Care Home: Blyth House

What the care home does well The home is bright and well decorated and provides a homely and friendly atmosphere for residents. Eight residents who took part in this inspection process said they are happy with their rooms and with the home and that staff and the manager are very friendly and helpful. The registered manager is at the home each day and residents say they can speak with her whenever they want to and that she is quick to help to sort out any problems they have. Management work well with the Commission and all nine requirements made at the last inspection were dealt with. There is a stable staff team in post who know the residents well and the use of agency staff is currently kept to a minimum. Residents are relaxed and comfortable and in their interactions with staff and relatives and residents say that staff are very kind and caring and they feel that they can ask the for anything they need. Residents know the manager and said they would speak to her if they had any concerns. Good food and beverages are available and residents consistently said that the food is good and they can ask for food they like. Residents religious needs are being catered for and all residents I spoke with and those who responded to the inspection surveys said that they are happy at the home and that the staff are helpful. What has improved since the last inspection? There is now clear written information provided for residents about the fees and charges so that they understand the rights and obligations of the home and the service to be provided. Moving and handling practices are now good with regular monitoring of staff practice and review of risk assessments. Residents I spoke to generally said they are asked about their care needs regularly. Medication management is now good with very consistent recording and closer checks being done by the manager. Good food is provided and residents said they are able to say if they want something different and it will be provided. There is now information taken up by the home about agency staff training and experience so that the staff in question are able to provide a good service to residents. There is also a good induction process for agency staff. The home now ensures that new staff do not work directly with residents until they have a full Criminal Records Bureau check and are safe to work with residents What the care home could do better: The home has an activities worker whose hours have been reduced since the last inspection. The residents said they like the service provided by this worker and it is generally felt that increasing the level of support provided by her in developing and maintaining activities would benefit residents greatly. The homes management should look into this and see if this can be facilitated. The garden would be far more accessible for residents if there was a wheelchair ramp installed to the rear of the main building. Residents I spoke with said being able to go straight into the garden would be easier than having to be taken around the front and side of the building. The homes management should look into whether this is possible to provide for residents. The home needs to include more formal training for staff in some key areas of support such as the care of Dementia and Mental Health and End of Life care. The manager said she plans to do this. The manager needs to make sure that all care and nursing staff have formal supervision more often. This does not mean that staff are not supervised at the moment but that there are not a clear written records always maintained. Key inspection report Care homes for older people Name: Address: Blyth House 16 Blyth Road Bromley Kent BR1 3RX     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: Sean Healy     Date: 1 9 0 4 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Blyth House 16 Blyth Road Bromley Kent BR1 3RX 02084603070 02084661627 blythhouse@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chislehurst Care Limited Name of registered manager (if applicable) Ms Rhona Delores Robinson 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 Additional conditions: The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Blyth House provdes nursing care for service users in the category of Older Persons. The home has been registered to the current provider since September 2002. The home was previously registered under the Registered Homes Act 1984. The premises have been adapted and are purpose built. It has bedroom accommodation on the two floors. Communal areas are located on the ground floor with the laundry located in a separate building at the rear. All rooms are for single occupancy with many having Care Homes for Older People Page 4 of 31 Over 65 16 0 2 0 0 4 2 0 0 9 Brief description of the care home ensuite facilities. A garden is located to the rear of the building with hard parking to the front of the building. The rear garden is accessed by a side gate. The top floor of the building is used as staff accommodation and is therefore not part of the registered premises. The home operates with qualified nurses and care assistants throughout the twenty-four hour period. Residents are supported by GP services and specialist health provision such as the Community Psychiatric Nurse and eating disorder specialists. Fees range from 620 pounds per week for residents whose care needs are less complex to 750 pounds per week for those with higher care needs. Additional charges are made for hairdressing magazines papers toiletries and clothing. The home has developed a Statement of Purpose and Service Users Guide and this provides prospective residents and their representatives with information on the care provided. Inspection reports available from the home and copies are given to residents. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality Rating for this service is 2 Star. This means that the people who use this service experience Good quality outcomes. This rating has improved since the last key inspection. The inspection was unannounced and took place as a visit to the home on the 19th April 2010. The home provided an Annual Quality Audit Assessment AQAA which was also used to inform the inspection. The registered care manager facilitated the visit. Four care staff completed inspection surveys about their employment and understanding of their job. Four staff employment files were examined to check that they had been properly recruited trained and supervised. One relative of residents contributed their views of the home when speaking to me and three others completed inspection surveys. Five residents discussed their views on the Care Homes for Older People Page 6 of 31 home with me and three other residents responded to inspection surveys. Four residents files were examined including assessments and care plans. The inspection involved a tour of the premises and examination of a range of management documentation. The home currently has two residents vacancies. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The home has an activities worker whose hours have been reduced since the last inspection. The residents said they like the service provided by this worker and it is generally felt that increasing the level of support provided by her in developing and maintaining activities would benefit residents greatly. The homes management should Care Homes for Older People Page 8 of 31 look into this and see if this can be facilitated. The garden would be far more accessible for residents if there was a wheelchair ramp installed to the rear of the main building. Residents I spoke with said being able to go straight into the garden would be easier than having to be taken around the front and side of the building. The homes management should look into whether this is possible to provide for residents. The home needs to include more formal training for staff in some key areas of support such as the care of Dementia and Mental Health and End of Life care. The manager said she plans to do this. The manager needs to make sure that all care and nursing staff have formal supervision more often. This does not mean that staff are not supervised at the moment but that there are not a clear written records always maintained. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a Contract or Statement of Terms and Conditions and an assessment of need completed prior to admission. Residents have received confirmation that based on assessment the service was suited to meeting their needs. Intermediate care is not provided. Evidence: There was a requirement made at the last inspection for the home to keep records of the fees charged to residents including a breakdown of who is responsible for paying these fees. This requirement is now met. There is an up to date Statement of Purpose and Statement of Terms and Conditions for living at the home and the five residents I met and spoke with said that they had Care Homes for Older People Page 11 of 31 Evidence: received a copy of these. All residents have full and detailed assessments of need on file. I examined four residents files and all had a detailed assessment of their health and social care needs. The residents at the home have been placed in both three London borough local authorities with Bromley as the main contracting agent. Seven residents are privately funded. Core care assessments have been provided by these local authorities and the show the primary care needs of the residents to be associated with ageing needs with secondary care needs such as dementia and mental health support being prominent. All residents files I examined showed that they had a contract in place which included the fees paid for their care and showed the service they can expect from the home and their rights and responsibilities. I spoke to five residents about the choice they were given in living at the home and whether they were aware of the Service Users Guide and their fees rights and obligations. Those who were able to discuss this with me said that they were aware and were given an opportunity to visit the home before moving in. All said they were very happy living at the home. The home does not provide intermediate care for residents and therefore a standard six does not apply to this home. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Health and personal care needs are well set out in care plans and care plans and risk assessments are now consistently reviewed each month. Health care needs are being met and medication is well managed Evidence: There were two requirements made at the last inspection regarding moving and handling. The first of these asked the home to ensure that staff have the correct training and supervision of their practices in moving and handling so that residents are supported safely. This is now met and all of the homes care staff have up to date moving and handling training and the manager ensures that all staff who are not fully familiar with residents are led in their work by experienced staff. The management also have now made arrangements with the agency to send written confirmation of staff training before they start work at the home. A record of this is kept on file. Care Homes for Older People Page 13 of 31 Evidence: The second requirement made asked that the homethat moving and handling risk assessments be reviewed to reflect current practice and the equipment used. This requirement was also met. I examined for residents moving and handling risk assessments and these were up to date and are reviewed each month as part of the care plan review. The files I saw had a care plan for each resident whcih was signed by them and the residents who spoke to me said the home asks them about their needs and shows them their care plans. A requirement was made at last inspection asking that medication given be accurately and consistently recorded. I found that this requirement was met. I examined four residents care plans and medication records and these were well managed with very consistent recording. The medication is supplied by one pharmacy and the Nomad system is used. The manager carries out weekly checks on medication systems and audits are sparodically done by Bromley PCT pharmacists. I examined care plans for 4 residents and found that all had a care plan based on their assessment of health and social care needs. All were comprehensive and were reviewed on a monthly basis. Many included high levels of personal care support needs where areas of risk are assessed especially regarding moving and handling. The care plans also showed residents food preferences preferred activities health care needs and emotional support needs. The majority of residents have support needs in bathing dressing and a number need support with mental health and the care of dementia. Continence care and physical support are also provided for other residents. I found these areas to be included clearly in care plans. A visiting relative said that she felt that the homes management and staff understand how to provide the care residents needs and are very helpful and courteous. GP visits happen monthly at the home or more often by request. The residents and the manager said that the GP is quick to come out when needed. Other health care professionals attending the home include the Chiropodist the Oral Hygienist the Dentist Nutrition nurse and dietician. None of the residents have tissue viability issues as this is very well managed by the home. Medication is well managed by the home and none of the current residents manage their own medication. The medication policy is up to date. The home carries out an assessment of the residents wishes and abilities to self medicate as part of the referral and moving in process. All residents spoken to said they are very happy for the home to look after their medication. Storage facilities are adequate and temperatures of the storage cupboard are checked maintained at a safe temperature. Medication labeling and storage is generally good with consistent checks now being done by management. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the 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 are satisfied with their lifestyle and more stimulating in house activities and exercise opportunities are now being provided. They are supported to maintain contact with family and friends. Residents are involved with making decisions about their life and are given a choice of good and wholesome food. Evidence: Residents care plans include a list of activities offered which are recorded as part of the daily handover system. Activities included are a visiting musicians cinema hairdressing quiz evenings and exercise sessions and reminiscence sessions. On the day of inspection a visiting violinist played a broad range of music in the lounge area for about 12 residents who clearly enjoyed the performance. Residents religious support needs are also included for those who want this support. Residents said that they are supported to go to church if they want to and sometimes church ministers come to the home. There is an activities co-ordinator employed for 8 hours weekly having had her hours Care Homes for Older People Page 15 of 31 Evidence: reduced since the last inspection. A number of residents said that the activities person is very good but that they would like it if she was available more often and provide some additional help for staff who may not know how to play some games such as scrabble. The staff also commented that this would be helpful. Many of the residents are very physically disabled and it is very important that the in house activities provided are interesting and regular. It is recommended that the registered provider assess whether it is possible to increase the activities co-ordinators hours and include checking all staff abilities and understanding of games provided in her work. (Refer to Recommendation OP12) All the residents I spoke to said they had family who visit and also who take them out on a regular basis. They are able to entertain visitors in their room but mainly prefer to use the front room with their visitors. One visitor I spoke with said that they always receive a welcome when they visit the home and they feel that they can visit at any time. Five residents I spoke to confirmed that family and friends are welcomed into the home. Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. The support needed is included in their care plans. Currently none of the residents finances are managed by the home. There was a requirement made at the last inspection for the home to make sure that residents have a choice of healthy food available to them. After examining the records of food given and speaking with five residents I have determined that the home does now provide a choice of good healthy food for residents. The home provides a wholesome and nutritious diet for residents and offers a choice of food on a daily basis. Five residents whom I spoke with said that the food is good and they are offered a choice every day. The homes menus reflect residents preferred meals and a varied menu is on offer. The kitchen was clean and tidy. I looked at records of food provided and sampled a meal and found that the food was wholesome and well presented. Good records of food eaten are maintained as part of the homes system for monitoring healthy diets. Care Homes for Older People Page 16 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Satisfactory systems are in place to manage complaints and the protection of vulnerable adults. Evidence: The homes complaints policy was last reviewed in 2009. This policy adequately shows how complaints are to be managed and residents have been given a copy. Five residents confirmed this. The registered manager is at the home on a daily basis and residents commented that they are available to speak with them whenever they need to. There have been no complaints made since last inspection. The Statement of Purpose includes a summary of complaints policy and all of staff had received training in how to deal with complaints. There have been no allegations of abuse made since the last inspection. The home has a written policy and procedure in relation to Adult Protection. The procedure states that all suspicions or allegations of abuse must be referred to the local authority for investigation under their procedures. A copy of the local authoritys Adult Protection procedures is available to staff in the home in addition to the homes own policy. The Adult Protection policy was last reviewed in 2009 and shows clearly how to report suspicion of allegations of abuse. All four staff training files I examined showed that all Care Homes for Older People Page 17 of 31 Evidence: had received adequate training in adult protection and safeguarding procedures. Care Homes for Older People Page 18 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People 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 live in a comfortable safe and generally well maintained environment. Evidence: The premises have been adapted and are purpose built for provision of care. It has bedroom accommodation on the two floors. Communal areas are located on the ground floor with the laundry located in a separate building at the rear. All rooms are for single occupancy with almost all now being ensuite toilet and sink. A garden is located to the rear of the building with hard parking to the front of the building. The rear garden is accessed by a side gate. The top floor of the building is used for staff accommodation and is therefore not part of the registered premises. A requirement was made at the last inspection for some bulbs to be replaced and this was done immediately following the last inspection. Since then five bedrooms have had ensuite toilet and sinks added and all communal areas have had new carpets fitted. The new conservatory is now completed and is used as a recreational relaxing area. Three residents told me that they were very pleased with this improvement and that they could also use it to entertain their visitors. A new bath has been fitted and a Care Homes for Older People Page 19 of 31 Evidence: new more secure front door has also been installed improving the security in the home. Overall the premises are now in very good order and are maintained to a good standard. The home is clean and smells fresh and airy. However there are a few areas that could still do with further work as follows. 1) The Laundry room is in need of retiling and repainting. 2) The ground floor toilet has some piping which needs to be covered in. 30 The rear garden is currently wheelchair accessible only if residents exit the front of the building and go around the side of the home. In order to do this most residents would need support from staff and this gives a feeling of being separate from the home. This could be rectified if a wheelchair ramp was installed to the rear of the home to access what is a very pleasant garden area. The manager and provider must give consideration to these areas and include decisions reached in the homes Development Plan. (Refer to Requirement OP19) Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the 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 numbers and skill mix of the staff meets residents needs, and they are in safe hands at all times. Residents are now protected by the homes recruitment and induction practices. Staff are trained and competent to do their jobs but training in some important areas of residents care for a number of staff needs to be planned. Evidence: There was a requirement made at the last inspection for the home to ensure they had information about the training and qualifications of agency staff used at the home provided by the agency in order to ensure that residents were supported by qualified and experienced staff. This requirement is now met as there was clear evidence available today showing that the relevant staff agencies send information by fax to the home about the training and qualifications of staff they send before they arrive at the home. There was a requirement made at the last inspection for the home to ensure that new staff do not work one to one with residents until the home has received a fully enhanced satisfactory CRB check. As there were no new care staff employed since the last inspection it was not possible to verify this from recruitment data. However the manager explained that the practice of starting new staff on a POVA first check Care Homes for Older People Page 21 of 31 Evidence: followed by a fully enhanced CRB check has now been stopped. Therefore this requirement is now met. The home had adopted this practice to overcome delays experienced in having CRB checks completed which sometimes ran on for a number of months. The manager accepted that this practice would only be used in exceptional cases and that the norm is now to wait for a full CRB check to be completed before allowing any new staff to commence providing care. The staff team is made up of a registered manager who is an experienced manager and 12 nursing and care staff employed on full time contracts. There are also up to six part time care staff employed and seven auxiliary staff who take care of cooking cleaning and laundry. A written staff roster is kept to show which staff were on duty at any time. There is one nurse and 3 care staff on duty between 8am and 8pm and one nurse and one care staff providing night waking support. There is a part time activities coordinator also available and I have made comments separately under Standard 12 of this report recommending reviewing her hours with a view to increasing the level of input provided in developing activities. These ratios are very reasonable ensuring that residents have adequate support available and all of the five residents and one visitor said that they felt staff were always available and quickly answered the call bell consistently. The use of agency staff used has also been reduced since the last inspection with only 9 shifts being booked in the previous three months. This is a good achievement and helps maintain a consistent service. The homes full time nursing and care staff are made up of one male and 11 female staff. Who support up to 16 residents. Currently there are 14 residents at the home 11 of who are female and three male. This reflects a reasonable ratio of same sex support being available to residents. The cultural backgrounds of residents are also reflected well in the staff team and residents commented that their cultural needs are understood and are being met by staff. Residents and relatives said that they felt there were adequate numbers of staff on duty and that all were quick to provide help when needed. The manager is qualified to NVQ level 4 and nine of the approx 15 care staff had achieved NVQ level 2 or 3 which is over 60 of care staff. Recruitment policies and procedures are in place. Four employee personnel files were viewed. These were generally well kept and included all of the information required by regulation. Care Homes for Older People Page 22 of 31 Evidence: There is an induction schedule in place for new staff which is largely in line with the Skills for Care requirements. The four staff files examined showed that they had received a detailed induction. The home has developed a more thorough induction for agency staff which I saw and found to be a good means of informing agency staff about their duties. I would recommend that staff be reminded of the need to always ask agency staff to show their photographic identification immediately on arrival at the home and that this be included in the agency induction checklist. (Refer to Recommendation OP29) Inspection of staff files showed that generally training needs are now being planned. The home has a training schedule which includes equal opportunities diversity health and safety fire safety moving and handling infection control medication and food hygiene. Staff files I examined showed that a good level of training is being planned for and attended by staff. Some important features of the care needs of residents are not fully reflected in the homes training plan for care staff. These are Dementia Mental Health Managing eating disorders and End of Life Care. It is important that these areas are included in the training that staff are expected to complete as these areas feature in the support needs for a range of residents (Refer to Requirement OP30) Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has an experienced manager and can show that it is run in the best interests of residents. Residents financial interests are safeguarded appropriately. The health safety and welfare of staff and residents are promoted and protected. Evidence: The homes manager is registered with the Care Quality Commission and has the experience and qualifications needed to manage the service. The manager is a registered nurse and has achieved NVQ 4 qualification in care and management. Five residents I spoke with and three others who completed inspection surveys said they were happy with how the home was run. Visitors commented that they were very happy with the homes management and that they were always made to feel very welcome. They felt that the manager and staff were very open and responsive to Care Homes for Older People Page 24 of 31 Evidence: residents care needs. All residents I spoke with said they were very happy living there. They said they were fully consulted about the move to the home and are confident that they can speak with the manager when they need to. Three residents responded to the inspection surveys and these also showed confidence in the homes management. At the last inspection there was a requirement for the home to ensure that risk assessments regarding moving and handling for residents are up to date and are adhered to by staff. I examined four residents risk assessments and moving and handling and observed three residents being supported in transfers by care staff and found that there are now good plans and practices in place which are reviewed and monitored by the manager. A range of important management activities in the home are now being consistently implemented. These include monthly review of residents care plans carrying out appropriate CRB checks on staff and planning and recording of staff induction and training. The owner and registered manager of the home must carries out formal monthly monitoring inspections of the care provided including care plan reviews the management of staff and of the repairs renewals and refurbishments needed. This ensures that the quality of the care and the home are now maintained to a good level. The home has a system for carrying out monthly surveys for staff residents and relatives. Results of these are sent to the area manager for consideration and results are included in quarterly residents meetings. The manager does monthly monitoring checks and does a written report showing improvements needed. However the annual audit system has only been partially implemented and must be fully implemented so that continuing development needs of the home are planned in an informed manner. (Refer to Requirement OP33) Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. All of the residents or their family are responsible for their bank accounts and DSS benefits. All four staff files examined showed supervision to the generally happening but not as consistently as is required although care staff said they felt well supported by the management and their files showed evidence of reflective practice and personal development taking place. The management must ensure that all care and nursing staff have supervision with their line manager at least 6 times a year and that formal notes of these are maintained. (Refer to Requirement OP36) All health and safety and fire safety documentation was checked and found to be up to Care Homes for Older People Page 25 of 31 Evidence: date and in order. Improvements have been made in reviewing residents moving and handling risk assessments and in checking staff practice in this area of support. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The registered manager and provider must give consideration to the improvements suggested in this report and include decisions reached in the homes Development Plan. This is in order to provide safe clean and accessible facilities for all residents 31/12/2010 2 30 18 The registered provider and 30/09/2010 manager must include important areas for staff training in the homes formal schedule of training as discussed in this report Standard 30 This is to ensure that the residents are always supported by skilled staff in all aspects of their care needs. Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 33 24 The homes Annual Quality Assurance Audit system must be fully implemented as discussed in this report. This is to ensure that continuing development needs of the residents and the home are planned for in an informed manner. 30/09/2010 4 36 18 The registered provider and 30/06/2010 manager must ensure that all care staff and nursing staff have supervision with their line manager at least 6 times a year and that formal notes of these supervisions are maintained. This is to ensure that residents are supported by staff who are fully informed and directed by the homes management in their work 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 12 The registered provider and manager should assess whether it is possible to increase the activities coordinators hours and include checking all staff abilities and understanding of games provided in her work as discussed in this report. The manager and provider should remind staff of the need to always ask agency staff to show their photographic identification immediately on arrival at the home and Page 29 of 31 2 29 Care Homes for Older People 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 include this in the agency induction checklist. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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