Care Home: Bywell House

What the care home does well Residents are happy with the care and support they receive. Comments include `they look after us and verify illness` and `they look after me very well`. Staff treat residents with respect and maintain their rights to dignity. Visitors are made welcome and there are no restrictions on visiting times. Residents say they know of someone they can talk to informally if not happy and that they know how to make a formal complaint. What has improved since the last inspection? New pre admission assessment documentation has been introduced that if completed in full will identify all needs of potential residents. New care planning documentation has been implemented that gives clear instructions to staff with regard to how residents needs should be met. Records now evidence regular weight monitoring, health care intervention and personal care such as bathing for residents. Medication is now stored, recorded and administered correctly and safely. Activities to stimulate people with dementia are now available, including reminiscence and memory games. Meal times are now an enjoyable event for residents with choices available at all times. Residents bedrooms now include working lights and furniture of an acceptable standard. The emergency call system has been replaced, the lounge, dining room and many corridors and bedrooms decorated. All requirements made by the Environmental Health Authority have also now been met. These include replacing the freezer, repairing the oven, labelling foods and implementing a cleaning schedule for the kitchen. Infection control practises have improved reducing any potential risk to residents. Infection control policies have been implemented that now include sanitising procedures for commodes and toilets. Staff have received training appropriate for their roles and responsibilities. The manager is now registered with us. Daily checks are now undertaken by staff for the hoists, wheelchairs and profiling beds.The registered manager has started to implement quality monitoring systems that will allow the home to monitor it is meeting residents needs safely and consistently. What the care home could do better: Supervision of staff must be planned in advance in order that staff receive formal and consistent support. Risk assessments must be completed for any resident with known behaviours that may cause injury to themselves or others so that risk is where possible reduced. We did note that none of the care plans have been signed by the resident and/or their representative. The home should be able to demonstrate people are involved and agree to the contents of their care plans. The registered manager agreed that medication labels that give instructions to be administered `as directed` should be clarified with the prescriber in order that staff have clear instructions. The registered manager agreed that outside activities should be explored for those residents who have expressed a wish to participate in these. The risk assessment for the environment with regards to health and safety should include the communal lounge area in order that any potential risks have been identified for all areas of the home. Quality monitoring systems should continue to be embedded in order that improvements made can be monitored and sustained. Key inspection report Care homes for older people Name: Address: Bywell House 2 Longfellow Road Worthing West Sussex BN11 4NU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Webb     Date: 0 2 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Bywell House 2 Longfellow Road Worthing West Sussex BN11 4NU 01903236062 01903236062 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hazelwood Care Ltd Name of registered manager (if applicable) Mrs Theresa Goldsmith Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Bywell House is a care home registered to accommodate up to 20 older people in the categories dementia, (DE), and mental disorder (MD). The property is a detached building situated in a residential area on the outskirts of Worthing. The town centre and seafront are within walking distance and there are local Care Homes for Older People Page 4 of 31 Over 65 0 0 20 20 1 0 0 3 2 0 0 9 Brief description of the care home shops and other facilities nearby. Buses and mainline trains are easily accessible. People living at the home are accommodated in twenty single bedrooms, which are located on the ground and first floors. A vertical lift provides access to each floor. Communal accommodation consists of a lounge and a dining area, which are located on the ground floor. There is an enclosed garden to the front and side of the property for people to use. This service is privately owned by Hazelwood Care Ltd. The Responsible Individual who acts on behalf of the company is Mr. Manvinder Singh. The Registered Manager is Mrs Theresa Goldsmith. The fees for this care home currently range from four hundred and eighty five pounds to five hundred and thirty five pounds per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited this home on Wednesday the 2nd of September 2009, arriving at 11.00am and staying until 4.30pm. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. We also looked for evidence that the home had addressed requirements made at the previous key inspection that took place in March 2009. The registered manager was present during our visit and assisted us throughout by providing documentation and answering any questions we raised. During our visit to the home examined the care records of two residents and recruitment records of two care staff. We also looked at other documentation maintained in the home such as staff training records, quality audits and complaints. In addition to this we looked around the home, examined medication and indirectly observed interactions between residents and staff. Care Homes for Older People Page 6 of 31 Since the key inspection that we carried out in March 2009 we have also undertaken two random visits to the home due to Statutory Requirement Notices (SRN) being issued. At these we looked at medication, care planning, staffing, management and health and safety and found the SRNs to be met. Five residents and eight staff completed questionnaires and returned them to us before our inspection. Information from all of the above sources was assessed and used to help us form judgements on the quality of service people living at the home receive. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? New pre admission assessment documentation has been introduced that if completed in full will identify all needs of potential residents. New care planning documentation has been implemented that gives clear instructions to staff with regard to how residents needs should be met. Records now evidence regular weight monitoring, health care intervention and personal care such as bathing for residents. Medication is now stored, recorded and administered correctly and safely. Activities to stimulate people with dementia are now available, including reminiscence and memory games. Meal times are now an enjoyable event for residents with choices available at all times. Residents bedrooms now include working lights and furniture of an acceptable standard. The emergency call system has been replaced, the lounge, dining room and many corridors and bedrooms decorated. All requirements made by the Environmental Health Authority have also now been met. These include replacing the freezer, repairing the oven, labelling foods and implementing a cleaning schedule for the kitchen. Infection control practises have improved reducing any potential risk to residents. Infection control policies have been implemented that now include sanitising procedures for commodes and toilets. Staff have received training appropriate for their roles and responsibilities. The manager is now registered with us. Daily checks are now undertaken by staff for the hoists, wheelchairs and profiling beds. Care Homes for Older People Page 8 of 31 The registered manager has started to implement quality monitoring systems that will allow the home to monitor it is meeting residents needs safely and consistently. 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 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admission policies are in place that if followed should ensure prospective residents needs are identified before they move into the home. The specialist needs of residents with dementia are being met resulting in a quality of life that meets individuals expectations. Evidence: There have been no new residents who have moved into the home since our last key inspection. The registered manager showed us new pre admission assessment documentation that she intends to complete for any potential new residents. The new documentation includes sections for recording life history including childhood, adolescence, young adulthood, middle age and later years. It also has sections for recording personal details including religion, next of kin, medical history, psychological history, medication, communication, mobility, eating and drinking, cognitive behaviour, personal hygiene, sleep patterns, breathing and elimination. Care Homes for Older People Page 11 of 31 Evidence: Before we visited the home five residents completed questionnaires and returned them to us. Four state that they received enough information about the home to help decide if it was the right place for them before moving in and one that they did not. A number of residents at the home have dementia. Evidence sited in other areas of this report indicates residents needs relating to dementia are now being met. Bywell House does not offer intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of residents are being met consistently and safely but risk assessments and changes in practice must be imbedded consistently to ensure safety. Medication practises offer safeguards to residents. Residents are treated with respect and their rights to privacy upheld. Evidence: A requirement made at our last key inspection with regard to care planning is now met. We examined the care records for two residents. New care planning documentation has been implemented in full by the registered manager, that gives clear instructions to staff with regard to how identified needs should be met. The new format is organised with information easily obtainable. However for one individual where records detail bruising due to known behaviours detailed information was not included in the new recording format, reducing its effectiveness. All files that we looked at contained care plans for identified needs that have been reviewed and signed and dated by the person completing them on a monthly basis. Plans were seen to be in place for needs including communication, bathing, skin needs, mobility, Care Homes for Older People Page 13 of 31 Evidence: personal choices, and mental health. All included instructions for staff such as the number of staff required for assistance, equipment required, preferences and choices. We did note that none of the plans have been signed by the resident and/or their representative. Eight staff completed questionnaires and returned them to us before our inspection. Six state they are always and two they are usually given up to date information about the needs of residents. Residents files also contained risk assessments for areas including falls, nutrition and skin. For one resident body charts have been completed for bruising. The registered manager informed us these were as a result of known behaviours. No risk assessment or care plan was in place for this behaviour. A requirement made at out last key inspection with regard to health care intervention is now met. We found evidence of regular weight monitoring, health care intervention and personal care such as bathing. Health records for 2009 now evidence residents have received treatment from a range of specialists including district nurses, general practitioners, chiropodists and opticians. Before we visited the home five residents completed questionnaires and returned them to us. Three state they always and two they usually receive the care and support they need. Additional comments were recorded of they look after us and verify illness and they look after me very well. As a result of our last key inspection two random visits to the home have been undertaken where medication was examined. Evidence gained from these visits demonstrate that previous requirements with regard to medication have been met. During this visit to the home we examined the homes medication systems and found all to be in good order and up to date. The registered manager informed us that since our last visit to the home a new pharmacy is now supplying the home with medication. Records were in place for medication entering the home, being administered and returned to the pharmacist if no longer required. We did note that for two residents who are prescribed creams the instructions on the pharmacy label reads to be administered as directed. The registered manager agreed to clarify specific requirements with regard to administration times. Monitoring records are in place for the room where medication is stored and for any medication that requires storing in a fridge. Care Homes for Older People Page 14 of 31 Evidence: Controlled drugs were also seen to be stored and recorded appropriately. Throughout this visit to the home we indirectly observed staff treating residents with respect and maintaining their rights to dignity. For example staff were heard calling residents by their preferred names as described in their care plans and ensuring bathroom and bedroom doors were closed when assisting with personal care. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are offered that meet the needs of all residents. Residents are helped to exercise choice and control over their lives. Visitors are made welcome. Dietary needs are catered for and choices available. Evidence: A requirement made at our last key inspection with regard to activities is now met. During the morning of our visit residents were observed sitting in the lounge watching television and also joining staff to play a variety of musical instruments. During the afternoon residents were observed participating in a memory quiz. Residents were observed to enjoy all activities during the day. A notice board in the lounge gives information about forthcoming activities such as music for health and physical intervention. Activities to stimulate people with dementia were seen to be available, including reminiscence and memory games. Five residents completed questionnaires and returned them to us before this inspection. Four state the home always and one that it usually arranges activities Care Homes for Older People Page 16 of 31 Evidence: they can participate in. Two additional comments of more outside activities were recorded. We discussed these with the registered manager who agreed these should be explored further. During this visit to the home we spoke with a relative of a resident. They told us that they are always made welcome and that there are no restrictions on visiting times. They also told us that they felt improvements had been made since the registered manager has been in post and that these include better activities and more choice with regard to meals. Two requirements made at our last key inspection with regard to meals were evidenced as met at the random visit we undertook in May 2009. During this visit to the home we sat and ate lunch with residents in the dining room and found the improvements have been sustained. For example tables have been rearranged to give more space and linen table cloths and napkins are now provided. Fresh fruit was seen to be readily available to residents and sign is now on display on the patio doors that lead to the dining room informing people they cannot be used at meal times. Staff were seen to respect this. Staff assisted residents discreetly, residents were offered choices of hot and cold drinks and were able to choose from two meals. Plate guards were brought to tables before meals were served and put on for those residents who required this tool. Residents appeared to enjoy their meal. The atmosphere at lunch time was relaxed. Residents were heard to laugh and join in conversations with other residents and staff. We viewed residents individual meal records. These demonstrate that residents are offered choices everyday and that alternatives are given when the two main options that day are not wanted. Five residents completed questionnaires and returned them to us before this inspection. Four state they always like the meals provided and one that they usually. Two additional comments were also recorded of I am liking the more choice of food and the snacks that I can go and help myself to and food is good. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints process for residents, which promotes peoples rights to raise concerns. Generally the home is now taking appropriate action to safeguard residents. Further training and ensuring robust documentation is in place will promote residents safety further. Evidence: As at our previous inspection we saw that the complaints procedure is displayed in the home. The registered manager informed us no complaints have been received at the home since our last inspection. Five residents completed questionnaires and returned them to us before our inspection. All state they know of someone they can talk to informally if not happy and that they know how to make a formal complaint. The home has a copy of the revised West Sussex Multi Agency Safe guarding Adults procedures besides its own policies and procedures on safeguarding adults. As a result of a previous safeguarding investigation the home agreed to ensure all staff receive training in safeguarding, mental capacity and deprivation of liberty. Records and discussions with the registered manager confirm that all ten care staff have received training in safeguarding and seven on mental capacity. The registered manager informed us the remaining staff will undertake mental capacity training in September of this year. Additional information supplied to us after our inspection by Care Homes for Older People Page 18 of 31 Evidence: the registered manager informs us that deprivation of liberty training was included in the recent training that staff took part in. When examining care records we found that one resident had body charts completed for bruising on four separate occasions. Two of these were as a result of falls. The other two instances staff had recorded unexplained. We discussed this with the registered manager who confirmed safeguarding alerts had not been raised. She informed us that this persons behaviours are known and can result in bruising. The registered manager contacted the local authority who confirmed alerts were not required if other documentation such as a risk assessment are in place for known behaviours. The registered manager said she would complete this as a matter of priority. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a pleasant, clean and homely environment to live in. Evidence: At our last key inspection an immediate requirement was issued with regard to an unsafe window in a residents bedroom. As agreed, within 24 hours we were supplied with evidence that action had been taken to reduce the risk to the resident. In addition to this the window has now been replaced. Three other requirements were also made with regard to the environment and infection control measures. Evidence gained at this inspection demonstrates all of now been met. For example all residents bedrooms that we viewed including working lights and furniture of an acceptable standard. We did note that three residents bedrooms did not have hot running water when we tested. The registered manager immediately arranged for the homes maintenance person to address this, which they did while we were still at the home. The emergency call system has been replaced, the lounge, dining room and many corridors and bedrooms decorated. Care Homes for Older People Page 20 of 31 Evidence: All requirements made by the Environmental Health Authority have also now been met. These include replacing the freezer, repairing the oven, labelling foods and implementing a cleaning schedule for the kitchen. Staff were observed to use personal protective equipment when carrying out tasks such as cleaning spillages and when assisting with personal care. Personal protective equipment seen to be sited in various places around the home including at the entrance to the kitchen, laundry, bathrooms and landing near residents bedrooms. Infection control policies have been implemented that now include sanitising procedures for commodes and toilets. The registered manager informed us that all beds and commodes in residents bedrooms have been replaced. All areas of the home that we saw were clean and free from offencive odours. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels appear to meet residents needs. Staff understand the needs of people with dementia and are trained to care for residents. Recruitment practises safeguard residents. Evidence: The staffing structure at the home consists of the registered manager, a deputy, senior care, care assistants, kitchen staff, housekeeping and maintenance. There are currently nine residents and the rotas demonstrate that staffing levels are being maintained at two care staff of a morning, afternoon and during the night. In addition to this the registered manager works five days per week and the deputy three. Seperate kitchen and domestic staff are also allocated each day and a maintenance person works full time at the home and another located near. One of the cooks has recently left with additional care staff who hold a food hygiene certificate being allocated to this role. The registered manager informed us an advertisement has been placed to recruit for this role. We indirectly observed care practises. Staff were seen to understand the needs of people with dementia by the way they positioned themselves when interacting and the level and pace they spoke with residents. Five residents completed questionnaires and returned them to us before this inspection. Two state staff are always and three they are usually available when needed. Three state staff always, one usually and one sometimes listen and act on Care Homes for Older People Page 22 of 31 Evidence: what they say. At our last key inspection two requirements were made with regard to staffing. At a random inspection in May 2009 evidence found these to have been met. For example a qualified first aider has been identified on each shift and this is highlighted on the homes rota. Training records also demonstrated that the majority of staff had now received training in health and safety training, first aid, moving and handling, five, infection control, protection of vulnerable adults, tissue viability and continence promotion, nutrition and diet, medication and dementia. At the random visit we viewed the recruitment records of five staff, including the three newest people to commence working at the home. All contained records including two references, application forms, two forms of identification, verification of training undertaken and Pova first disclosures. Three did not include evidence of a full enhanced CRB disclosure. The manager informed us two of these staff were in the process of completing their induction and all three did not have any direct contact with residents. The manager did not have a copy of the Department of Healths guidance for employing staff who do not have a full enhanced CRB. At this inspection we again viewed staff recruitment documentation finding all the required records to be in place. Since our last visit to the home a recent photograph of each member of staff has been included in their records. A notice board at the entrance to the home has also been installed. This also includes photographs of each member of staff. Induction records on file evidence that new staff receive guidance over a four week period and that this covers care planning, residents, policies and procedures, health and safety, care practises and health and safety. There are currently ten care staff employed at the home. Three hold a National Vocational Qualification (NVQ) level 2 and one at level 3. The registered manager informed us three other members of staff are due to start this qualification. Eight staff completed questionnaires and returned them to us before this inspection. All state they are given training relevant to their role. When asked the question what does the home do well comments were recorded of high standard of care teamwork, communication has improved and management are now enrolling staff for more training and all care plans are very informative and up to date Care Homes for Older People Page 23 of 31 Evidence: When asked the question what could the home do better comments were recorded of more staff that speak fluent English I think they should employ more staff who speak English properly, as it is sometimes hard for me to understand the staff, so the residents have no chance and more English people who understand the culture better, of the home. We discussed these comments with the registered manager who said that no one had raised this as an issue with her. She agreed to discuss this subject in the next staff meeting. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of this home is now meeting the needs of residents safely. Quality monitoring systems should continue to be embedded in order that improvements made can be monitored and sustained. Staff have started to receive supervision. Plans must be put in place to ensure this is consistent and regular for everyone. Residents health, safety and welfare is promoted and protected. Evidence: The manager of the home completed her registration application with us on the 24th August 2009. The registration certificate was seen on display and formally recognises Ms Goldsmith as the registered manager. At our last key inspection an immediate requirement was issued and four other requirements made. These related to health and safety, quality monitoring and staff supervision. With regard to the immediate requirement we received written confirmation within 24 hours that action had been taken by the home to address the concern. Care Homes for Older People Page 25 of 31 Evidence: At a random visit we undertook in May 2009 we found that three of the four requirements had been met. For example the previous practise of using commodes to transport residents around the home has now ceased. We were informed the commodes known as sani chairs have been removed from the home and three wheelchairs purchased. We also found that records were in place that details daily checks undertaken by staff for the hoists, wheelchairs and profiling beds. Health and safety risk assessments were not in place for equipment used to move people. We talked to the manager about this who said she thought it was sufficient for equipment to be documented in residents care files. We explained that health and safety legislation requires assessment of risk not only for residents but for staff and the environment. We directed her to the Health and Safety Executive for further information. At this inspection we found that risk assessments have been completed for all areas of the home apart from the lounge. The registered manager assured us this was an oversight and would review the current assessment to include this area. Since our last key inspection the registered manager has started to implement quality monitoring systems. These include questionnaires for residents, relatives, staff and health care professionals. In addition audits are undertaken for areas including training, complaints, the environment and health and safety. Reports in line with Regulation 26 of the Care Home Regulations 2001 were viewed. The format of these has altered since our last key inspection with the reports now containing greater detail and an action plan as a result of each visit. The registered manager informed us that no money is held on behalf of residents with residents and or their relatives being invoiced directly from the organisations head office for any monies that require reimbursing. At the random visit staff informed us that two staff meeting have taken place since February 2009 when the manager commenced working at the home. At this visit we were shown the minutes of another meeting that has since taken place. In addition to this most staff have received one individual supervision session. The registered manager informed us she was due to arrange further sessions for staff but did not yet Care Homes for Older People Page 26 of 31 Evidence: have dates arranged. We discussed this with the registered manager who agreed supervision should be planned in advance in order that staff receive formal and consistent support. Eight staff completed questionnaires and returned them to us before our inspection. Six state the manager regularly gives support and meets with them and two that she often does this. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 In line with Regulation 13(3)(c) the registered person must ensure care planning documentation including an assessment of risk is completed for any resident with known behaviours that may cause injury to themselves or others. This must happen in order that residents needs are met safely and consistantly. 02/10/2009 2 36 18 In line with Regulation 18(2) 02/10/2009 the registered person must ensure all staff receive regular, formal supervision. This must happen to ensure staff are fully supported. Care Homes for Older People Page 29 of 31 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 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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