residents are happy living at Belmont Lodge. They speak positively about the care team. Comments include `the staff are all nice, on days and nights`, `the staff team are very kind and helpful, I am quite independent but they are always there to help if needed`, `The night and day staff are very good, I know the night staff quietly check on me at night to see that I am alright`, `male or female, the staff are very good`. The standard level of personal care that residents receive is good and staff are available to help when required. The staff team is quite stable, no agency staff are used and the levels of knowledge and skills that staff have are developing positively. The management team have an open and honest approach and are keen to develop a good service. The manager has a good rapport with the residents and deals with any concerns in proactive and objective way. Residents have choice in their day to day lives. Staff promote this and the home has the facilities/room to help with this. What has improved since the last inspection? Since the last inspection the new manager has reviewed the staffing levels and these have been increased based upon the dependency/needs of the current residents. They remain under regular review. The management team have obtained an up to date electrical safety certificate for the home. What the care home could do better: Since we last visited the home, the manager has left and a new one has started work. From our inspection, it is clear that systems and services have taken a step backwards and the new manager is making every effort to address this and develop the staff team. In light of this we did find areas for work at the home, but are confident that the new manager has the experience and skills to put these right. For example, work is needed on care planing and management for residents. We are confident that residents are receiving a good standard of basic care but work is needed on their specialist needs and any risks that may be relevant to them. The management of residents` medication needs to tighten up and the development of internal audits may help with this, so that issues are identified and addressed. The manager has started to put in place a more suitable activities programme for the residents with a new staff team. However, this is in its infancy and requires more work and actual assessment of residents` needs. Progress has been made with the staff training but this needs to continue and the recruitment procedures for new staff need to be more efficient. Staff supervision also needs to develop more. The manager and his team need to continue with their work on the premises with regard to signage, so that residents independence can be encouraged and in relation to the specialist needs of those residents with dementia. Key inspection report Care homes for older people Name: Address: Belmont Lodge Care Centre 392/396 Fencepiece Road Chigwell Essex IG7 5DY     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: Diane Roberts     Date: 1 4 1 2 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: Belmont Lodge Care Centre 392/396 Fencepiece Road Chigwell Essex IG7 5DY 08444725178 08444120628 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Diomark Care Limited care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Persons of either sex, age 65 years and over, who require care by reason of old age (not to exceed 46 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 10 persons) The total number of service users accommodated in the home must not exceed 46 persons Date of last inspection Brief description of the care home Belmont Lodge is a large detached house located in a residential area in Chigwell. The home is registered to provide residential care to 46 older people including 10 places for people who have dementia. Residents are accommodated in 34 single rooms and 6 double rooms. The home has five day rooms including a large dining room and a library. Accommodation is provided on both floors of the home and there are two passenger lifts. At the rear of the home there is a good size rear garden with patio Care Homes for Older People Page 4 of 32 Over 65 10 46 0 0 Brief description of the care home area. Ample off road car parking is provided to the front for visitors, and bus services pass the building along the main road. Local shopping facilities are a short walk away. Information regarding fees is available from the home. Past inspection reports are available from the home, and from the CSCI internet website. 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: We visited the home for a whole day and met with the manager and his team. Later in the day it was also possible to meet with the senior management team. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they think they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to three residents and three staff at the home and prior to that we sent out surveys to residents, relatives and staff, asking for feedback on the home. The response was quite good and these comments are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 7 of 32 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 8 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 9 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. New residents can be assured that they would be properly assessed prior to coming into the home but they cannot be sure that they would always have all the information they needed. Evidence: A service user guide and welcome pack is available in every bedroom, which is good. However on talking to new residents, they had not seen the guide and did not realise it was so easily available. The staff who admit residents need to ensure residents have access to this information. On reviewing the guide, the content is sound but the format requires a review to make sure it is user friendly for all the resident groups in the home. At the current time the manager undertakes all pre-admission assessments and residents we spoke to confirmed that they had been assessed prior to admission. A pre-admission assessment form is completed and we reviewed two of these that were Care Homes for Older People Page 10 of 32 Evidence: recent. Overall the assessments were completed well and gave a good picture of the person and their needs, which would enable the team at the home decide as to whether a placement would be suitable and the persons needs could be met. It was positive to see that the assessment would be appropriate for both resident groups in the home, with behavior and awareness assessment information being pertinent to those with dementia. Over time the assessment could be developed more to prompt the collection of more person centred information. This would help to enable a smooth transition at the time of admission. The assessments reviewed were variable in this approach with one detailing preferences and wishes and the other not. From other assessment records, some person centred information was seen to be obtained at the time of admission. The manager, in his AQAA, said that brochures are sent out and people are invited to come and view our facilities. He also said that we encourage people to think carefully about the choices they make with regard to admission to the home and wherever possible they we try and meet with family members. In addition to the managers assessment, information was also available from social services referring authorities and these contained some key pieces of information, which on review, had not been subsequently used in the residents assessment and care plan and essentially can be lost. The use of these documents should be reviewed. Residents we spoke to regarding their admission said I am glad I came in, there are many advantages, a nice garden, the staff are excellent and very kind and the manager does well, he cares about us, I settled in well and bought lots of bits and pieces from home which has helped with the move and I am quite satisfied with my choice of home, its my home. Care Homes for Older People Page 11 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. Residents can expect that their basic personal and health care needs would be generally met but they cannot be assured that any specialist needs would be managed fully at the current time. Evidence: Since coming into post the manager has been reviewing the care planning system that was previously in place and updating it. Residents care plans are being rewritten and many new forms and records are now being used, that staff are getting use to. We looked at three care plans and also used two further plans to cross reference where required. Overall the manager is putting a good system in place, but it is clearly in its infancy and there are shortfalls. This relate to staff experience of person centred care planning and not currently having a monitoring system in place whilst the new plans are being developed. Care planning training is planned for 2010. It was also noted that at the current time, residents who could have input into their care plans are not aware that these records are in place or that they could see them. This should be addressed. Care Homes for Older People Page 12 of 32 Evidence: Residents had an assessment of their needs in place that leads into care planning. The quality of the assessment was variable. Some contained a good level of detail and person centred information, such as behavior triggers, resident insight, communication and preferences whilst others did not. Residents generally had the care plans in place that they required but these were not always reflective of their current needs, especially as the review times were lengthy, in places up to three months. For example one resident had experienced a small stroke and this was not noted in a care plan. There were also needs around reoccurring urinary tract infections but again this was not noted in a care plan and in both cases there was no guidance for the staff team on how to manage these issues. The manager has introduced short term care plans for acute issues and although these were in the care plan, they were blank. On talking to care staff about the residents as individuals and their care needs, they do have a good level of information but the detail and person centred approach is limited at times. Development of the care planning system and more input from care staff into it, should help to address this. The manager said that they plan to review care plans monthly now and that he will introduce a quality audit sheet to help drive the standard up. In his AQAA, the manager said All care plans are reviewed at least monthly and where appropriate more frequently including daily if required. The evidence does not support this statement. Overall more detail and especially person centred information is needed in the care plans. For example under communication and confidence staff had written for X to tell staff their likes and dislikes. It would be more appropriate for staff to find these out and detail them throughout the care plan so the resident does not have to keep stating these choices and staff can remind themselves. In dietary care plans there was little information on personal preferences and care plans on sleeping stated maintain drug regime rather than detailing any residents choices and what may help them have a good nights sleep. The care plans also need more work to detail how care needs are going to be met as this aspect of the planning was weak at times and often gave limited guidance to staff. Social care plans were also weak and these are discussed more in Section 3 of this report. In saying this, there were also a few good examples of care planning, with sufficient detail to guide staff and person centred information, especially in regard to care planning around communication. The manager in his AQAA said that dementia mapping had been commenced. We found no evidence of this in the care records and the manager confirmed that this had yet to start. The provider has appointed a dementia care lead to help services with this registration to develop in line with current thinking and practice. Care Homes for Older People Page 13 of 32 Evidence: Staff are meant to record daily notes but on review these are not recorded consistently and vary in quality. For example one resident came out of hospital and had daily notes written for 2 days and then there was a gap of 6 days. This does not help to inform the staff team or give a good account of the care provided and the wellbeing of the resident. Some staff do however write good notes which are informative and reflect the resident themselves and the care provided. Staff were also noted to use a communal recording book which comments on residents. This information was often missed from the individuals care plan and possibly then not used at the time of review. The use of such records should be reviewed. Residents who commented on the care management said I have a key worker but I do not remember who it is, they gave me a special buzzer to use that I can have with me, the staff come very quickly, I use to see my care plan but I have not seen it for quite some time now, the staff are careful not to disturb me and they bring me a drink very early in the morning if I want one, I have not seen my care plan and I am not really sure what one is and the staff are good with your dignity when bathing etc., they are not indelicate. It was also noted that on the feedback questionnaires, the manager has just started from residents, that one out of three did not know who their key worker was. The manager in his AQAA said that the care plans are devised in consultation with the resident/relative and with contributions from our Lifestyle Team. We would not concur with this statement at the current time. Residents generally had a range of risk assessments in place covering manual handling, skin condition and risk of pressure sores, pain and nutrition. Not all residents had all the required risk assessments in place, for example, some did not have a nutritional risk assessments. Whilst residents had assessments in place they had not been kept under a regular review and many had a gap of three months between August and November 2009. Where risks had been identified, there was not always the appropriate care plan in place. For example, residents identified at being at risk of developing pressure sores had no evidence of what action or decisions had been made on the management of the risk or any ongoing guidance for staff and those identified as at cause for concern nutritionally also did not always have care management plans in place. It was also noted that one resident, who had possibly climbed over a bed rail and experienced a fall, did not have a risk assessment in place to assess whether it was safe to use them for this person. The was some evidence that residents are now being weighed more often but this remains inconsistent and requires more attention to ensure that residents nutritional status is more accurately monitored as far as possible. There was evidence that residents were seeing health care professionals such as physiotherapists, but any advice and exercises given were not evident in the care records or within a care plan, which does not help to guide Care Homes for Older People Page 14 of 32 Evidence: staff in supporting and encouraging the resident to, for example, improve their mobility and independence. Records showed and residents confirmed that they saw their doctor if required in a timely manner and that they had access to other health care professionals such as chiropodists. Medication management at the home was reviewed. The team use a blister pack and packet system and a local pharmacy supplies and supports the team by undertaking audits for them. Staff were seen to have access to up to date medication resources such as books. The manager said that he had asked the doctors to come in and undertake medication reviews in the next few weeks. Many of the residents had prescriptions for creams and topical medication that did not link to care plans or had been signed for by staff as applied. The rational for use may require review. Systems at the home do need to improve. Medication administration sheets had significant gaps in signing and on checking it appears that these items have been given but not signed for, however we cannot be totally sure with packet/bottled items as not all were dated on opening. Dates of opening also need to be recorded on items such as eye drops, which often have a limited shelf life. Staff who are giving/considering as and when medication on behalf of residents need to use a code to show that the item has been considered, if not given. It was positive to see that some residents are self medicating. Risk assessments were in place but one had not been reviewed since 2007 and the other had an inconsistent review pattern but was more up to date. Residents who commented on the medication said they sometimes wake us up to give us sleeping tablets, this needs to be looked at and we are never told of any changes on our prescriptions unless we ask. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents experience choice in their daily lives, some aspects of their social care is still developing and this could limit positive outcomes for them. Evidence: From talking to residents, staff and from the records, it is clear that the routines of the day are generally resident led and from discussion, the manager is promoting this approach. Staff confirm that they understand residents rights to choose and can given examples. Residents say they can do as they please, staff give them plenty of choice, I think people have a choice about when they get up and go to bed, we lay in a lot more now than we use to and I have free choice about how I spend my time. The social care plans we looked at had a limited content and did not provide a real assessment of the persons social care needs and how those needs could be met or how any social intervention may help maintain skills, promote independence and self worth. Staff did identify that residents may want company and they were quite clear with their objectives on some plans, but there was no real guidance for staff on how they were going to fulfill the objective. When we spoke to residents, they were able to discuss their interests with us and on looking at the care plans, these were not always evident. This is an area that needs work. Care Homes for Older People Page 16 of 32 Evidence: The manager has introduced new records in relation to social care and activities in the home. At the current time these are not always completed and gaps were noted even for residents who could complete these records and/or communicate their needs well. It was noted that residents did not have their hobbies and interest sheets completed or their life histories, despite being in the home several months. The activities officer works in the home for several hours each day during the week but also undertakes administrative duties. He has been in post for two months and new activities records have been introduced. An activities programme is in place and the activities officer said that he goes by the programme and also asks residents what they would like to do and tries also to gauge what mood they are in. From discussion, whilst there are activities going on, it is clear that this aspect of the home is in its infancy and still developing. The activities officer has yet to sit down and record the activities that are taking place and there are therefore no records to review. There was some recorded evidence on quality assurance forms that residents had been making Christmas cards. The activities officer has no previous experience or training, but from discussion has an appreciation of residents needs and a keenness to develop the role. In his AQAA, the manager said we have recently increased the lifestyle team by two part time staff and a further member will be required later in the year to ensure that lifestyle is a priority seven days a weeks through to 10.00 p.m every evening. At the current time there is no assessment of residents individual needs. Group activities are evident from observation and discussion, but individual needs may not be being met. The programme in place is limited and does not allow for any one to one time other than for manicures and pedicures. Other activities offered on the programme include, reminiscence therapy, films, flower arranging, crafts, floor games and an outing every first Thursday of the month.The staff are planning a pantomime for the residents and have already developed a large Christmas grotto/winter wonderland for residents to look at and visit. On discussion this was popular with the residents. This area will be developed over the year with different themes, such as Valentines Day and Easter. One resident helps with a trolley that is taken round to sell toiletries and other small items to all residents and this happens twice a week. A small library is available in one corner of the second dining room, with some comfortable chairs.Entertainers visit the home. Carol singers are going to visit the home nearer Christmas and relatives and friends have been invited to visit the home as well during this time. Since starting at the home the manager has ensured that residents cultural and religious needs are met, for example a service is held on Friday evenings for Jewish residents. Residents who commented on the activities said A nice Care Homes for Older People Page 17 of 32 Evidence: lady comes and does exercises to music with us, I try to go to that, there are not enough activities and I am unsure about the other ones offered, I go to bed early sometimes as I do get bored, I do my own activities and choose not to take part in the ones offered and I choose not to take part in the activities due to the dependency of the other residents. Lunch was observed in both dining rooms and for those residents who choose to eat in their rooms. Residents were seen to be enjoying lunch and they were, where required, sensitively supported and encouraged by the staff team. No condiments were available in the lounge where residents who have dementia primarily sit. This should be reviewed as this does not promote independence and the retention of skills and staff are available at this time to support residents. It was positive to see that residents have access to wine, sherry and other alcoholic drinks should they wish/be able. A weekly menu list is available in the dining room and records show that residents have choice and preferences are taken into account. Pictorial menus are being developed. The manager reported that they would only keep a nutritional record if a specific problem had been identified. This was discussed along with simple recording system to help monitor residents intake, especially those with dementia, over a period of time. Residents who commented said good food spoiled by the cooking, its has improved but it could be better, the new manager has a new menu in place that we can see and you can that alternatives are available, I choose to eat in my room although they do encourage me to come out, the food could be better, good food ruined by the chef, however, I dont starve, Fresh fruit is available and cooked breakfasts one day a week, the food is quite good, its improved, decent choice and its hot when needed, I choose to eat in my room. Care Homes for Older People Page 18 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. Residents can be confident that any concerns or complaints raise would be dealt with appropriately and that, as far as possible, they would be protected from abuse. Evidence: The manager has a complaints procedure in place and this is displayed in the home and is also available in every room within the service user guide. There is a suggestion box in the main hallway that residents and visitors etc. can use. Residents who commented said they knew how to raise a complaint. The manager keeps a complaints file but there is no formal system for logging complaints and monitoring the management of them. The manager in his AQAA stated that three complaints had been received in the last year, but only two could be found on the file. A logging system would help with this. Of those available, one of the complaints had records missing and this related to an matter before the current manager came into post and he could not account for the missing records. This complaint related to the experiences of a respite resident. The second complaint related to the care management of another resident. There was better evidence that this matter had been looked into and that the senior management team had also had input. The managers AQAA showed that these complaints were not upheld Residents we spoke to said you can talk to the manager anytime, he is very pleasant to deal with and the manager is very helpful, if I suggest anything or ask anything he pursues it and generally does it or sorts it out for me. In his AQAA the manager outlines his plans for raising the profile of advocacy in the home and providing a booklet which talks about Care Homes for Older People Page 19 of 32 Evidence: the best interests of residents and the use of advocacy. On talking to staff, they show an appreciation and understanding of adult protection matters and training records show that a high level of compliance has been achieved with regard to training staff on this subject. Care Homes for Older People Page 20 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. Residents live in a clean, safe and generally well maintained home. Evidence: We looked around the home with the manager and viewed all the communal areas and a sample of bedrooms and bathrooms. Overall the home was very clean and no odours were noted. Since we last visited the home a significant amount of redecoration has taken place. The manager confirmed that he had a substantive budget to completely refurbish the home and there was evidence that this was in progress. For example, during our visit work was being undertaken to remove a steep staircase in the home, providing more room and making the upstairs of the home easier to walk around and deploy staff. Plans are also in place to refurbish the bathrooms and steadily renew carpets and flooring. The new decor is helping to make the home feel brighter and following specialist advice, primary colours are being used to help residents to find their way around independently. Plans are also in place to improve the corridor lighting in some areas of the home. Some textured items/pictures have been developed and put on the walls to interest residents who have dementia. This is a positive step but these are limited at the current time and could be developed further. The manager has started work on the signage in the home and this will help those residents with dementia maintain a level of independence. He has yet to put names on bedroom doors but said that these were on order. In his AQAA the manager said we plan to provide better signage for the centre internally Care Homes for Older People Page 21 of 32 Evidence: and externally. The manager has moved the office and has developed a hair dressing salon which the residents enjoy going to. More work is planned to decorate the salon and provide more reminiscence items. Bedrooms are of a good size and many of the double bedrooms in the home are sold as large single rooms. Residents had personalised their rooms and had bought in their own pieces of furniture. The home benefits from several lounge areas and opportunities for small seating areas, The home also benefits from having a large and well maintained garden with good paving and a protected pond. A sensory trail has also been developed. The home has a secure central courtyard that residents have access to and the manager plans to develop this area further. Documentation in relation to fire safety was reviewed. The manager had an up to date fire safety risk assessment in place completed in April 2009. This will need regular review in light of the ongoing building works. An unsatisfactory staff fire drill was completed in May 2009, with adverse comments noted in the records. A repeat fire drill was then undertaken in August 2009 and this was positive. However it is of concern that 3 month gap was left before staff were tested again. Records showed that the emergency lighting system is checked regularly and so are the fire alarms, although this is inconsistent at times. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a stable and generally competent staff team whose skills are developing. Evidence: At the current time the staffing levels are one senior and 5 care staff on the morning shift, one senior and four care staff in the afternoon and evening and one senior and three care staff at night. On discussion the manager plans to leave these levels in place even after the building work upstairs has made the layout of the home easier to monitor. The manager said that residents dependency levels are checked and used to help decide staffing levels but this information was stored at head office and not available to see. He confirmed that since he has been in post he has increased the staffing levels by one on each shift in relation to the dependency of residents. The rotas show that these levels are maintained and agency staff are not used. The manager reports that the staff tram is stable and turnover is quite low. Residents who commented on the staff team said young staff here but they are quite good with people, the staff are all nice, on days and nights, the staff team are very kind and helpful, I am quite independent but they are always there to help if needed, The night and day staff are very good, I know the night staff quietly check on me at night to see that I am alright and male or female, the staff are very good, The AQAA shows that out of the care staff team of 25, 9 have completed an NVQ Care Homes for Older People Page 23 of 32 Evidence: qualification. NVQ qualifications are being encouraged and 7 staff are going on to complete NVQ level three and 4 more staff are completing NVQ level 2. This should bring the team at the home over the 50 desired level. Two staff files were checked in order to assess the robustness of the recruitment procedures in the home. A checklist system is in use and overall the recruitment of staff is generally sound. However, they do need to tighten up the process in relation to chasing late references and ensuring that staff are contracted correctly under their immigration status, for example, working the correct hours. There was evidence on file that staff were completing an in house induction and had been given the Common Induction Standards to complete as well. Training records show that overall training in the home is coming on well. Nearly all the staff have had training in the care of people with dementia and compliance levels for manual handling, fire safety and adult protection are good. There are gaps in relation to health and safety and food hygiene but records seen show that sessions are booked to cover these shortfalls along with further training update for adult protection and training on care planning. The manager, who is a qualified nurse, undertakes one in house training session every month on, for example, diabetes. Records should be maintained to show that staff are trained in these conditions associated with old age. The manager records in his AQAA that 20 staff have been trained in infection control. Staff who commented said the manager is very forward coming with training and is very good in caring for the staff team. Care Homes for Older People Page 24 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 management of the home is working towards a home that is run in the best interests of residents and with their input. Evidence: A new manager started working at the home in June 2009 and he plans to apply for registration. He is a qualified nurse with a degree in health studies. Since that time there is evidence that he has been addressing shortfalls in the systems and services in the home and is making steady progress. From discussion he is aware of the needs of people with dementia and is committed to providing a good service in the home. Staff and residents spoken to speak highly of the new manager and the changes that are happening in the home, which they all feel are for the better. They feel that the atmosphere has improved, its more homely and that they like living and working at the home. Comments included the home is so much better in all ways since the new manager started work here, its better organised and the home has improved with the new manager, especially the entertainment and having a residents committee. The manager is holding staff meetings and the minutes show that shift management is Care Homes for Older People Page 25 of 32 Evidence: discussed along with residents choice and mealtimes. He has also introduced the staff member of the month award for good practice etc. Since starting work at the home the manager has set up a residents committee and residents spoken to confirmed this and their attendance at meetings. Minutes of meetings show that residents discuss, for example, staffing at weekends, redecoration of the home, menus and teaching about diabetes. The manager has a quality assurance system in place that primarily consists of feedback questionnaires for residents and relatives that will be used yearly. He has recently sent these out and they are just starting to be returned. It was possible to see a blank questionnaire. It may be of value to have some input from residents on how user friendly the form is to help ensure a good return, as whilst the subject areas are appropriate it may not be easy to use. Two completed forms from relatives were seen, which, overall, were quite positive. The manager said that he will analyse the results and develop an action plan for any areas/issues that require attention. He also plans to seek feedback from the staff team using a questionnaire in the future. In addition to the managers feedback questionnaires, the activities officer has just stared to complete short feedback questionnaires that are completed on more regular basis. It was possible to review four of these and they use questions to check that residents are having choices in their daily routines, how happy they are with the food and how they find the activities. Overall the responses were positive about the food and choice. Consideration should be given to undertaking internal audits that cover, medication, care planning/management and staff recruitment and training, to help monitor and drive standards up further. Relatives meetings are also being held by the manager. The minutes show that relatives are feeling positive about the home and the changes being made and that the management team are promoting a open style of management. Comments from relatives included efforts are being made to smarten the home up, its a clean, friendly home, laundry is put away in the wrong rooms, there are often mix ups with the laundry despite clothes being labelled, The home has improve 100 with the new manager, for example, more activities and more staff on duty and the staff are friendly and helpful and they work hard The management team at the home do look after small amounts of personal monies on behalf of residents. A double signatory system is used and the accounts are audits by the company twice a year. Staff spoken to confirmed that they have had supervision but from discussion and review of the records, this is inconsistent and a regular system has really yet to be Care Homes for Older People Page 26 of 32 Evidence: developed. On discussion with the manager, he confirmed that they were not up to speed with the system but it was underway. He plans to develop the senior carers to undertake some of this work and introduce observation supervision of care practices. Records seen confirmed that some staff supervision is taking place and these include group supervisions/meetings where the staff all have the same record on file covering the issues discussed. Accident records were seen and found to be completed fully and followed up where required. No health and safety issues were noted when touring the home. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 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 Where possible consult 12/03/2010 residents and relatives about care planning and ensure that all the care plans needed are in place and keep these under regular review to ensure that they are current. So that residents can be assured that they are receiving the care they need in a way that they would wish. 2 8 12 Residents must have all the risk assessments in place that they require, linked to care plans and kept under regular review. So that any risks to residents are appropriately managed. 14/02/2010 3 9 13 Staff must ensure that they follow policy and procedures for the safe administration of medication. 05/02/2010 Care Homes for Older People Page 29 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 So that residents can be assured that they get the medication prescribed. 4 12 16 Residents must have their social care needs assessed and planned for and kept under review. So their social needs in relation to group and individual activities are met. 5 28 19 A robust recruitment procedure must be in place for new staff. To help ensure that residents are safe. 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 14/03/2010 14/02/2010 1 1 Review the format of the service user guide to ensure that it is suitable for all resident groups in the home and work with staff to ensure they make this information available. Continue to develop a more person centred approach to the assessment process and ensure that information from external sources is taken into account. Continue to develop a person centred approach to care planning. Put systems in place so that residents know who their key worker is. Continue to consult with residents regarding the food services at the home in order to further improve feedback. 2 3 3 4 5 7 8 15 Care Homes for Older People Page 30 of 32 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 6 7 8 9 10 11 16 19 28 29 33 36 Introduce a logging system for complaints to help with complaint management and record keeping. Ensure that all records in relation to fire safety are kept up to date and that staff have regular fire drills. Continue to develop staff by encouraging and facilitating NVQ qualifications. Continue to ensure that staff have all the training they require to undertake their roles and responsibilities Consider the development of further internal audits to help monitor and improve standards. Work should continue on the development of the staff supervision system. 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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