Care Home: Cairndhu Rest Home Ltd

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well The people living at Cairndhu told us that they can make their own decisions whilst living there. They are able to plan their day for themselves. One person explained that they like the food with one person describing it as `lovely` and another as `very good`. A choice of meal is not routinely cooked, however people explained that if they do not like the main meal, `you get something different. Whatever you like. The staff come around and ask us what we want`. There is very relaxed atmosphere in the home and people clearly enjoy living there. We observed staff routinely interacting with residents and those people spoken with clearly had a trusting and positive relationship with staff and had a good sense of wellbeing. People told us they enjoy the activities provided. There is also easy access to the garden at the rear of the home which can be enjoyed by people. We were told that visitors are welcome at any time. People told us that staff are good at helping them with their personal care. They said that `staff are lovely and they are very prompt when we need them`. We saw that people where appropriately dressed and had good standards of hygiene which shows that staff are careful to support the personal care of people. People told us that they are listened to and helped if they have any concerns. A couple of people told us, `we can go to the staff or manager and they will sort things out`. They told us that the manager and deputy are very approachable and helpful. The people living at Cairndhu told us that they like the staff who work there. One person told us, `staff are very good and very friendly. They are helpful and come when I want them`. We observed that staff were friendly and provided support to people when needed. It was clear from observing daily life in the home that staff have built up good relationships with the people living there. In discussions with staff they displayed a good knowledge of peoples support needs and of how they like to spend their day. Veronica Parker is the registered owner and manager of Cairndhu. She has many years experience within the field of care for older people and has worked at the home for some time. Ms Parker has a very good knowledge of the support needs of the people living at Cairndhu and is motivated to provide them with an individual service in which they can feel at home. What has improved since the last inspection? Following the previous inspection in June 2009 we made a number of requirments which the home have addressed. The home now have a system for reviewing the care planning documentation on a monthly basis so that care needs are more likely to be continually monitored. Some health and saftey issues have been addressed such as the provision of window restrictors to upstairs rooms to lessen the risk of people falling as well as improving infection control in the home by the provision of liquid soap and paper towels in all communal bathrooms and toilets. The manager has also improved the way quality systems in the home are audited and monitored so that we can see an improvement in the overall management so that the home is run in the best interests of people living there. We have also received a number of `Notifications` from the home telling us about happenings and events. This means that the home are communicating better and are meeting regulations so that people are protected. What the care home could do better: We looked at the various information supplied by the home to ensure that people are aware and can make an informed choice about moving in. The `Service User Guide` needs to be updated and displayed and made available in the home to compliment the existing information. We discussed the latest good practice around the Mental Capacity Act and how this protects peoples rights to make choices. The Pre admission assessments carried out need to include assessments of mental capacity as discussed. We would further recommend that the managers of the home update themselves regarding the Mental Capacity Act so that they are fully aware of how this can be used to effect peoples rights. We looked at the way medicines are stored for safekeeping. Controlled Drugs administered by staff must be stored in a metal cupboard, which complies with the Misuse of Drugs Regulations 1973. This will ensure the home are complying with the law. We would also recommend that the storage of other medicines is considered and the advice around best practice be considered. We looked at how care is recorded and monitored. Although generally improved we would require that all care needs are considered and planned in the `care plan`. This includes acute and short term health needs such as people who may have an infection [for example]. This ensures that all care needs are considered and can be monitored consistently. Currently the daily records that staff complete do not relate to the care plan. We discussed how the daily records can be made more relevant by the inclusion of a care plan index included in the file. We recommend that people are included in the evaluations of the care plan on a regular basis. This evidences that people are involved in their care. We recommend that permanent curtain screening replaces the mobile screens currently in use in shared rooms. This to ensure more independence for people who may want privacy We recommend that any person on PRN [give when necessary ] medication is monitored by the inclusion of a care plan supporting this. This ensures that such medication is given consistently and is also reviewed regularly. We looked at the way the manager and staff ensure people are kept safe in the home and any alleged mistreatment is managed. The role of the Local Authority safeguarding team and the contact number need to reinforce so that staff are fully aware of their role and the investigation process. The good practice recommendations concerning the management of the laundry should be addressed including separation of clean and dirty areas and the painting of the laundry floor. We looked at staff files to see how the manager recruits staff and checks to ensure they are suitable to work with vulnerable people. All staff employed must have clear records of thorough checks carried out including CRB and relevant references. We would recommend further improvements to the health and saftey monitoring and communication by the inclusion of checks on limited opening of windows above ground floor, monitoring of the risk of burns form radiators and the recording of communication with relatives following accidents to people in the home. Key inspection report Care homes for older people Name: Address: Cairndhu Rest Home Ltd 6 Warren Road Blundellsands Liverpool Merseyside L23 6UB     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: Michael Perry     Date: 1 4 0 6 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 32 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 32 Information about the care home Name of care home: Address: Cairndhu Rest Home Ltd 6 Warren Road Blundellsands Liverpool Merseyside L23 6UB 01519248427 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Noemail Cairndhu Rest Home Ltd Name of registered manager (if applicable) Ms Veronica Parker Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 17 Date of last inspection Brief description of the care home Cairndhu is registered to provide personal care and support for seventeen older people. Staff are available in the home twenty-four hours a day to assist the people living there; meals and laundry facilities are also provided. The house is a semidetached property in a residential area of Blundellsands. It fits in well with local houses and is not immediately distinguishable as a care home. It is well located for getting to local facilities including shops, cafes, pubs, Crosby Beach and public Care Homes for Older People Page 4 of 32 Over 65 17 0 1 8 0 6 2 0 0 9 Brief description of the care home transport. Cairndhu is owned and managed by Veronica Parker who has worked in the home for many years. She is assisted by a deputy manager and a staff team who are experienced carers and well known to the people living there. Accommodation within Cairndhu is provided over three floors. Private accommodation is available in either single or double bedrooms, with a lift providing access to the upper floors. Shared accommodation is all downstairs and consists of a sitting room to the front of the house and a large dining room with lounge to the back of the house. The home also has a large front garden with parking and rear gardens with seating areas. The current fees for the service range from 349 - 400 pounds weekly Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The inspection was unannounced and was conducted over a period of one day. All day areas were seen and some but not all of the residents bedrooms. Care records and other records kept in the home such as health and safety records were also viewed. Residents in the home were spoken with along with members of staff and the Manager. Comments have been used in the report. We also directly observed the care and suport being given. The manager completed an Annual Quality Assurance Assessment [AQAA] prior to the visit, which is a detailed document that gives us a lot of information and update about the home and assists in focusing the inspection. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? Following the previous inspection in June 2009 we made a number of requirments which the home have addressed. The home now have a system for reviewing the care planning documentation on a monthly basis so that care needs are more likely to be continually monitored. Some health and saftey issues have been addressed such as the provision of window Care Homes for Older People Page 7 of 32 restrictors to upstairs rooms to lessen the risk of people falling as well as improving infection control in the home by the provision of liquid soap and paper towels in all communal bathrooms and toilets. The manager has also improved the way quality systems in the home are audited and monitored so that we can see an improvement in the overall management so that the home is run in the best interests of people living there. We have also received a number of Notifications from the home telling us about happenings and events. This means that the home are communicating better and are meeting regulations so that people are protected. What they could do better: We looked at the various information supplied by the home to ensure that people are aware and can make an informed choice about moving in. The Service User Guide needs to be updated and displayed and made available in the home to compliment the existing information. We discussed the latest good practice around the Mental Capacity Act and how this protects peoples rights to make choices. The Pre admission assessments carried out need to include assessments of mental capacity as discussed. We would further recommend that the managers of the home update themselves regarding the Mental Capacity Act so that they are fully aware of how this can be used to effect peoples rights. We looked at the way medicines are stored for safekeeping. Controlled Drugs administered by staff must be stored in a metal cupboard, which complies with the Misuse of Drugs Regulations 1973. This will ensure the home are complying with the law. We would also recommend that the storage of other medicines is considered and the advice around best practice be considered. We looked at how care is recorded and monitored. Although generally improved we would require that all care needs are considered and planned in the care plan. This includes acute and short term health needs such as people who may have an infection [for example]. This ensures that all care needs are considered and can be monitored consistently. Currently the daily records that staff complete do not relate to the care plan. We discussed how the daily records can be made more relevant by the inclusion of a care plan index included in the file. We recommend that people are included in the evaluations of the care plan on a regular basis. This evidences that people are involved in their care. We recommend that permanent curtain screening replaces the mobile screens currently in use in shared rooms. This to ensure more independence for people who may want privacy We recommend that any person on PRN [give when necessary ] medication is monitored by the inclusion of a care plan supporting this. This ensures that such medication is given consistently and is also reviewed regularly. Care Homes for Older People Page 8 of 32 We looked at the way the manager and staff ensure people are kept safe in the home and any alleged mistreatment is managed. The role of the Local Authority safeguarding team and the contact number need to reinforce so that staff are fully aware of their role and the investigation process. The good practice recommendations concerning the management of the laundry should be addressed including separation of clean and dirty areas and the painting of the laundry floor. We looked at staff files to see how the manager recruits staff and checks to ensure they are suitable to work with vulnerable people. All staff employed must have clear records of thorough checks carried out including CRB and relevant references. We would recommend further improvements to the health and saftey monitoring and communication by the inclusion of checks on limited opening of windows above ground floor, monitoring of the risk of burns form radiators and the recording of communication with relatives following accidents to people in the home. 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are admitted appropriately so that their care needs can be established and met by the home. Evidence: We looked at how people are admitted to the home by sampling two care files and looking at records as well as speaking to the people concerned. Before anyone moves in senior staff meet with them and carry out an assessment of their support needs. They also obtain copies of the persons social services assessment and care plan. This means they have the information they need to make sure that the persons needs can be met at Cairndhu. We discussed the new Mental Capacity Act and the need to formally assess peoples mental capacity as part of the admission. We would recommend that this is included in the pre assessment documentation so that capacity around the decision to move into the home is established. Such assessments are important as they form the basis of Care Homes for Older People Page 11 of 32 Evidence: decisions about ongoing care. The manager and deputy have not undertaken any updates around the Mental Capacity Act and we would recommend this so that they become more aware. An information pack about the home is given to everyone who needs it and is available in peoples bedrooms. This gives them information about how the home is run including who the staff are, how to raise a concern and social activities in the home. In addition it provides people with information about benefits and the local area. This information pack is printed in large letters so it easy for people to read. We looked at the master copy of this guide which was given to us by the manager. Currently this service user guide is kept in the office. We discussed how it should be available also in the home. This guide was out of date. For example it referred to the old ownership of the home. The inspection report available in the folder was from 2006. The manager needs to update this guide and make it available in the home. The information provided to people and obtained about them helps everyone to decide if Cairndhu is the right place for the person to live. It also helps staff to plan how they will provide support for the person. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get support with their health and personal care in the way they want although this can be further improved by including them more in the planning and monitoring of the care. Evidence: A requirement from the last inspection was to ensure that there is a system in place to ensure that the plans of care in place for people in the home [which plan and monitor the care] are reviewed on a monthly basis. This includes various assessments to monitor peoples health and wellbeing. We looked at two care files of people in the home and found that this area has improved and there is now clearer records so that it is possible to follow the care given as well as planned. For example one person has had input from district nurses in the past and this was clearly recorded and it was possible to follow progress made. When we spoke to people they told us that they are able to access health care when needed. For example people told us about going for optician appointments as well as dental and chiropody appointments. We saw from the care notes that one person has Care Homes for Older People Page 13 of 32 Evidence: had a visit from the GP recently and has been prescribed antibiotics. Overall there is better monitoring systems in place although we had some discussion about how things could be further improved: * The person who is on antibiotics for a urine infection did not have a care plan in place to monitor this. For example a written plan which highlights the need to maintain fluid intake and observe for signs of continued infection. This helps staff to organise proper interventions and record and monitor the outcomes over a short time frame. We discussed how a short term care plan for more acute care needs could be added to the daily care recording so that staff can be more aware. * The daily records that staff complete do not relate to the care plan. We discussed how the daily records can be made more relevant by the inclusion of a care plan index of care needs included in the file so that staff can more easily remind themselves of the main care needs. * There is no evidence currently of people being involved in their care reviews. We recommend that when the monthly evaluations/ reviews are being completed that on some occasions the persons care plan is discussed and there views recorded. This helps people to be more involved in their care. People told us that staff are good at helping them with their personal care. They said that staff are lovely and they are very prompt when we need them. We saw that people where appropriately dressed and had good standards of hygiene which shows that staff are careful to support the personal care of people. There are two bedrooms in the home which are shared. We saw one of these rooms and observed the portable screens that are in place to help ensure some privacy for people who are sharing. These screens are cumbersome and difficult to manage for elderly people and we would recommend that a curtain track and curtain is put in place. This would make people more independent as it would be easier for them to access and use when needed. We looked at the medicines and found safe monitoring of the administration of medicines with records up to date and accurate so we were able to audit and track the medicines given. One person we looked at is on medication PRN [give when necessary]. It is important to be clear about why the medication should be administered so that staff can be consistent in their approach. A note of this such as a care plan attached to the medication record which highlights this would benefit staff and would also act as a useful monitoring tool as it could be reviewed regularly as part of the care planning system. Care Homes for Older People Page 14 of 32 Evidence: The storage of medicines is a concern and should be reviewed. There is a controlled [under the Misuse of Drugs Act 1971 and associated Regulations 1973] medication stored in the medicine cabinet. The purpose of legislation is to impose control on Controlled Drug [CD] manufacture, prescribing, supply, possession and record keeping. The impact on care homes is limited but does require special arrangements for storage, administration, records and disposal. The current arrangements do not meet the regulations and the manager must review this with the supplying pharmacist and ensure proper storage is made available. The Care Homes Regulations 2001 state that controlled drugs should be kept in a designated Controlled Drugs cupboard when staff are responsible for giving them to people. The 2007 Amendment to Regulations makes this mandatory for all care homes. We would also strongly recommend that the current storage for regular prescribed medication be reviewed in the light of proper security. Currently the storage cupboard location and construction does not meet best practice. We have discussed the concerns with the manager and have alerted her to current good practice advice in this area. Many medicines are attractive commodities and managers should arrange for medicines to be stored discreetly and not be open to more easy access. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy the social aspects of the home and are supported well so that they can live a comfortable lifestyle. Evidence: The people living at Cairndhu told us that they can make their own decisions whilst living there. People are able to get up or go to bed as they please and can choose whether to eat in the dining room or their bedroom. One person explained that they like the food with one person describing it as lovely and another as very good. A choice of meal is not routinely cooked, however people explained that if they do not like the main meal, you get something different. Whatever you like. The staff come around and ask us what we want. We were told that although there are set mealtimes within the home if people were not ready for their meal at these times they were able to eat later. The dining room is very pleasant and most people enjoy going for meals there but can also have meals in their room if they wish. There is very relaxed atmosphere in the home and people clearly enjoy living there. We observed staff routinely interacting with residents and those people spoken with Care Homes for Older People Page 16 of 32 Evidence: clearly had a trusting and positive relationship with staff and had a good sense of wellbeing. They explained that there is not a lot of activities on a daily basis but its enough. Some people enjoy the bingo and games arranged as this provides a good level of communal interaction. There are occasional trips out such as a yearly barge trip. There is also easy access to the garden at the rear of the home which can be enjoyed by people. We were told that visitors are welcome at any time. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a positive approach to concerns and complaints so that people can feel listened to and can be safe. Evidence: Information on how to raise a concern or complaint is made available to people in their information packs. In discussion with some of the people living there it was clear that they know how to raise concerns and are confident they will be listened to. A couple of people told us, we can go to the staff or manager and they will sort things out. They told us that the manager and deputy are very approachable and helpful. A copy of local authority safeguarding adults procedures is available in the home. Staff we spoke with were able to explain and understand about abuse and how to recognise it and said they would report any concerns to the manager. The manager displayed a positive approach but said she would investigate any issues. When we spoke in more depth we were a bit concerned that both manager and staff were not aware of the wider picture in terms of how such an investigation would be managed and the key role of the social service safeguarding team. We would recommend that the policy and procedure is reaffirmed with staff and they [and the manager] update themselves. This will ensure that everybody is aware of the need to report any concerns through the safeguarding team so that they are investigated in the proper way. No concerns or complaints have been raised about the service since our last inspection.However, clear recording sheets are available to monitor, and act Care Homes for Older People Page 18 of 32 Evidence: upon any that may arise.This open approach to concerns and complaints helps to ensure that the people living at Cairndhu feel safe and confident in the home and the staff supporting them. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cairndhu provides a warm, comfortable and homely environment, that had adaptations to meet peoples needs so they can live comfortably. Evidence: Situated in a residential area of Blundellsands, Cairndhu is set back from the road and provides a peaceful environment with well maintained gardens that people can sit and relax in. It is well located for easy access to public transport, a local busy shopping area and the beach. Downstairs there is a front lounge with TV and to the rear of the house is a linked dining room and second lounge with patio doors leading out into the garden. The home appears bright and well maintained generally so that people living there can be comfortable. Most of the bedrooms are single. Where bedrooms are shared, screens are provided for privacy [we have made recommendations for improvements here under health and personal care] Bedrooms are located over the three floors of the house with a passenger lift to get to the upper floors. Ongoing decor is evidenced by, for example, the provision of a new shower room and bedrooms being decorated.We observed that if they wish to, people can have a phone and kettle in their room. This all helps people to remain as independent as possible. Care Homes for Older People Page 20 of 32 Evidence: We saw that previous requirments made for windows above ground floor to be made safe and provision of handwash facilities in bathrooms and toilets have now been met. This ensures a safer environment and also helps people maintain good hygiene. Aids and adaptations are provided to support the people living there. These include call buzzers, ramps, handrails and bath chairs. The laundry is located in the cellar and provides washing and drying facilities. This area could be improved in terms of overall management to help reduce the risk of any cross infection. We saw that both rooms used for laundry were cluttered and used for excess storage. This reduces the ability for space for separate management of clean and dirty clothing and linen which should be kept separate if possible. We discussed ways in which the laundry could be better managed by providing separate areas and maintaining a clear environment so that the laundry can more easily be cleaned and provide better infection control and strongly recommend that this is reviewed. A separate recommendation for the laundry floor to be painted still needs to be considered. Again this would make the floor less impervious and easier to clean. Throughout our visit the people living at Cairndhu were seen to use their own bedrooms and the communal areas as they chose with no restrictions on where they can go. When people have visitors they are able to meet with them in communal areas or in their own bedrooms as they prefer. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff need to be recruited with thorough checks in place to ensure they are suitable to work with vulnerable people. This helps protect people in the home. Evidence: The people living at Cairndhu told us that they like the staff who work there. One person told us, staff are very good and very friendly. They are helpful and come when i want them. We observed that staff were friendly and provided support to people when needed. The staff rota showed that there are two carers working during daytime hours with an additional carer at busier times. There is also a cook and domestic on duty and the manager and deputy are available throughout the day. At night there is one carer and a carer sleeping on the premises to help with any emergencies. The people living at Cairndhu told us that there are enough staff to support them and to provide help when needed. It was clear from observing daily life in the home that staff have built up good relationships with the people living there. In discussions with staff they displayed a good knowledge of peoples support needs and of how they like to spend their day. Records showed that before the manager appoints a new member of staff, a series of checks are carried out. These checks help to ensure staff are suitable to work with people who are vulnerable. We looked at the file of a staff member who has started in Care Homes for Older People Page 22 of 32 Evidence: the home since the last inspection. We were concerned that full and proper checks had not been made to ensure the person was fit to work with vulnerable people. These anomalies were: *The application form did not list a complete work history. Only one job was listed. A full history is important so that employers can check any gaps. * There were no references given on the application form. The references seen were character references [one of which was dated 4 months prior to employment]. The previous work listed on the application form had been a care home but no reference was available from this source. Again a reference from a previous care home [and last employer] is important to check to ensure the person has worked satisfactorily. * The Criminal Record check [CRB] seen was carried out at the last home the person worked at. At the time of employment at Cairndhu [pre 16th October 2009] it was a requirement that the home carry out their own CRB check. The manager explained that she thought the CRB was portable and could be used but there was also no record of any further checks made [recommended] to ensure current veracity of the record and to risk assess the person. We have discussed with, and given further information to, the manager to ensure that future staff are employed with proper checks in place. This protects people living in the home by ensuring staff employed are suitable to work with vulnerable people. Most of the staff working at Cairndhu have obtained a recognised qualification in care (NVQ). At our inspection in 2008 and again in 2009 we identified that staff had not had moving and handling training since 2006. This training needs to be updated regularly to ensure that staff are aware of the latest guidance on how to support people in a way that is safe for both the person and themselves. We saw records and spoke with staff and this training has now been carried out. Other records showed that staff have had updates in all of the statutory training requirments and this is monitored by the manager with a training matrix which projects when further updates are needed. Staff said they receive a lot of training. Further evidence of this is the amount of staff with National Vocational Qualifications [NVQs] with most staff having completed this. This shows that staff have the basic skills and knowledge to carry out care in the home. We spoke with the manager have recommended further training in the Mental Capacity Act and Deprivation of Liberty Safeguards [DOLs] as this is important to Care Homes for Older People Page 23 of 32 Evidence: peoples ability and right to make decisions for themselves and both staff and managers need to ensure they are up to date. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The managers of the home have developed systems to endure ongoing monitoring and improvements so that the home can be run in the best interests of people. Evidence: Veronica Parker is the registered owner and manager of Cairndhu. She has many years experience within the field of care for older people and has worked at the home for some time. She also holds a management qualification. Lines of accountability within the home are clear and this information is passed to the people living there and their relatives in the homes statement of purpose. The people who live at Cairndhu, their visitors and staff told us that they find the manager approachable and that she supports them when needed. Ms Parker has a very good knowledge of the support needs of the people living at Cairndhu and is motivated to provide them with an individual service in which they can feel at home. The main criticism in the last inspection report was that the paper work in the home was not being kept up to date and that this could have an adverse effect on the Care Homes for Older People Page 25 of 32 Evidence: people who live there as basic systems such as health and saftey checks may be missed. At the time we made a number of requirments for the manager to meet to improve things. These were around clear systems to monitor quality standards in the home, completion of notifications to us [CQC] so that we can monitor how the home is operating, as well as a number of health and saftey issues that needed addressing. We found on this inspection that the record keeping was much clearer and these requirments have been met. This means that the manager has been able to meet statutory requirments and plan improvements to the service. Before we visited the home we asked the manager to complete a self assessment questionnaire to assess how well the home is operating. The form was returned to us completed and the information recorded was sufficient to show the areas of the home that had improved and also some development ideas for the future. This was some improvement from the previous inspection although we did have further discussion how detail could be improved further. By complying with regulations the manager helps to make sure that the people who use registered services are safeguarded. A system is in place for checking monthly health and safety records, care records and medication. These are carried out regularly. It was a concern that some areas of health and saftey, although obvious to see when we toured the home had not been addressed. For example one fire exit was obviously blocked but no action had been taken to address this [addressed at the inspection]. Also a past requirement has been addressed regarding restricting the opening of windows above ground floor so people are protected from falls but the health and saftey checks carried out do not continue to monitor this. We advised that some additions to the routine checks are needed such as the windows as mentioned and also ensuring radiators in bedrooms are not putting people at undue risk of burns. We looked at how the home records and manages accidents. Records were clear in there recording. We did not see any records of whether relatives or advocates had been alerted to accidents [unless residents request otherwise]. This is important as good communication here helps nearest relatives to feel reassured and included. We would recommend that this is carried out and a record made. Although the management of records in the home has improved we are still concerned that some key elements of practice such as updating care needs, storage of medicines and recruitment checks for new staff need further attention, and these have been highlighted in the report, there is evidence from this inspection that the managers are committed and capable of ensuring this is carried out. Care Homes for Older People Page 26 of 32 Evidence: Staff at Cairndhu do not act as appointee for any resident of the home. This is good practice as it helps people to be as independent as possible, with support from their families if needed. Some people have lockable storage in their room to store money if they choose and the home has a safe storage facility that people can use. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All short term care needs 16/07/2010 must also be recorded in the care plan. This ensures proper planning and monitoring of care needs. 2 9 13 Controlled Drugs administered by staff must be stored in a metal cupboard, which complies with the Misuse of Drugs Regulations 1973 This ensures safe and secure storage of medicines and complies with the law. 16/09/2010 3 29 19 All staff employed must have clear records of thorough checks carried out including CRB and relevant references. This protects people by ensuring staff are recruited properly. 16/07/2010 Care Homes for Older People Page 29 of 32 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 1 The Service User Guide needs to be updated and displayed and made available in the home to compliment the existing information. Pre admission easements need to include assessments of mental capacity as discussed. We would further recommend that the managers of the home update themselves regarding the Mental Capacity Act. 2 3 3 7 The daily records that staff complete do not relate to the care plan. We discussed how the daily records can be made more relevant by the inclusion of a care plan index included in the file. We recommend that people are included in the evaluations of the care plan on a regular basis. We recommend that permanent curtain screening replaces the mobile screens currently in use in shared rooms. This to ensure more Independence for people who may want privacy 4 8 We recommend that any person on PRN [give when necessary ] medication is monitored by the inclusion of a care plan supporting this. The current storage of medication needs reviewing with the supplying pharmacist and the good practice guidance discussed as part of the inspection needs to be considered. 5 18 The role of the Local Authority safeguarding team and the contact number need to reinforce so that staff are fully aware of their role and the investigation process. The good practice recommendations concerning the management of the laundry should be addressed including separation of clean and dirty areas and the painting of the laundry floor. We would recommend further improvements to the health and saftey monitoring and communication by the inclusion of checks on limited opening of windows above ground floor, monitoring of the risk of burns form radiators and the recording of communication with relatives following Page 30 of 32 6 25 7 37 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 accidents to people in the home. Care Homes for Older People Page 31 of 32 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. © 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!