Care Home: Bury Metro - Spurr House

What the care home does well To ensure that the home can fully meet people`s needs an assessment is undertaken before an admission is agreed. It was clear from watching what went on that there were good relationships between the people living at the home and the staff team. The atmosphere was very relaxed and friendly. The home had a very enthusiastic activities organiser who provides a varied activities programme that helps to keep people stimulated and motivated. The home provides comfortable and homely surroundings for the people living there. Attention was given to good control of infection practices by the staff team. The home exceeds the minimum standard for having more than 50 percent of the permanent staff team trained to NVQ Level 2 and above. The permanent staff team are properly recruited and criminal records checks are undertaken to ensure that they are suitable to work with vulnerable people. An external manager undertakes monthly quality assurance visits to the home, to make sure that everything is in order. What has improved since the last inspection? The manager keeps care staffing levels under review to ensure that the assessed needs of the people can be met at all times of the day. To ensure that the home is well run the home had a new suitably qualified manager in post who is registered with us. There was also a new deputy manager at the home. All members of the staff team had been provided with fire safety training to ensure that they know what to do in the event of a fire. What the care home could do better: The present risk assessment format must be reviewed to check that it is suitable for recording people`s healthcare needs or whether specialist healthcare risk assessments would be better to support care staff in making judgements about the levels of risk for people using the service. More information needs to be recorded about how to give people their medicines which were prescribed "as required" to make sure people get their medicines when they are needed and treatment is consistent. The arrangements for the main meal time need to be reviewed by the manager to ensure that people are getting enough to eat and drink and that mealtimes are a positive and safe experience. All members of the staff team need to undertake the planned training in safeguardingprocedures to ensure that they know what action they should take to protect people in the event of such an incident. Bedrooms that are tired in appearance must be redecorated. The manager needs to review the way staff are deployed throughout the home to ensure people receive good continuity of support that they need. Plans to improve dementia training for the staff team need to be followed through to ensure people receive the support they need. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bury Metro - Spurr House Spurr House Residential Care Home Pole Lane Unsworth Bury Lancs BL9 8SA     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: Julie Bodell     Date: 0 5 0 5 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 29 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 29 Information about the care home Name of care home: Address: Bury Metro - Spurr House Pole Lane Spurr House Residential Care Home Unsworth Bury Lancs BL9 8SA 01612537505 01612536106 c.hesketh@bury.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bury M.B.C. Name of registered manager (if applicable) Miss Catherine Marie Sullivan Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home is registered for a maximum of 36 service-users to include: Up to 36 service-users in the category OP (Older People, who do not fall in to any other category). The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Spurr House is owned by Bury Council and is run by the Social Services Department. The home provides residential care for up to 36 older people. Within this number respite care can be provided for up to 7 residents at any one time. A day care service is also provided for up to 10 older people each day. The home is situated in Unsworth and is close to local shops and offers easy access to the local motorway system. Car Care Homes for Older People Page 4 of 29 care home 36 Over 65 36 0 Brief description of the care home parking facilities are available. The home is a single storey building with ample wheelchair access. The building is divided into four units; each unit has its own lounge, dining room, bathroom and kitchen where residents and visitors to the home can make drinks and snacks. The home also has a conservatory and a large lounge with wide screen TV, video facilities, and a CD music system. Thirty-six single en-suite bedrooms, four assisted bathrooms and two assisted showers are provided. Hoists, aids and adaptations are available for residents use. A Service User Guide (Residents Information Guide) describing the homes services is available and the provider gives other information about the home to new and prospective residents and their families verbally. A copy of the latest inspection report is available in the entrance area of the home. Additional charges are made for hairdressing, personal newspapers, preferred toiletries and outings. 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: This key inspection took place over one day starting at 7.00am in the morning. The home had not been told that we (the commission) would visit. We spoke with the registered manager, two night care staff and two day care staff, as well as people living at the home. We looked around parts of the building, looked at some paperwork and watched what was happening around the home. A pharmacist inspector also visited the home to look at the safety of the medication practices at the home. This visit was just one part of the inspection. We also looked at other information we had about the home. Before the visit the home manager was asked to complete a Care Homes for Older People Page 6 of 29 questionnaire to provide up to date information about Spurr House. We also received survey forms from fifteen people using the service, some of who were supported to complete them by a relative and three from members of the staff team. What the care home does well: What has improved since the last inspection? What they could do better: The present risk assessment format must be reviewed to check that it is suitable for recording peoples healthcare needs or whether specialist healthcare risk assessments would be better to support care staff in making judgements about the levels of risk for people using the service. More information needs to be recorded about how to give people their medicines which were prescribed as required to make sure people get their medicines when they are needed and treatment is consistent. The arrangements for the main meal time need to be reviewed by the manager to ensure that people are getting enough to eat and drink and that mealtimes are a positive and safe experience. All members of the staff team need to undertake the planned training in safeguarding Care Homes for Older People Page 8 of 29 procedures to ensure that they know what action they should take to protect people in the event of such an incident. Bedrooms that are tired in appearance must be redecorated. The manager needs to review the way staff are deployed throughout the home to ensure people receive good continuity of support that they need. Plans to improve dementia training for the staff team need to be followed through to ensure people receive the support they need. 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 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were properly assessed before agreeing to move in so that they could be assured that the home was able to meet their needs. Evidence: At the time of our last key inspection visit the home was working towards becoming a specialist dementia unit as part of an integrated service with other health and social care professionals. This is no longer the case and the home has been included in the current review of services for older people living within the Bury area. No new permanent admissions to the home had been made during the period of review. There were 21 people residing at the home on a permanent basis. People had been involved in the review process and on file there were copies of the consultation document, Consultation on Improving Future Housing Choices for Older People. Two IMCAs (Independent Mental Capacity Advocates) had been to talk to people about their views on the consultation. We looked at the care records of three people and found copies of Care Homes for Older People Page 11 of 29 Evidence: an assessment on each file undertaken by a staff member from the home. The assessment covered personal care and physical well being, diet and weight including dietary preferences, sight, hearing, communication, foot care, mobility and dexterity, history of falls, continence, medication, mental state and cognition, social interests and hobbies, personal safety and risk and carer and family involvement. The manager or the deputy manager would meet the person before they moved into the home unless it was not possible, for example an emergency admission. The manager told us that a community care assessment would also be undertaken by a qualified social worker prior to an admission being agreed. Information from both assessments would be used to generate the care plan that gives direction to care staff as to how the person is to be cared for. Some people had used the short stay service prior to a permanent admission so they and their relatives had had the opportunity to make their own assessment about the home. The manager carefully assessed the dependency levels of people wanting to use the short stay to ensure that the care of people living permanently was not compromised due to staffing levels. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall we found that medicines were handled safely and peoples health was not at risk. Evidence: The care files of three people were looked at. These contained detailed care plans, which had been signed in agreement by a relative, kept up to date and reviewed monthly. Care plans were well written and covered a range of personal and healthcare needs including physical well being, diet and weight including dietary preferences, sight, hearing, communication, foot care, mobility and dexterity, history of falls, continence, medication, mental state and cognition, social interests and hobbies, personal safety and risk and carer and family involvement. General and specific risk assessments were in place. The manager told us that healthcare risk assessments were under review by adult care services senior management team to see how they could be improved to support care staff to determined the level of risk. Healthcare risk assessments need to support staff in Care Homes for Older People Page 13 of 29 Evidence: making judgements around the level of risk using all the relevant information they have about the person and prompt them to request support from relevant healthcare professionals depending on the outcome. This is an outstanding requirement from our last visit. During the inspection the pharmacist inspector looked at how well medicines were handled to make sure that people were being given their medicines properly. This was because we had received reports from the home that there had been two instances of poor medicines handling. We looked at medication records belonging to four people together with their medicines. The manager spent time with us during this part of the inspection and showed a good understanding of how to handle medication safely. Medicines were all stored safely and there was proper storage for controlled drugs, powerful drugs which must be locked away in a special cupboard and medicines which needed to be kept in a fridge. We found that the records about medication were good and showed clearly that all medicines could be accounted for. The records also showed that people were given their medicines as prescribed. There were also good records kept when medicines could not be given as prescribed. Household remedies such as paracetamol were properly recorded and it was clear when such remedies had been administered. We recommended that formal permission was asked of each persons doctor to give these remedies. We also recommended that more information was recorded about how to give people their medicines which were prescribed as required. This is to make sure that people get their medicines for the right reasons exactly when they are needed and treatment is consistent regardless of who is administering the medication. Specific systems had been put in place to make sure that people who only stay in the home for short periods of respite care are given their medicines properly, and their health is protected. We saw that there were good systems in place to support people who chose to look after their own medicines to do so safely. Staff had recently done medication training to help them handle medicines safely. Care Homes for Older People Page 14 of 29 Evidence: The manager did effective checks, audits, each month to make sure that staff were handling medicines safely and peoples health was not at risk. People were observed being treated in a courteous manner throughout our inspection. Good relationships were observed between people living at the home and the care staff on duty. Care staff members were relaxed and friendly in their approach. We spoke with two people living at the home and they spoke positively about the care and support they received from the staff team. People appeared well dressed and cared for and staff were seen cleaning peoples glasses and checking that hearing aids were in use. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were offered choices and consulted regularly about the kind of lifestyle they wanted and peoples special dietary needs were met. Evidence: We arrived at the home at 7.00am. Only one person was up and night staff confirmed that they were under no pressure to get people up until they were ready. The morning routine was relaxed and unhurried. The home employed a very enthusiastic part time activities coordinator. She has recently returned to the home after a period of ill health. There is a programme of social and recreational activities. A record is kept of each session and of who participated in them. The resource manager at a recent visit suggested that the outcome for people who participated in an activity needed to be recorded in their records. Residents meeting minutes were available for 03.02.09. Ten people attended and they discussed, meals and menus, changes being made to the conservatory and they talked about activities. People said suggested forming a DVD club and having a sherry while watching and a bingo session at the weekend. A number of locations for trips out were suggested including Heaton Park, Knowsley Safari Park, Southport, Care Homes for Older People Page 16 of 29 Evidence: Blackpool, pub lunches and Bury Market. A hairdresser was visiting on the day of our visit and many people had their hair done throughout the day. Other people were seen to be singing along to old and war-time songs and reading newspapers and books. Some people preferred to spend time in their bedrooms watching television. The manager told us that the number of people using the day care service was decreasing to give more time to people who were living at the home permanently or using the respite service. Where people had limited ability to make decisions and choices about their everyday living arrangements care staff assisted them by offering choices about what clothing to wear and helping them to choose from the menu. People are able to bring personal items into the home such as televisions, radios, photographs, pictures and ornaments. We did not look at the kitchen during this visit because it was preparing to close down for a week to be refurbished. A memo was on the notice board on each unit informing people and alternative arrangements had been made. The menu for the day was on the wall of each unit. Tables were nicely set with tablecloths and cups and sauces. Breakfast consisted of grapefruit, porridge, cereal, fruit juice, tea and coffee. A cooked breakfast was available on request. The main meal of the day was Lamb Hot Pot or sausages followed by chocolate sponge and custard or ice cream. Some people had special diets and others needed their food liquidised to help them to swallow food easily. We joined people for lunch on one of the units and watched what happened over the mealtime. A substantial amount was served, but the custard in particularly was very hot. Care needs to be taken to check this as people, particularly those with dementia might burn themselves. Some people also had difficulty chewing and swallowing the meat. We were concerned that the meal was hurried and the music was not switched off to enable people to concentrate on there meal so some people were singing and trying to eat at the same time. People did not receive the assistance they needed or enough time was not spent encouraging people to eat because staff were either involved in completing other tasks because their shift was due to end or they were moving too quickly from person to person. The resource manager in her recent visit had also commented on the support arrangements at mealtimes. The arrangements for the main meal time must be reviewed to ensure that people are getting enough to eat and drink and that mealtimes are a positive and safe experience. The manager was in the process of reviewing mealtimes and the menus. 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. Systems are in place to ensure that people are protected from abuse and harm and they know who to contact if they want to make a complaint. Evidence: Complaints information was displayed in the home and this information was also included in the Service User Guide (residents information guide). No formal complaints had been made to us about the service. There had been two internal complaints. They had been investigated through the adult care services complaints procedure and both had been upheld. The manager said that all complaints were treated seriously and were viewed as a means of improving the quality of the service provided. In the returned surveys we received most people and there relatives indicated that they knew who to speak to if they were unhappy and also how to make a complaint. One person commented, I can speak to anybody. The home had a copy of the Bury Local Authority inter-agency safeguarding policy and procedure. The manager told us that approximately half the staff team had received training in safeguarding awareness. The other half of the team had been inducted through supervision and given a handout. It was intended that they would receive formal training once the newly commissioned training was in place. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, well-adapted, and clean environment for people to live in but work still needs to be done to improve the standard of some bedrooms. Evidence: Spurr House was well maintained in communal areas. Most areas of the home were refurbished three years ago, which included a new roof and new window frames and doors being fitted. Corridors were redecorated, new lights fitted and new carpets laid. Two bathrooms and two shower rooms were also fully renovated. There was good accessibility around the building with ramps, assisted baths and other equipment provided. Improvements had been made to the security arrangements to the home to keep people safe. The home had a full time handyman. The foyer had recently been decorated and plans were in place to decorate the main lounge. There was a very pleasant enclosed garden and courtyard area in the centre of the home, which was safe for people to use. This area was attractive and had a water feature. Fresh flowers were in place in most lounge areas throughout the home. The conservatory was being used as the smoking area. However this limits its use to those people who do not smoke and so plans were in place to divide the conservatory into three areas to also include a family room and a treatment room. Care Homes for Older People Page 19 of 29 Evidence: We checked the water to a number of baths, which were set at safe temperatures. Thermometers were found in the bathrooms to enable care staff to check water temperatures were safe, before giving a person a bath. Some bedrooms had been upgraded during the refurbishment programme. However, we looked at twelve bedrooms at random and as at our last key inspection visit it was clear that some bedrooms were very tired in appearance and in need of attention. We were informed that two bedrooms had been decorated and there were plans to decorate more in the near future. Some people with dementia were struggling to use the concertina type doors to the en-suite facilities in their bedrooms. Ways to improve this situation also continue to need to be looked at to see if improvements can be made. The requirement made at our last inspection visit therefore remains outstanding. The building was clean and tidy throughout and was free from malodour. One person commented that the level of cleanliness was, Much improved since new management. We saw that staff adhered to good control of infection procedures at all times throughout this visit. The home has a properly equipped laundry. One persons clothes were being washed seperately and with special soap powder and this had helped to reduce a skin complaint. Care Homes for Older People Page 20 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. Staff recruitment and training ensure that people are cared for and supported safely. Plans are in place for further dementia training for the staff team. Evidence: At our last key inspection visit concerns were expressed by both staff members and in returned surveys about staffing levels at the home. Feedback at this inspection visit confirmed that generally staffing levels had improved and that there were now five members of staff on duty to support people. One on each unit as well as a floating staff members and senior staff. Although there were two care staff members on long term sick leave, overall sickness levels and the use of agency staff appeared to have reduced. Two carers cover the night period with on call support being provided. The manager kept staffing levels under review to ensure ratios were sufficient to meet the needs of those people with high levels of dependency and the social and emotional needs of all people living at the home, many who have dementia. A handover meeting was held at shift changes to help keep staff up to date about what was happening at the home. We discussed with the manager about the need to review how staff were deployed. Many care staff rotate from unit to unit and the outcome for people living at the home could mean that they do not get the continuity they need, particularly those people Care Homes for Older People Page 21 of 29 Evidence: with dementia. One relative commented that in their view, Full time key workers are essential for every permanent service user. The local authority carried out the required range of background checks on all staff including a Criminal Records Bureau (CRB) check. We had previously inspected employment files at Bury Adult Care Services human resources section and found the recruitment process to be robust, safe and promote equality and diversity. The staff training records show that 31 staff members are qualified to NVQ (National Vocational Qualification) Level 2, which exceeds the standard. 6 staff hold NVQ Level 3 and the deputy manager is working towards NVQ Level 4. The staff team had access to relevant training to carry out there roles safely and effectively. The training record shows that most care staff have received the training they need to carry out their roles safely and effectively. Mandatory training includes, fire safety, food hygiene, infection control, health and safety, first aid, moving and handling and medication training. Some staff members mandatory health and safety training is dated but overall appeared to have improved since our last visit. Evidence shows that the manager is assessing competence and where necessary is supporting staff to improve with an action plan to monitor and record progress. All the staff team had received training in equality and diversity and most had undertaken Mental Capacity Act training. Most of the staff team had received training in dementia awareness. One relative in a returned survey commented that, If staffing levels were increased and more specialist training given care and support would be improved. Another stated, Better training of staff urgently required for dementia sufferers. The manager was looking at introducing the certificate in dementia awareness training at the home and the training packs were seen. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home. Evidence: The home had a new manager who had registered with us. The manager had twenty one years experience working with older people and had eight years management experience. She holds the combined NVQ Level 4 and Registered Managers Award. To ensure her continuous professional development she had undertaken regular training in the previous 12 months, which included medication training, deprivation of liberties and safeguarding training, moving and handling and MUST training, as well as attending complaints investigation and managers training and development days. There was also a new deputy manager. Support workers spoken with and comments in returned surveys commented that the new managers were approachable and listened to any concerns that they raised. In a returned survey one staff member commented that they were, Very good with staff. Care Homes for Older People Page 23 of 29 Evidence: There are clear lines of accountability within the home and with external management. The registered manager was in regular contact with the resource manager, who the manager said she felt supported by. The resource manager carried out regular visits to check records and speak to people living there to ensure that the home was being run in their best interests. A written report was then produced of the findings. A copy of the last report was seen. The manager had completed an action plan to help ensure that any issues raised by the resource manager were addressed. Regular resident and staff meetings took place and minutes were kept. The local authority had recently produced a range of quality assurance questionnaires for people living at the home, their relatives and members of the staff team. The outcome of the survey was generally positive outcomes and an action plan had been put in place to address the issues that had been identified called You said, we did. Issues included staff wanting regular supervision sessions and staff meetings and improved staffing levels. The two support workers spoken with confirmed that action had been taken to address the issues that had been raised. We discussed with the manager the Inspecting for Better Lives process including AQAAs, KLORA, inspection reports and judgements and quality ratings system and the impact the ratings will have on services. The manager said that she felt that infection control and medication practices had improved and staff morale by involving staff in decision making. Staff now had a fuller picture about what was happening in the home through more detail handovers. She said that meals and special diets had improved but more work was needed as well as improvements to the environment. It was noted that on the AQAA (Annual Quality Assurance Assessment) that was sent to us that many of the homes policies and procedures were either not identified or needed to be reviewed. We were informed that the adult care services management team were in the process of reviewing all policies and procedures. It was recommended that this task needed to be completed as soon as possible to ensure that the staff team and people are protected by clear procedures that reflect current practice and legislation. The home held money for a number of people for safekeeping. We checked the money and records for two people and found them to be in order. Secure storage is available for the safekeeping of money and of any valuable items. We looked at maintenance of equipment service checks including gas safety, which with the exception of the electrical fittings and fitment check (NEICIC) were in order. We were informed that the home had received quotes for the work needed and this would be undertaken in the near future. At our last two key inspections we required Care Homes for Older People Page 24 of 29 Evidence: that the staff team receive fire safety training to ensure that they know what to do in the event of a fire. The manager informed us that all the staff team had undertaken fire training and that night staff had undertaken fire marshall training. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 8 15 The present risk assessment 31/07/2008 format must be reviewed to ascertain whether or not it is suitable for peoples healthcare needs and whether specialist healthcare risk assessments would support staff better in making judgements about the level of risk. That where identified as needed bedrooms that are tired in appearance, are decorated. 30/09/2008 2 24 23 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 15 The present risk assessment 30/06/2009 format must be reviewed. This must be done to ascertain whether or not it is suitable for peoples healthcare needs or whether specialist healthcare risk assessments would support staff better in making safe judgements about the level of risk to peoples health. 2 24 13 That where identified bedrooms that are tired in appearance are decorated. This must be done to ensure that people have a better standard of accomodation. 30/09/2009 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 9 It is recommended that formal permission was asked of each persons doctor to give household remedies. Page 27 of 29 Care Homes for Older People 2 9 It is recommended that more information is recorded about how to give people their medicines which were prescribed as required to make sure people get their medicines when they are needed and treatment is consistent. It is recommended that the arrangements for the main meal time are reviewed by the manager to ensure that people are getting enough to eat and drink and that mealtimes are a positive and safe experience. It is recommended that the remaining members of the staff team undertake the planned safeguarding training so that they know what action to take in the event of a person being abused. It is recommended that policies and procedures are reviewed and updated to ensure they reflect current practice and legislation. It is recommended that plans to check the homes electrical fittings and fitments is undertaken as soon as possible to ensure the safety of the people living at the home. 3 15 4 18 5 33 6 38 Care Homes for Older People Page 28 of 29 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). 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