Care Home: Broomhills

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What the care home does well Residents are happy living at Broomhills. They speak positively about the staff and comments include `they look after me well` and `they are a nice bunch who always stop and chat to you`. Residents are happy with standard of care provided and also feel that the food is good. Prospective residents can expect to be properly assessed prior to admission so they can be assured that the home is right for them. The manager is keen to continually improve the home, the services offered and develop the staff team. The manager is objective regarding complaints and residents and relatives feel comfortable in raising any concerns. Staffing at the home is stable and overall the staff team are quite well trained. The home is clean, safe and well maintained. What has improved since the last inspection? Since the last inspection the team have worked on improving the care planning/management and this is evident from spending time in the home and reviewing records. The atmosphere in the home has improved and staff interact much more with the residents now. What the care home could do better: There are still some areas for work, which the management team are aware of. Some aspects of care management require a little more monitoring to ensure that residents needs are met in full and the provision of activity based care needs pursuing but this has been hindered by not having an activities officer in post. Staff supervision needs to be more consistent and consideration needs to be given to expand the training programme offered to care staff. Key inspection report Care homes for older people Name: Address: Broomhills Stambridge Road Rochford Essex SS4 2AQ     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: Diane Roberts     Date: 0 4 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 29 Information about the care home Name of care home: Address: Broomhills Stambridge Road Rochford Essex SS4 2AQ 01702542630 01702542553 broomhills@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Joanna Martine Smith Type of registration: Number of places registered: care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: No more than 47 persons to be accommodated at any one time. Up to 23 persons of either sex to be accommodated who are over 65 years of age and who have dementia. Up to 47 persons of either sex to be accommodated who are over 65 years of age. Date of last inspection Brief description of the care home Broomhills is registered to provide personal care and accommodation for 47 elderly people, included in this number the home can provide accommodation for up to 23 service users who have dementia. The original house is a 100-year-old building of character. There are thirty seven single and five double rooms, most with en suite facilities. The home is currently using three of the five shared rooms as single Care Homes for Older People Page 4 of 29 Over 65 0 47 23 0 0 2 0 4 2 0 0 9 Brief description of the care home accommodation. There is a choice of lounges and a separate dining room. There is an activities room in part of the basement. Accommodation is provided on three floors and all areas can be accessed by the way of two passenger lifts. Broomhills is set in three acres of grounds. Local facilities are a mile and a half away in the town of Rochford. The home has a Statement of Purpose and Service Users Guide in place. A copy of the most recent inspection report was available and on display in the home. Current fees at the home were quoted as being from £378.00 for a contracted bed and £525.00 to £650.00 per week for a privately funded bed, depending on the room. Additional charges are made for chiropody, newspapers, toiletries and some transport costs. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home for a day and met with the manager and her team. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to 5 residents, 3 relatives and 3 staff at the home and prior to that we sent out surveys to residents and staff asking for feedback on the home. The response was limited from residents due to the level of dependency but wherever possible and their comments are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 7 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can expect to be properly assessed to ensure that their needs can be met and that they would have all the information they needed to help make a decision about the home Evidence: The manager has a service users guide in place and this was seen to be available in both the main reception and in residents rooms. The guide is up to date but the format requires some work to ensure that it is suitable for those residents living with dementia to use. The manager has a system in place for the pre-admission assessment of any prospective new residents. On the whole the manager undertakes all the assessments and occasionally the care team managers do them as well. We looked at two recently completed assessments. Overall they were completed well and gave a good level of detail about the medical history of the individual, any equipment that may be required Care Homes for Older People Page 9 of 29 Evidence: and enough information on the level of care and support needed, to allow the team at the home to make an informed decision as to whether they would be able to meet those needs. Within the assessments there was some good person centred information regarding residents individual preferences, abilities and mood etc. but this could still be expanded upon to further aid a smooth transition into residential care by giving staff more information about the individual themselves. More information is also needed for those living with dementia on how the dementia is actually affecting their day to day lives and, for example, what skills they retain. In addition to the managers assessment, the team had access to assessment information from the referring local authority where appropriate. Whilst overall the assessment information is generally good, staff need to ensure that they transfer all the information gained into the subsequent care plan, so it is not lost and can be evaluated on an ongoing basis. For example, issues regarding refusing personal care and a history of urinary tract infections, carer preferences etc. identified at the point of assessment were not highlighted in subsequent care plans. The manager in her AQAA said we explore the suitability of referrals prior to, during and following any pre-admission assessment. We speak with the potential resident and encourage pre-admission visits to the home. She also said that she is planning to develop the information made available to potential new residents. We saw that the manager also repeats these assessments for those residents who have been in hospital a while, to ensure that the home can continue to provide care for them. This is a good practice. Relatives who commented said that they visited the home unannounced and that they were made welcome and shown around. Comments included my relative is so much better since they have been at the home, my relative was welcomed really well, we have seen the last report and the service users guide and the staff were good at helping my relative settle in and orientating her to the home. We saw that a copy of the last inspection was available in the reception area of the home. Care Homes for Older People Page 10 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a person centred approach to the management of their care and their care needs generally met quite well. Evidence: The manager has a care planning/management system in place. This consists of an assessment of needs, risk assessments and care plans. We looked at three care plans in detail and used two further plans for cross referencing. Residents had up to date needs assessments in place that then identified the appropriate care plans to be put in place. Overall residents had the care plans that they needed in place with only the odd one missing and this is discussed further in this section of the report. Care plans were sufficiently detailed to guide staff and contained some person centred information to help staff be aware of residents preferences, behavior etc. For example, X can get frustrated with too much prompting from staff and x loves to talk about dancing. Independence was seen to be promoted, especially in relation to support given with personal care. For example, staff are to motivate x fully to carry out her own personal care independently. The inclusion of person centred information could still be developed further to improve the person centred care planning as it was variable Care Homes for Older People Page 11 of 29 Evidence: between care plans. Social care plans were limited and these are discussed in section 3 of this report. Staff complete daily notes and whilst informative, stating that they ate well or slept well etc., they did not always reflect the care plan or give a picture of the residents wellbeing or mood. Daily notes do evidence that residents are offered choices in their daily routine and that staff have respected those choices, for example with personal care or when to get up. There is also good evidence of communication with families when required. Overall the care plans were up to date and the manager has introduced a new care plan review monitoring system to help with this. However, staff do need to ensure that once residents have returned from hospital, they review their assessment and care plan promptly to ensure that their needs continue to be met if they have changed, Staff need to link into the up to date assessment completed by the management team. Records show evidence of full placement reviews and these have included the resident and there social worker. We observed that staff need to pay a little more attention to detail when providing personal care as residents could do with more support to shave, do their hair and attend to their nails, although later in the day we did see staff helping some residents with their nails. The manager said that some residents, who are living with dementia, are reluctant with personal care and this is detailed in their care records. More ongoing training for staff on caring for people with dementia may help to address this matter so that staff have the skills they need to provide the support needed. One relative we spoke to was very happy with the care of his relative and said that they had no concerns and that the staff team at the home communicate well with the family about any matters. Other comments included the staff are good, they take time to explain things to residents, my relative is well looked after, the staff communicate well and always account for everything that has happened. The staff we spoke to knew the residents and their current needs quite well and knew the level of support that residents needed. Staff had variable levels of knowledge about the residents past life, social interests etc. One carer knew a lot about the residents and had clearly been talking to them and another knew a limited amount of information and confirmed that they had not read the care plan. Residents we spoke to said everything is fine and I feel well, the staff are good with my dignity. The manager in her AQAA said We promote person centred care whilst maintaining independence and dignity. We would generally concur with this statement. The manager also added under the section What we could do better , It is recognised Care Homes for Older People Page 12 of 29 Evidence: that we, as a team, at times need to explore how we use our time effectively with each resident to achieve the best possible outcome across the differing requirements of each resident group. It is positive that this is being questioned and should be reviewed in line with staff comments regarding the current staffing levels. See section 6 of this report. Residents were seen to have up to date manual handling assessments in place and where appropriate falls risk assessments, with care plans in place for the management of any identified risks. We found that occasionally some of the falls risk assessments were not up to date. having been last reviewed in January 2010. There was evidence that where needed residents had been referred to the falls prevention team and that there had been input from the residents doctor and the visiting district nurses. Staff are monitoring residents who they have assessed are at risk nutritionally. This is being supported by weekly reviews from community nurses. Records show that staff are weighing residents and completing nutritional assessments. However we did note that staff were identifying the need for care plans in place and these were not always completed. Staff were also inconstant in their recording of whether residents were a low or medium risk following assessment. This needs to be tightened up to ensure that residents nutritional needs are met appropriately. Residents had risk assessments in place in relation to the prevention of pressure sores. These were up to date, linked to detailed care plans and from observation, residents had the appropriate pressure relieving equipment in place. Since we last visited no residents at the home have developed a home acquired pressure sore. From the records it is clear that residents have good access to their doctor and that they are contacted in a prompt manner when needs be. Residents also see opticians, chiropodists and other heath care professionals. Those residents on fluid charts were observed to be having them completed well and staff were observed to be offering drinks. We reviewed the administration of medication at the home. The team use a blister pack system. Medication administration charts were seen to have clear prescriptions and be appropriately signed by staff and corresponded with the blister packs. As and when medications were appropriately recorded by staff and records kept for the reason for administration. Each resident had a photo in place and a medication profile which gives a good level of information as to what each medication is for. Overall the administration of medication was good although staff need to ensure that they note the date of opening on any liquids and boxes for auditing purposes. Care Homes for Older People Page 13 of 29 Evidence: Senior staff in the home undertake regular medication audits and we saw records for the last one which was completed in February 2010. The results of the audit were satisfactory. Residents who commented said we get our medication on time. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall residents experience good outcomes with regard to choice and mealtimes but activities could be better. Evidence: From records and discussion with residents and staff, the routine of the day is primarily resident led. Residents said that they have choice about when they get up and go to bed etc. and staff gave accounts of the daily routine which confirmed this approach. Staff discussed residents rights and choices that they make. Residents who commented said you can do as you please and spend your time how you see fit and I go to bed whenever I like. The manager has employed a new activities officer but she is on maternity leave and an advert is out to cover this post. Staff were observed to undertake activities with the residents in the lounges late morning after care team managers were heard to ask them to do something. In a home primarily for people living with dementia, the staff need to be more aware that social activities are an integral part of their work at all times. However overall the atmosphere was much more inclusive of residents at this inspection. The activities programme said games and puzzles in the morning and a quiz in the afternoon. Staff we spoke to said that they were aware of the programme Care Homes for Older People Page 15 of 29 Evidence: but did not always follow it and do choose other things to do with the residents. They said, along with the manager, that at the current time the activities room, which is a good resource, is not really used. We saw some games, such as ball throwing, parachute games/exercises etc. going on, but this was limited and primarily group focused. A quiz was held in the afternoon and staff were chatting nicely with residents and doing their nails. Some residents were seen to be reading the newspaper. Residents who were in their rooms were not seen to have any one to one time and staff spoken to said one to one time primarily consisted of manicures. The records in relation to the activities undertaken are inconsistent, over the last three months, but do show that residents have had external entertainers visit the home, taken part in Tai Chi and had local choirs visiting. They also watch films, do colouring/arts and crafts and have quizzes. From the above evidence, residents group social needs are probably being met but more work is needed on developing a person centred approach to ensure that their individual needs are met so that their independence, skills and self worth are promoted further. Social care plans are limited and do not really contain an assessment of their needs in relation to social care, just really noting some preferences and that staff should encourage residents to take part. Staff need to be clear what individual social support is needed for each resident. Residents were seen to have good family trees in place, giving staff detailed background information on the individual, their life and career etc. The manager said that the team at the home are planning to start a gardening club and have entered the companies Bloomin Marvelous competition this year. An activities board is available but the format could be improved with regard to clear signage and font size. The home now benefits from having access to a new large minibus with a tail lift, that is shared between a few homes and should facilitate more outings. The manager in her AQAA said we have developed a relationship with a local primary school and residents have been to the nativity play and members of the preschool have attended events at the home. Residents we spoke to about activities said I use to use the activities room but not since the last activities lady left, I use to like that, There is usually something that I can do and I dont do much here, I use to enjoy gardening. The manager in her AQAA said Residents interests and needs are considered whilst they are encouraged to take part in meaningful activities. Activities are delivered in group and one to one style interactions and residents choice and preferences are taken into account. Whilst we concur with this to an extent, the evidence shows that whilst this approach is being adopted, it is limited at the current time. We reviewed mealtimes at the home. We saw that residents had access to jugs of Care Homes for Older People Page 16 of 29 Evidence: drink in their room during the day as well as having tea and coffee etc. available at other times. The tables were laid nicely for breakfast and lunch although tablecloths are not used. Staff were seen to be laying the tables and not using the opportunity to ask residents if they would like to be involved. The manager said that she plans to purchase table cloths and flowers etc. for the tables. Menus were available on the tables and music is often played during mealtimes. The manager says that they are currently developing pictorial menus to help residents choose their meals. Staff were seen to be helping residents in a sensitive way during mealtimes and this has improved since our last visit. Residents that we spoke to about the food said it is as good as it can be and we get a good choice, the food is very good and if I eat in my room, its always still hot, you get a reasonable choice and you can have a hot breakfast if you want, with afternoon tea there is sometimes cake and sometimes there is a banana and The food is OK, we get a choice and occasionally I like to have a cooked breakfast. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their concerns would be listened to and that, as far as possible, they would be protected from abuse in the home. Evidence: The manager has a complaints procedure in place and this is displayed around the home and can be found in the service users guide, which is freely available. We looked at the managers records in relation to the management of complaints within the home. The managers records are good and account for what has been done in relation to each complaint. Staff are equally good at recording concerns raised with them for the manager to deal with. Records show that the manager meets with residents and relatives and that matters are dealt with promptly. Since we last inspected there have been eight complaints. These relate to care management, finances, laundry and hairdressing. The manager in her AQAA said in relation to complaints that a philosophy of transparency and honesty is maintained. Residents who commented said if I had a concern or a complaint, I think it would be dealt with properly. One relative we spoke to said that if they raise any query or concern it is never an issue and it is always dealt with properly. Staff spoken to show a good awareness of adult protection procedures and the manager has the local guidance available. From staff training records it shows that nearly all the staff have attending recent training on adult protection, with only 6 Care Homes for Older People Page 18 of 29 Evidence: outstanding. The manager in her AQAA said that they plan to have an in-house dignity champion who will be specially trained in the deprivation of liberties and residents rights etc. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, safe and well maintained home. Evidence: We looked around the home with the manager and visited all floors, a number of bedrooms, bathrooms and all the communal areas. Overall the home was seen to be very clean and well maintained. No odours were noted. The manager in her AQAA said that a continual programme of decoration and improvement is in place. Residents rooms have been personalised and residents we spoken to were happy with their rooms. The company plan to refurbish the kitchen in early Spring 2010 and the maintenance man is in the process of redecorating the upstairs corridors. The home has a snoozelum room near the main lounge and residents were seen to use this during the day. It has been improved since out last visit with better seating and use of the equipment. More could be done to improve the home with regard to pictures and interactive items to stimulate residents. Access to the laundry has improved since our last visited as a lock has been fitted to help with residents safety. The manager employs a maintenance man at the home who works for 20hrs per week on maintenance and 20 hrs on duties such as carpet and furniture cleaning. Records in relation to fire safety were checked and these were in order with the Care Homes for Older People Page 20 of 29 Evidence: required checks and drills being undertaken on a regular basis. A fire safety risk assessment has been completed but this needs reviewing as it is dated 2007/8. It was noted that the electrical safety certificate for the wiring of the home was dated 2004 and out of date. This should be addressed. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by and stable and generally well trained staff team. Evidence: The current staffing levels are 1 care team manager and 5/6 carers in the morning, 1 care team manager and 4/5 carers in the afternoon and evening and 1 care team manager and 2/3 care staff at night. Higher numbers are provided depending on the dependency of the residents. Care staff are deployed to cover mealtimes in the dining room and to cover the lounges to provide activities. All staff who commented on the staff surveys felt that there should be more staff on duty to provide individual care to residents. The manager needs to review this with the staff team. The manager has had a turnover of staff since coming into post but at the current time has no care staff vacancies and is not using any agency staff, which is good. Staff who commented were happy that the team at the home was now more permanent/consistent and they felt that this made a difference to the level of care that they could provide. Relatives who commented said the care staff are good and there are two who are particularly good, the staff genuinely care. Residents who commented said the staff are prompt if you ring the buzzer, on the whole the staff team are quite nice, day and night and the staff are a nice bunch, they do stop and chat to you. At the current time 13 out of 23 of the staff have achieved an NVQ qualification and Care Homes for Older People Page 22 of 29 Evidence: records show that other staff are currently undertaking these courses. We looked at the files of staff recently recruited to the home to check if the recruitment process at the home is robust and protects residents. Overall the staff files were in good order and all the required checks and documentation were in place. Interview records are held and any gaps in employment are explored with the applicant. Applicant identification is also checked. Records of induction are evident for both the home and for ongoing Skills for Care. Training records show that overall the compliance levels for training at the home are good with all staff attending mandatory training. In addition to this nearly all the care staff have attended training in the care of people living with dementia and infection control. Consideration should be given to proving more training on conditions associated with old age and on matter such as nutrition of the elderly, especially for those residents living with dementia. Staff spoken to were happy with the level of training offered by the company and felt that overall it was good. There was evidence on the staff files of up to date training certificates including detailed training in the care of people living with dementia. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home and a management team that has their interests at heart. Evidence: The new manager at the home has a background in health and social care, working in this field for 19 years. She has worked as a manager for the past 11 years, running residential homes for older people. The manager is currently applying for registration with the commission and has completed the registered managers award. Staff spoken to said that the management of the home was good and that the new manager and deputy manager would be the making of the home. Staff felt very positive that the the management team would continue to move the home forward. Staff commented that the manager was professional. Records show that the manager meets regularly with the staff team on both days and nights and covers such issues, for example, as standards of care, nutrition, health and safety, activity based care and training. Care Homes for Older People Page 24 of 29 Evidence: The manager undertakes a monthly audit at the home and actions any items raised. The company completes a yearly audit, which includes seeking feedback from residents and relatives and an action plan is also developed, where required. In addition to this the manager completes audits of accidents in the home and other key areas, such as pressure sores, weight loss etc and these are monitored by the companies quality monitoring team. Residents we spoke to said its nice here and I have got no complaints, I am happy living here. Relatives said we are very happy with the home, since the new manager has been here, the home is more efficient, you cannot fault her, the administrator is good -she puts herself out to help you in any way that she can, can fault this place, my relative is very well looked after, we are always welcomed into the home, my relative likes the food and the staff. The manager has held two relatives meetings, although attendance was poor. She plans to write individually to relatives to invite them to the next meeting, in an effort to have a more successful attendance. The managers records showed that supervision over the last year has been inconsistent but recent records show that there are efforts to get this back on line with regular meetings/observations. etc. Some staff we spoke to said that they had had supervision whilst others said they had not or were unsure when they last had it. One carer confirmed that she had recently had an appraisal and felt that the new manager was addressing staff supervision in the home. Accident records were reviewed and found to be properly completed and where required issues had been notified to the appropriate authority. The management team monitor accidents and review any patterns, times etc. and would look into any residents/areas of concern. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Care plans must be in place for those identified at being nutritionally at risk. To help ensure that their needs are met in full. 14/05/2010 2 12 16 Through assessment and care planning residents individual social care needs must be met. So that their independence, retained skills and self worth is promoted. 31/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 1 2 7 Continue to develop the service users guide so it is user friendly. Ensure that information gathered at the time of assessment is utilised in the subsequent care plans. Ensure that care plans are reviewed an update when required, for example, when residents return from hospital. Page 27 of 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 4 5 19 19 An up to date fire safety risk assessment and electrical safety certificate should be in place. Consideration should be given to providing and more stimulating environment through pictures and interactive items. Consideration should be given to providing staff training on conditions associated with old age. Continue to develop the staff supervision programme. 6 7 30 36 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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