Care Home: Brookfield

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What the care home does well Residents and relatives are generally happy with the standards of care and services at the home. Feedback about the service, provided in the range of surveys sent, and confirmed through conversations with people was positive about the home and staff. Comments included, "The staff are very kind and helpful" and another stated " I come to Brookfield three times a week. It is welcoming, well staffed stimulating and the person I visit really enjoys living here". Staff training is provided and the staff team at the home is stable. Staff recruitment is good and the home has a thorough induction programme in place. Prompt referrals are made to healthcare professionals. What has improved since the last inspection? A more proactive approach by the manager has been adopted which has resulted in all the ten requirements made at the last inspection being met. An activities book has been in place since August 2007 and has been maintained recording service user`s daily activity including those undertaken on a one to one basis or in a group according to service user`s individual choices. Social care plan methodologies which record choices and how service users would like care delivered, are now included in all care plans. A satisfactory assessment process is now in place to evidence that the home can fully meet the needs of prospective new residents. Care records now evidence an individualised approach to care and the social side of care. The complaints and adult protection procedures have been reviewed and made more accessible in the home. Training for staff has improved and relevant courses such as advanced dementia training and NVQ level 2 and 3 have been attended. Improvements have been made to the premises such as decorating and re-carpeting. Radiators are now covered and window restrictors fitted. What the care home could do better: The assessment process of health and safety, risk assessments and quality assurance within the home needs to be further developed and kept under regular review. The home needs to develop a system whereby the premises are regularly checked in relation to maintenance and health and safety. This with particular reference to any stair gates used being appropriately risk assessed so that service users are safe. Also the home should upgrade the premises in relation to the garden so that the physical design and layout of the home enables people to live in a safe, wellmaintained and comfortable environment, which encourages independence. The AQAA showed the manager had an understanding of the home, but requires much more documented detail and specific evidence included to demonstrate this. The AQAA was completed briefly and appeared to just mirror the standards in some areas. The Proprietor Mrs Dorval was given the opportunity to present further supporting information and ask questions throughout the inspection to further support and clarify progress in all areas inspected. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brookfield 7-9 Hayes Road Clacton on Sea Essex CO15 1TX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Laker     Date: 0 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Brookfield 7-9 Hayes Road Clacton on Sea Essex CO15 1TX 01255427993 F/P01255427993 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Jos Dorval,Mrs Lystra Dorval care home 11 Number of places (if applicable): Under 65 Over 65 0 11 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 11 0 The residential service is primarily aimed at older people (over 65 years) who require personal care and assistance. The home is also now registered to admit service users who are diagnosed with a dementia condition. The home has a passenger lift installed to reach the upper floor. Most of the accommodation is within single bedrooms, although one twin room remains in use. The home pre-existed at the time of National Minimum Standards coming into operation on 1st April 2002, therefore the level of toilet and bathing facilities existing at that time remain available. On this basis, these facilities comply with requirements of National Minimum Standards. There is one sitting room and one dining room. There is a small courtyard garden to the rear and a small forecourt for parking at the front of the premises. The home has a statement of purpose and service users guide in place. The current fees are 390 pounds a week and additional charges are made for toiletries, Care Homes for Older People Page 4 of 32 Brief description of the care home hairdressing and newspapers. 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: 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 the people who use this service experience good quality outcomes. This inspection was carried out as part of the annual inspection programme for this home. The registered manager who is also the proprietor was available on the day of the inspection. The inspection focused upon all of the key standards. A full tour of the premises was undertaken. Evidence was also taken from the Annual Quality Assurance Assessment (AQAA) completed by the management of the home and submitted to the CQC. This is a self assessment required by law and provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvement would be noted on this, as this contributes to the Care Homes for Older People Page 6 of 32 inspection process and indicates the homes understanding of current requirements, legislation changes and own audited compliance. Five residents, two staff and the manager were spoken with during the inspection. We sent feedback/comment sheets to the home for both residents and relatives for completion prior to the inspection. Four have been received from staff, two from relatives, four from service users and one from a healthcare professional. The comments have been taken into account in the body of this report. 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 Care Homes for Older People Page 8 of 32 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. The home has an assessment system in place that does generally ensure that they can meet the needs of people they admit to the home. Information is available to prospective residents to ensure they will receive accurate information about the service or facilities on offer when deciding to move to the service. Evidence: The home has an existing pre-admission assessment system in place and assessments from two recent admissions were inspected and was in receipt of Care Management assessments provided by social services highlighting the specific and immediate needs, and relevant information for each of these people. The home had also carried out their own admission assessments, which overall do reflect the needs identified within the Care Management assessments and give detail Care Homes for Older People Page 11 of 32 Evidence: of physical ability and dependency needs in personal hygiene, mobility and continence. This was noted to not always correlate with the care plan however the quality of the assessment information, which varied on who completed the assessment had improved since the last inspection. Further training has been undertaken in this area and staff spoken with confirmed this. One care management assessment made reference to a service user smoking and this was not evident in their pre admission assessment or care plan. The AQAA in the choice of home section states We carry out a full and thorough pre admission assessment but then goes on to say that their plans for improvement over the next twelve months were to ensure a more in depth pre admission was undertaken. This is confusing and does not indicate that assessment processes clarify that they can meet prospective service however improvements from the last inspection in this area were noted. The home does confirm in writing that they can meet prospective service users needs however continues to use the same standard letter as noted at the last inspection. It is important that the letter reflects the homes practice and we were informed that these were to be made more person centred and individually developed. Two relative surveys received highlighted that they felt the home met the care needs of their relative overall, one health care professional survey returned agreed that the assessment processes ensure that accurate information is gathered, and two out of four service user surveys returned said yes they had enough information to make an informed choice about moving into the home. New residents were noted to have copies of the service users guide. Brookfield does not provide intermediate care Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Peoples needs are assessed in a person centred way that enables staff to have a better understanding of each individual. People can be assured that the care and support required to meet their needs is planned and recorded sufficiently well to guide staff in promoting their well being and safety. Evidence: Since the last inspection there has been good progress in the development of care plans with regard to their content. The manager stated that new paperwork has been introduced such as methodologies of care which describe the care needed and how the service user would like it. These documents were reviewed and evidenced good detail with regard to meeting service users needs and choices. For example one stated If becomes anxious take to their room and chat and comfort them, give them time to express feelings and another said Does not like lumps or grissel The AQAA just touches on this progress stating, Methodologies in the care plans have improved. Care Homes for Older People Page 13 of 32 Evidence: More specific detail would have clarified the improvements the home evidenced on the day of inspection. Care plans have been developed according to the individuals care management and pre admission assessment and whilst the care plans now reflect elements of individually tailored care; the space available on some care plan documentation such as daily evaluations, still limits the amount and clarity of the information provided. The care and support plans now include essential information relating to behavioural, emotional, social, mental and physical health needs. Staff have undertaken specific dementia training course to enable them to address the needs of those service users with cognitive impairment, confusion and short-term memory loss. One member of staff spoken with confirmed that training has been undertaken. Improvements were also seen in the dating and signing of documentation. Risk assessments have been redeveloped so they clarify the risks or hazards identified and provide instruction with regard to reducing the risks identified. Clear management strategies of risk should be incorporated within care planning arrangements for example: one risk assessment did not include preventative measures for risks such as smoking and falls assessments where stated needs assistance did not all include preventative measures such as how to maintain a safe environment, suitable aids and the assistance required. It was however noted that continence assessments now include risk management strategies for pressure sores. The AQAA states Documentation in risk assessments has improved eg falls, pressure sores and nutrition Staff spoken with understood the importance of risk assessment and one stated We cover this in our NVQ training and it makes sense Review of care records identified changing needs, and renewed management strategies. Daily care notes should also be written showing that staff have made reference to the care plans. The AQAA identifies under what we could do better and the comment relating to health and personal care To maintain the standards and to do more training. Staff training was discussed with the manager and records were evidenced for relevant recent training. The management approach of the home has improved and this inspection evidences a more proactive and not reactive approach to the inspection process. Health records indicated prompt referral to healthcare professionals and information received. Healthcare professionals have commented that the home works cohesively with them and generally felt outcomes for the residents were good. One survey returned stated I would happily live here in my old age Relatives commented that communication was usually good from the home and that they felt the healthcare needs of their relatives were usually met. The home has now provided suitable locked storage facilities for controlled drugs to comply with legislation and as recommended by the Royal Pharmaceutical Society although at the time of inspection no residents were on controlled drugs. This meets a requirement made at the last two inspections. A lockable fridge has also been Care Homes for Older People Page 14 of 32 Evidence: purchased. A Monitored Dosage System is used in the home. Medication records, storage and administration were sampled and inspected for people living at the home. The medication records were found to be in general good order. MAR sheets were neat but there were some missing signatures and some hand written prescriptions without two signatures. A signature audit may be of value to keep this issue in check. Staff need to make better use of the omissions code. Items are checked into the home and a returns system is in place. No residents are presently self-administering. A list of drug givers with their signatures and initials is used. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Social care standards at the home generally ensure that residents individual and group needs are met and their strengths optimised. The meal service at the home is satisfactory and the daily routine and activities in the home are flexible and optional, with people who live at Brookfield being encouraged to make choices with regard to their social, cultural, religious and leisure activities. Evidence: On arrival all residents were observed to be in the lounge listening to music, chatting and watching TV. The television was on at one end of the lounge area. A daily activity timetable was observed in the staff area at the last two inspections, which was more task orientated than an individually tailored approach to suitable and appropriate occupation according to peoples choice and preference as and when they required. This has not changed since the last inspection. It includes :Monday - Music, sing along and dance Tuesday- cake baking with support Wednesday - cream tea, cake making, sherry morning, shopping for cakes. Care Homes for Older People Page 16 of 32 Evidence: Thursday - cards, dominoes, puzzles, papers and magazines Friday - shopping/sea front, dance and exercise Saturday - films, videos and cake making Sunday - sherry morning, socialise and chat. At the bottom of the timetable it states residents can go out at ay time. From observation and staff rota, staffing levels are limited to two, most days, it is therefore unclear as to how residents are supported to go out at any time, particularly as staff also carry out cooking duties which may not facilitate service users choices about outings to an optimum level. This was discussed with the manager and staff on the day of inspection who stated that at present only two residents did not have relatives to take them out and most service users enjoyed outings with their family. One resident has a volunteer come to the home to help their family with outings and the manager stated that she would increase the staff complement if required to facilitate residents choices regarding external activities. One staff member spoken with stated We offer them what they want Surveys confirmed that residents and relatives were happy with the way their social care needs were being met, and clear methodologies of care with regard to social activities are included in service users plans of care. One stated Likes to go for walks with staff and friends and help staff in the kitchen, fold laundry and will say if she wants to go out Another stated Likes to sit in sunshine out the front with staff, enjoys a cigarette and tidies her handbag. One also confirmed Doesnt like to go out or socialise with other residents but likes to be around people. can become agitated but enjoys cream teas. An activities book has been in place since August 2007 and records show service users daily activity via one to ones or group activities according to service users individualised choices. Care plans now indicate residents participation in any activities and the outcome or benefit anticipated for the resident. Three residents spoken to confirmed that they had a choice about how they spent their time during the day. The service is developing its competence in meeting the needs of residents with varying levels of cognitive impairment. As previously mentioned in this report staff training in dementia evidenced this. Menus and food stocks were reviewed and it was found that they were adequate for the current service users group with not much use of convenience/processed and value brand foods. The use of such food products and their high salt and sugar content was discussed with the management at previous key inspections. The home has a two weekly rolling menu and one meal was observed in the home. A choice was offered which was not on the menu and all service users spoken to showed no dissatisfaction with their meals. There were not large amounts of fresh fruit or vegetables as stock but we were informed that stocks are replaced regularly and the last stock had just been used for that meal that week and a new order was to be placed for fresh fruit and vegetables to replenish stocks. Drinks and snacks are available throughout the day. Care Homes for Older People Page 17 of 32 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. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that ensures service users know their complaints will be taken seriously, listened to and acted upon. Procedures in the home ensure people living there can be confident that they are protected from abuse and that all carers are adequately trained to safeguard their welfare. Evidence: The home has an appropriate complaints policy and procedure, which promotes complaints being taken seriously and responses to them handled efficiently. The AQAA states Our complaintscomplaints policy and procedure has been updated and it is now more readily available to residents, relatives, friends, advocates and outside agencies Residents spoken to felt able to raise concerns, and were clear that they would speak to the manager if they had any complaints. One service user stated, I dont have any complaints they are lovely here. One staff member confirmed, I can speak to the manager if I have a problem. The home does have a system of maintaining any records of complaints received: The AQAA and manager stated that no complaints had been received since the last inspection. One has been made known to us but was dealt with appropriately by the home and the issue regarding the documenting of complaints was discussed with the manager. This would evidence the homes effectiveness at responding to complaints. The provision of the complaints procedure in alternative Care Homes for Older People Page 19 of 32 Evidence: formats i.e. large print was also discussed on this visit. Service users spoken with did display an awareness and understanding of the current policy and it was seen to be displayed prominently in the home. Management of complaints was discussed with the manager and the homes AQAA informs us that More training in the management of complaints and safeguarding vulnerable adults is planned. No safeguarding referrals have been made since the last inspection. The home has a policy relating to the protection of service users, which includes a statement on the protection of service users monies, referred to the homes Whistle Blowing policy, and does identify social services as the lead agency to which any concerns would be referred. All staff are trained in Safeguarding of Vulnerable Adults. Conversations with staff both new and existing, confirmed they had an awareness of the whistle blowing policy and the actions required to safeguard residents. Staff appraisals show that staff have identified adult protection as an ongoing training update required annually and a training matrix confirms staff attendance at this. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People living in Brookfield overall benefit from a homely environment that is clean and pleasant and provides a safe, well-maintained environment that is accessible to the people who live there and meets their individualised needs. Some improvements need to be made around maintenance if people are to remain safe. Evidence: A full tour of the premises was undertaken. At this inspection the nurse call system was working throughout the home. It was positive to note that more bedrooms had been decorated and re- carpeted since the last inspection and an electric bed had been purchased for the home. This gives a good impression of the home and makes the environment more pleasant for residents. The homes AQAA confirms that daily checks are carried out regarding service users rooms including the daily checking of call bells, and a number of maintenance and safety issues found to require attention at the homes last inspection were evidenced as being dealt with and were all in working order. At the last inspection the manager had been consulting with the local fire authority with regard to access of fire exits whilst making alterations to one bedroom involving installation of an ensuite with a view to making the bedroom a single. This is still ongoing and under consultation and has yet to be confirmed with the CQC. This Care Homes for Older People Page 21 of 32 Evidence: room was also noted to have a blocked fire exit, and although the proprietor stated at the last inspection that the fire authority stated it was alright to do this there was still no documentary evidence to substantiate this. Since the last inspection, window restrictors have been fitted to all upstairs windows in service user areas such as bedrooms and radiator covers are in place on all radiators now. The home was seen to be clean on the day of inspection and minimal odours were noted. The home has a cleaner from 7 am to 9 am on weekdays and care staff currently undertake all other cleaning tasks. On the day of inspection there was no cleaner on duty as she was rostered on days off. Although this did not affect outcomes for residents as the home was clean and welcoming on the day of inspection this was discussed with the proprietor with regard to the detraction of staff from care duties. Surveys returned did not highlight any problems with the cleanliness of the home, one stated Good food and clean washing and another stated The home is clean and welcoming and I have no problems with any of the services. Relatives and service users did however comment that the home could improve with better garden facilities. This was highlighted at the homes last inspection also. The garden is a courtyard with no grass verges and looks tired and uninviting. At the last inspection flowers in the borders were dead and overgrown with weeds and garden furniture needed replacing. This has only improved marginally with some cleaning up of rubbish and flower beds but obvious improvements are still required. Although the homes AQAA does not make any reference to the garden area, the proprietor stated that she intended to improve this area over the coming months and ask residents how they would like it so it becomes a welcoming area for residents to sit out in. Fire safety was reviewed and the checking and maintenance systems were seen to be in place and up to date. A recent fire officer visit in May 2009 showed that door closures previously needing attention and signage should be upgraded. This has been done and doors have been upgraded to ensure they are safe in the event of a fire. The laundry is located outside at the rear of the home and ongoing work is still underway to improve this area and provide a more suitable environment. The manager states in her annual quality assurance assessment that Regular meetings are held and environment problems highlighted Staff do check the premises and record anything noted in the occurrence/maintenance book and repeat this to the manager. A number of light bulbs that required replacing in two lights were pointed out to the manager on the day of inspection. Although a maintenance log is maintained, records are still limited and do not evidence that the work has been done and when. the proprietor/manager stated that she would be more vigilant in this area in future. The stairs to the linen cupboard on the third floor were steep and spiral and a risk assessment for staff using them on an ongoing basis should be in place. This was identified at the last inspection along with the need for an assessment of equipment and the environment for access, safety and appropriateness being undertaken on the 23/08/07 indicating, Access to stairs to private rooms on the second floor should be controlled by gates. These have not been risk assessed, Care Homes for Older People Page 22 of 32 Evidence: however advice has been sought from the fire authorities to ensure safe practice and that service users liberty is not deprived. The proprietor was advised to review the current guidance available on deprivation of liberty issues and ensure risk assessments were in place. Overall safe enviromental systems are in place and improvements have been made since the last inspection indicating a more proactive approach by the manager, to the ongoing maintenance of the premises. Care Homes for Older People Page 23 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. This judgement has been made using available evidence including a visit to this service. The home provides staff that were appropriately trained and qualified and they are generally felt to be in sufficient numbers to meet residents needs. Recruitment practices meet regulatory requirements set out to protect residents. Evidence: The home has a stable staffing team. Staffing levels remain unchanged and are currently 2 care staff plus the manager am and part pm. 2 care staff late pm and 1 awake and 1 asleep at night. On discussion with the manager and the staff, they agree the current dependency levels of the residents and feel that they can meet the needs of the current residents with these levels. The homes AQAA states We have a stable staff team and are able to meet all residents needs Relative surveys returned confirmed this also, one stated My relatives needs are all met very well. The current staff rota was inspected and showed that one member of staff was working from 7.45am to 6pm, six days a week. This was discussed with the proprietor and the member of staff concerned, with reference to the working time regulations and the staff members individual contracted hours. This is not considered best practice on an ongoing basis. The proprietor stated at the last two inspections that she plans to employ a cook if the Care Homes for Older People Page 24 of 32 Evidence: resident levels go up from 7, as at the current time the care staff do all the cooking and cleaning, which does take them away from residents physical and social care needs. She stated at this inspection she would be able to employ a cook when the home was at a full complement of 11 residents at the present time the home has 10 residents. At present the lack of a cook does not seem to affect positive outcomes for residents however the manager needs to and agreed to keep staffing levels at the home under close review to ensure that residents needs are being fully met, especially in relation to outings and social care, which could be affected by lack of staff. No agency staff have been used in the past three months, however the proprietor stated she would use agency if required. The proprietor states in the annual quality assurance assessment that 50 percent of the care staff have NVQ level 2 and above. This was confirmed and evidenced by reviewing training records and the training matrix that is now in place. Only one new members of staff has been employed since the last inspection. Recruitment procedures were checked for two files and found to be generally in good order. The skills for care induction is being used and was seen for new staff. No interview records are kept. The last inspection recommended that the application form be reviewed in light of the age discrimination act and to give a longer career history and that all new staff should be issued with the general Social Care Council (GSCC) guidelines, the proprietor confirmed this had now been addressed. The home has a policy in place for staff supervision which states that this should be carried out bi-monthly. Records seen evidence that this is happening and records identify any training needs. The manager does now have a planned training programme in place and uses the supervision/appraisal records and staff files to identify need. The AQAA also identifies the homes need to have More staff training to ensure standards are met. Staff training records show that most staff are up to date with mandatory training and have attended some additional specialist training on dementia, falls prevention and health and safety. Staff spoken with confirmed this. The manager is now working on using the skills and knowledge gained by staff through training to improve services and facilities in the home so outcomes can be improved and maintained for residents. Care Homes for Older People Page 25 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. This judgement has been made using available evidence including a visit to this service. Residents benefit from a generally well-run home and are protected by the homes procedures and health and safety practices. Systems are in place but should be developed further, to ensure that residents views form part of the monitoring and review of the home. Evidence: The proprietor/manager confirmed at the last inspection that she had completed the registered managers award but as yet is to receive the certificate. This is still ongoing. Documentary evidence was seen to confirm that her portfolio is being reviewed by Anglia University so a certificate can be issued as the company she completed the qualification with had gone into liquidation. Since the last inspection she has also undertaken other training including an advanced dementia care course. Previously there has been concern that despite undertaking training the manager had Care Homes for Older People Page 26 of 32 Evidence: yet to put proactive, consistent systems into place which reflect her learning on the course and that would benefit the residents and the home in general. Marked improvements have been made in this area as all the ten requirements made at the last inspection have been met indicating a much more proactive management approach by Mrs Dorval the proprietor/manager. The completion of the AQAA was noted to be brief and non specific, and mirroring the Older People Care Standards statements in areas and included repetitive statements such as To maintain standards. Although it showed an understanding of the home a much more detailed completion is required and would have clarified the homes development and progress. The proprietor was spoken to regarding this regarding the expectation that the AQAA is an up to date audit tool for the home and should identify how the home plans to develop and ensure positive outcomes for residents. A basic quality assurance system is in place, which consists of short tick box feedback questionnaires for residents, relatives and visiting professionals. There still needs to be a systematic approach and analysis of results. The questionnaires should help inform and improve practice and facilities in the home. No other formal audits are currently in place and this is still an area for development work in the home. The manager does not refer to quality assurance systems in her annual quality assurance assessment however questionaires were seen within the home for completion by relatives and visitors. The manager confirmed that the home does not hold any monies on behalf of residents. Items are purchased on behalf of the residents and then invoices are raised and sent to relatives. Records required for the protection of service users and for the efficient and effective running of the care home were reviewed during this inspection. Schedule 2 records, Information and Documentation in Respect of Persons Carrying on, Managing or Working at a Care Home, were generally found to be in good order. There are systems in place to maintain the health and safety of the home, and a clear policy statement of the arrangements to maintain health and safety in the home, including employer and employee responsibilities. Staff training records showed that staff had received training in relevant health and safety topics, including the moving and handling of people. The home maintains records to show that equipment and utilities are regularly serviced, and that appropriate internal checks are carried out (e.g. routine testing of fire alarms and emergency lighting, checking of bath and shower hot tap temperatures, checks on central hot water temperatures re risk of legionella, etc.). There are no other auditing systems in place for assessing health and safety in the home or a risk assessment system. This should be addressed. The home needs a range of risk assessments on safe working practices, including fire risk assessments and the use/storage of chemicals (with hazard sheets available for the chemicals used). Fire drills on a more regular basis need to be implemented to safeguard Care Homes for Older People Page 27 of 32 Evidence: residents and ensure staff are aware of the appropriate actions to take. Care Homes for Older People Page 28 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 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 The home needs to develop 30/09/2009 a system whereby the premises are regularly checked in relation to maintenance and health and safety. This with particular reference to any stair gates used being appropriately risk assessed so that service users are safe. Also the home should upgrade the premises in relation to the garden so that the physical design and layout of the home enables people to live in a safe, well-maintained and comfortable environment, which encourages independence. the home enables people to live in a safe, wellmaintained and comfortable environment, which encourages independence. Recommendations Care Homes for Older People Page 30 of 32 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 8 Residents risk assessments must contain sufficient detail to fully identify the risk and outline management strategies and correlate with any assessments made. Any transcribed medications must be clearly documented with evidence of two signatures to ensure the risk of medication errors being made are reduced. Consideration should be given to the appointment of an activities officer to help ensure that residents individual and group social needs are met. The homes systems for recording maintenance issues should be current and regularly updated. The home must continue to develop robust quality assurance systems to help ensure that the home is run in the best interest of service users. Systems should be in place for assessing health and safety within the home and environmental risk assessments undertaken. 2 9 3 12 4 5 19 33 6 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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