Care Home: Carey Lodge

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• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
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What the care home does well People using the service are thoroughly assessed prior to admission and are given opportunity to visit beforehand to ensure it meets their needs. They have a good range of information to help them make a decision if this is the right place for them to move in to. The health and personal care needs of people living at the service are generally being met at the service. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting people`s preferences and individual requirements. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. The premises are clean, spacious and well decorated, promoting a positive environment for the people who live there and which are suitable for the range of disabilities that people have. The service provides staff cover to meet needs and has a training programme to make sure that staff have the skills and competencies to meet needs. The management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? Medication practice has been improved through production of individual protocols for the use of `as required` medicines to treat anxiety or agitation. Better records are also being kept of medication administered to people using the service. A care plan for a person with a contagious condition had been improved to include mention of the condition and risk control measures that are to be adopted to contain spread of infection. Better staff handover arrangements are in place, ensuring that sufficient staff are supervising service users during these periods. What the care home could do better: Some attention is needed to care plans to ensure that full information has been recorded; we acknowledge that the new care plan format is new and a developing tool. Health care could be improved by making sure that people`s needs are properly monitored and reviewed and actions indicated in assessments like nutritional screening and likelihood of developing pressure damage are carried out accordingly.Recruitment practice could be improved by making sure that people`s backgrounds can be fully accounted for, to protect people using the service from risk of harm. Advice has been given to issue a receipt where people deposit items for safekeeping, so that they have a record of this transaction. Key inspection report Care homes for older people Name: Address: Carey Lodge Carey Lodge Church Street Wing Leighton Buzzard Bedfordshire LU7 0NY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Chris Schwarz     Date: 1 8 0 5 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 30 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 30 Information about the care home Name of care home: Address: Carey Lodge Carey Lodge Church Street Wing Leighton Buzzard Bedfordshire LU7 0NY 01296689870 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.fremantletrust.org The Fremantle Trust Name of registered manager (if applicable) Mrs Sue Charlotte White Type of registration: Number of places registered: care home 75 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 75 The registered person may provide the following category 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 category : Dementia (DE) Old age, not falling within any other category(OP) Date of last inspection Brief description of the care home Carey Lodge is located just off the Aylesbury to Leighton Buzzard road in the village of Wing. It is close to a church with local shops and pubs nearby. There is a health centre next to the service and another doctors surgery a short distance away. There are public transport links into nearby towns. The building is set back from the main road Care Homes for Older People Page 4 of 30 Over 65 0 75 75 0 1 9 1 1 2 0 0 9 Brief description of the care home and there is parking for staff and visitors. It is well sign posted. Accommodation for people using the service is spread across three floors in five houses. There is a passenger lift for access between floors, as well as the stairs. The two houses on the ground floor provide accommodation for people with dementia. All of the houses have single bedrooms with an en suite shower and toilet. Communal and individual rooms are spacious and designed to a high specification. There are garden areas which people can access. Information about the service is provided in a service users guide and statement of purpose. Fees at the time of this visit ranged from £640 to £779 per week. Thirty of the beds are block purchased by the local authority and the remaining forty five are for private referrals. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day from 9.30 am until 6.30 pm and covered all of the key National Minimum Standards for older people. The last key inspection of the service took place on 19 November 2009. Prior to the visit, a detailed self-assessment questionnaire, the Annual Quality Assurance Assessment, was sent to the manager for completion and surveys were sent to a selection of people living at the service and to peoples relatives or advocates. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, observation of practice and a tour of the premises. Some of the required records were looked at such as care plans, medication administration records, staff recruitment files, training records and health and safety Care Homes for Older People Page 6 of 30 checks. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager and external line manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Some attention is needed to care plans to ensure that full information has been recorded; we acknowledge that the new care plan format is new and a developing tool. Health care could be improved by making sure that peoples needs are properly monitored and reviewed and actions indicated in assessments like nutritional screening and likelihood of developing pressure damage are carried out accordingly. Care Homes for Older People Page 8 of 30 Recruitment practice could be improved by making sure that peoples backgrounds can be fully accounted for, to protect people using the service from risk of harm. Advice has been given to issue a receipt where people deposit items for safekeeping, so that they have a record of this transaction. 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 30 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 30 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 using the service are thoroughly assessed prior to admission and are given opportunity to visit beforehand to ensure it meets their needs. They have a good range of information to help them make a decision if this is the right place for them to move in to. Evidence: We were advised in the Annual Quality Assurance Assessment that each person is thoroughly assessed prior to admission. The manager told us that people who are offered a placement are given opportunity to try the service for a period of four weeks, which can be extended if they need more time to decide if they want to move in permanently. We were told that each person is given a contract of residence which outlines the terms and conditions. The manager advised us that information about the service was contained in a statement of purpose and service users guide which people are given copies of. She also told us that newly admitted people are given a welcome pack. Care Homes for Older People Page 11 of 30 Evidence: A mixed response was received in surveys from people using the service. Some said they had received enough information before they moved in, to help them decide if it was the right place for them. Some people said they had not received enough information and others could not recall. During the visit to the service, we saw that a copy of the statement of purpose and service users guide were available in the entrance foyer, together with other useful information. A welcome pack was looked at, and this included a copy of the service users guide, information about dementia (if a dementia care placement is being sought), frequently asked questions and information about the provider. Pre-admission assessments in peoples care plan files showed that their needs are comprehensively assessed before a placement is offered. Information included peoples name and preferred form of address, date of birth, next of kin and other significant contacts, ethnic origin, gender, the type of admission such as respite care or a permanent placement, and category of care such as dementia care. Peoples needs in relation to areas such as communication, personal grooming, moving and handling, health care, mental health and emotional well being, diet and nutrition, continence and skin care were noted and assessments were dated and signed. Intermediate care is not provided at this service. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the service are generally being met, although some attention is needed to care plans to ensure that full information has been recorded and that risk assessments are reviewed at the frequencies indicated by peoples changing circumstances. Evidence: Information in the Annual Quality Assurance Assessment showed that each person has a care plan and that these are checked and reviewed regularly. We were advised that falls are assessed and that people using the service have access to health care professionals. We were told that risk assessments were in place for areas such as moving and handling, pressure area care and nutritional needs. The manager advised us that staff who handle medicines have been trained to do so and that there were policies and procedures in place to provide staff with guidance on medication. We were told that improvements had been made to this area of practice such as updating care plans where people have contagious conditions, putting in place protocols for the use of as required medicines and monitoring, reviewing and recording changes to peoples health care needs. Care Homes for Older People Page 13 of 30 Evidence: People using the service said in surveys that they receive the care and support that they need and that the service makes sure they get the medical support they require. Relatives and advocates said the care service usually meets peoples needs and that the support was what they expected or agreed. They said the service responded to the different needs of individual people, such as needs arising from equality and diversity. One person said it was a wonderful, warm and caring home particularly for those like my mother who suffer from dementia. One relative said reviews had not been happening at the expected frequency and also that health care checks were not taking place routinely. During the visit to Carey Lodge, a sample of care plans was looked at from three of the house groups. These followed a corporate format and included a photograph of the person (in most cases), essential information such as their name, preferred form of address, date of birth, next of kin and doctor details and a personal profile that included information about likes and dislikes, family and friendships, previous occupation and religion and culture. Details of how peoples family wanted to be informed of changes to service users health were recorded and there was space to record things that were important to the service user. Significant areas of risk had been identified, peoples preferred routines were noted and needs were recorded for areas such as managing continence, diet and nutrition, communication, moving and handling, personal care and grooming and skin care. We saw that one care plan file looked at during the last key inspection had been improved to include information to alert staff to a contagious condition and measures necessary to prevent spread of infection. Information in some of the care plan sections was brief or had not been noted, such as under peoples likes and dislikes, special memories, places and people and religion and culture. We acknowledge that the care plan format was new and would therefore expect to see full completion by the next inspection. Risk assessments were in place, covering areas such as moving and handling, nutritional assessment, likelihood of developing pressure damage, personal emergency evacuation plans, falls and fractures (in some but not all cases), going out on trips and self caring. The manager was made aware of one file which did not have the basic risk assessments in place and we are confident that she will address this. Some of the risk assessments needed a date and signature. Where some peoples level of need indicated that they should be assessed regularly, records did not show that staff were always carrying out further assessment, such as for nutritional and pressure damage risks. A requirement is made to address this to make sure that peoples changing Care Homes for Older People Page 14 of 30 Evidence: health needs are properly monitored and reviewed and actions indicated in these assessments carried out accordingly. Records of peoples weight were being maintained and there were notes of visits by or appointments to see health care professionals such as nurses, doctors and chiropodists. The operations manual in the duty office contained a number of policies to provide guidance to staff, such as on dementia care, managing continence, moving and handling and medication practice. We also saw that a falls register was being maintained in the duty office. We saw that a dementia care audit had been carried out in March this year by the providers lead manager on dementia care. It reported on many positive areas of practice (such as health care and activity provision) as well as areas that could be strengthened (such as communication with service users and recording information about their lives and interests). Medication practice was looked at in some of the houses. Medication administration records contained photographs of each person for easy identification. We saw that one persons allergy to penicillin was noted on the record sheet (and at the front of their care plan file in red ink). Protocols for the use of as required medicines to treat agitation or anxiety had been written and medicine fridge temperatures were being monitored. Some of the care plan files that we looked at contained signed consent from doctors for use of homely remedies. Records showed that medication audits were being undertaken regularly to check that staff were administering and recording accurately and discrepancies were being followed up promptly. A record had been set up to log all instances where doctors had changed peoples medication, to make auditing easier. The supplying pharmacy had carried out their own audit, as part of their agreement with the service, in February this year. Care Homes for Older People Page 15 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting peoples preferences and individual requirements. Evidence: We were advised in the Annual Quality Assurance Assessment that the service had an excellent social activities calendar and that there were three National Vocational Qualification qualified activity co-ordinators working at Carey Lodge, who arrange events inside and outside the service. We were told that the activities programme is advertised around the building. The manager said there is an Age Concern advocate who regularly visits the service and that people are supported to stay in contact with their family and friends. Flexibility was described in routines, such as times for going to bed and getting up and choice of meals and mealtimes. We were advised that peoples care plans identify their interests and preferences for activities and that copies of menus are available in each of the houses for people to refer to. The manager told us of improvements such as more volunteers, two minibuses to facilitate more trips out and setting up a Residents Committee. Care Homes for Older People Page 16 of 30 Evidence: People using the service said in surveys that there are activities arranged for them that they can take part in. They said they usually enjoyed the meals at the service. A relative highlighted activities as an area which the service managed well. Relatives and advocates said the service usually kept them up to date with important issues. One commented about food meals varied, plentiful and many snacks provided. Another told us that activities were excellent and there were regular consultation meetings for relatives. During the visit to the service, we saw that the current months planned activities were displayed on notice boards in each of the houses and in the main entrance hall. Activities included Songs of Praise, communion, quizzes, hand massage, films, cookery, a ballroom dance, indoor gardening and a piano man. We saw people reading daily newspapers (and one service user delivering them to people), taking part in a general knowledge quiz, planting raised beds in the garden, playing dominoes, playing pool, watching a film, and sitting outside enjoying the warm weather. Staff were observed encouraging people to take part in setting tables ready for meal times and folding napkins. Several people had their hair done during the day in the services salon. Information about the Residents Committee was displayed on notice boards in the houses. The manager advised that these meetings are taking place every six weeks and have two representatives from each of the houses, with input from staff such as the chef, house keeper and activities organiser. Minutes of the meetings are distributed to houses and read out as part of an activity to make sure people know what was discussed and the outcomes. We also saw posters informing people about the Age Concern visitor and the last set of minutes was displayed. Peoples visitors were free to come and go and we saw portable pay phones to help service users keep in touch with friends and family. Links have been made with the secondary school next door and some of the children have been in to read to service users as well as being involved in a gardening project. The building has many quiet areas where people can sit and be peaceful, or see their visitors, as well as the communal lounges. Reminiscence items and themes have been incorporated into these quiet areas to add interest and a fish tank had been set up since the last inspection. People were seen to have a choice of food at meal times; their preferences are sought the previous day and staff said there is always enough of each option if people have changed their mind. Lunch options were sausages in onion gravy or omelette, with vegetables and choice of mashed potatoes or chips. There was treacle sponge and Care Homes for Older People Page 17 of 30 Evidence: custard for pudding. The tea time meal was smoked haddock or a selection of sandwiches. People spoken with across the service said they had enjoyed their food and usually liked what was provided. Dining areas had been attractively set with table cloths and napkins to make these occasions pleasant. People who wanted to eat in their room, in the lounges or quiet areas of the building were enabled to do so. We noticed that houses did not have menus displayed, to show or remind people what the options for the day were. In some of the houses staff had written the choices on the notice boards outside of the dining rooms. The manager advised us that daily menus were going to be written up and put on each table and we saw that this was reflected as one of the suggested actions in the dementia care audit. Care Homes for Older People Page 18 of 30 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. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. Evidence: Information provided in the Annual Quality Assurance Assessment showed that there had been seven complaints in the past year. The manager told us there were policies and procedures to ensure that complaints are responded to swiftly. We were also advised that staff undertake safeguarding training and that the service had three safeguarding trainers. We were told that people receive information about complaints and safeguarding in the information pack they receive on admission and that copies of the corporate feedback form were located around the building. The manager described thorough staff recruitment and financial management processes to protect people from risk of harm. No safeguarding referrals or investigations were indicated in statistical information provided by the manager. People using the service said in surveys that there was someone they could speak with if they were unhappy and that they knew how to make a complaint. Relatives and advocates also said they knew how to make a complaint if they needed to. One person said the service usually responded appropriately if they had raised any concerns, two others said the service always responded appropriately. During the visit we saw that the complaints procedure is made available to people in Care Homes for Older People Page 19 of 30 Evidence: the entrance foyer and details are included in the statement of purpose and service users guide. The complaints and compliments log showed that complaints are appropriately handled. No complaints have been made direct to the Care Quality Commission. A safeguarding procedure was contained within the operations manual. The services external line manager confirmed that it is being updated to reflect revised contact details for the Care Quality Commission. Staff receive training on safeguarding as part of their initial induction and then have in house updates. We are not aware of any safeguarding concerns for this service. A requirement has been made under the staffing section of the report to improve recruitment practice to make sure that the procedures used at the service are robust enough to protect people using the service from risk of harm. Care Homes for Older People Page 20 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are clean, spacious and well decorated, promoting a positive environment for the people who live there and which are suitable for the range of disabilities that people have. Evidence: The manager told us in the Annual Quality Assurance Assessment that the building is a new, purpose built care home which has been designed to high standards. We were advised that all bedrooms are spacious and provide en-suite facilities and that the building design has allowed creative use of space so that there are points of interest around the premises. We were told that people using the service are enabled to personalise their room and can have a key to ensure privacy. The manager told us that the building has a cafe/shop and a modern hairdressing salon and that the grounds were secure and safe with a courtyard garden with raised beds. People using the service said in surveys that the premises are always kept fresh and clean. A relative said about the premises absolutely spotless and comfortable accommodation. A relative said the laundry is a problem, mum seems to wear other peoples clothes without realising even though her name is on everything. Another said the service could improve by checking drawers and wardrobes to remove soiled clothing and clothes that do not belong to the person. Care Homes for Older People Page 21 of 30 Evidence: Carey Lodge is located just off the Aylesbury to Leighton Buzzard road in the village of Wing. It is close to a church with local shops and pubs nearby. There is a health centre next to the service and another doctors surgery a short distance away. There are public transport links into nearby towns. The building is set back from the main road and there is parking for staff and visitors. It is well sign posted. Entry to the building is via a doorbell or number coded door pad. Once inside the building, there is a bright entrance hall with plenty of comfortable seating areas and access to the garden. Staff put out bowls of sweets for people to snack on. At the far end of the entrance hall there is a cafe with bistro tables. The managers and other offices are located centrally off the entrance hall. The kitchen and laundry areas are located off one corridor. Both are equipped for a large care service. The manager and external line manager advised that different options are being tried to improve the laundry service. Accommodation for people using the service is spread across three floors in five houses. There is a passenger lift for access between floors, as well as the stairs. The two houses on the ground floor provide accommodation for people with dementia. All of the houses have single bedrooms with an en suite shower and toilet. Where people need or prefer a commode, this was provided. People had personalised their rooms to different degrees. Each house had spacious, adapted bathrooms and toilets. Lounge and dining areas were attractively arranged with comfortable seating; dining chairs had gliders for easy manoeuvrability. Each house had a kitchen area as part of the dining room. All parts of the building were clean, well decorated and designed to high specification. Rooms were being ventilated to let in fresh air. There was good odour control and appropriate sluicing and clinical waste arrangements were in place. Corridors were wide and had natural as well as artificial light; sensory nodules had been fitted to grab rails to guide people with visual impairments. A smoking room had been provided on the top floor for service users. The grounds were being attractively maintained with well kept lawned areas and flower beds. One part of the garden has a chicken coop with four chickens. Raised beds in the garden and planters for the balconies were being planted up on the day of this visit. Care Homes for Older People Page 22 of 30 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. The service provides staff cover to meet needs and has a training programme to make sure that staff have the skills and competencies to meet needs. Some attention is needed to recruitment practice to make sure that peoples backgrounds can be fully accounted for, to protect people using the service from risk of harm. Evidence: We were advised in the Annual Quality Assurance Assessment that staff are recruited in accordance with requirements and that the ratio of staff is determined according to peoples assessed care needs. We were advised that staff have access to an excellent training and development programme and that over half of the staff team had achieved National Vocational Qualification level 2 or above. The manager said that all staff receive an in-house induction and a corporate induction which covers all their mandatory training. We were told that all staff receive regular supervision and an annual development review. The manager said that the handover procedure between shifts had been improved to make sure that safe staffing levels were in place. People using the service said in surveys that there were staff available when they needed them and they listen and act on what they say. Relatives and advocates said care workers usually had the right skills and experience to look after people properly. One felt that some of the bank staff are not as caring as they could be but commented overall that there were very caring staff. Another relative commented Care Homes for Older People Page 23 of 30 Evidence: most staff are well trained and demonstrate a positive and caring attitude to the residents. They are generally treated with respect and dignity. During the visit we could see that staff deployment around the building is worked out before the start of each shift and written onto the notice board in the duty office. Improvement has been made since the last inspection to make sure that safe staffing levels are maintained during shift handover periods, by identifying which staff attend the handover. Staff who were met during the course of the day were polite and respectful to people using the service and had a good understanding of their needs. There was also appropriate use of humour. The recruitment files of three new staff were looked at. Two contained all required clearances and checks, one (for an administrative position) was awaiting a Criminal Records Bureau check. Two of the three application forms contained gaps to working history. One person was on duty and able to supply the information and the manager was heard making arrangements for the second person to provide these details when next in. We would expect gaps to peoples backgrounds to be picked up and discussed before or as part of the interview process, to make sure that peoples backgrounds can be fully accounted for. A requirement is made to address this. Training records showed that most staff were up to date with mandatory training, although some overdue updates needed to be organised. We are confident that the manager will address this as part of on going training programmes at the service. Care Homes for Older People Page 24 of 30 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 management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. Evidence: Information provided in the Annual Quality Assurance Assessment showed that the manager is experienced in health and social care and business management and has achieved the registered managers award, National Vocational Qualification level 4 and a diploma in management. She is also an National Vocational Qualification assessor and internal verifier. We were advised that there were clear lines of accountability at the service and that there were three administrative staff. We were told that there were internal and external auditing systems and that the manager was carrying out more monitoring throughout the service. Statistical information showed that equipment such as electrical circuits, portable electrical appliances and fire fighting equipment were being maintained according to recommendations and that there was an action plan to deliver best practice in the control and spread of infection. It was Care Homes for Older People Page 25 of 30 Evidence: indicated that there were written assessments for handling of hazardous substances. A range of policies and procedures was said to be in place to provide staff with guidance. We saw that forty four care staff had received training on safe food handling plus three catering staff and fifty three staff had been trained in infection control measures. A relative said the manager, Sue White, is capable and competent. The recent appointment of a new deputy should help to improve the overall management. The manager was on duty at the time of this visit and co-operated fully with the inspection process. We saw that there had been some change to the management structure; the dementia care manager was no longer at the service and a deputy manager had very recently been appointed to provide additional management support. The manager showed us objectives from the services development review and these had been shared with all staff. The Annual Quality Assurance Assessment had been completed within the timescale given and provided accurate information about the service. It also included details of what was being done to meet requirements from the last inspection. We saw that monitoring of the service is being undertaken by the provider and included the dementia care audit in March this year. People coming to live at the service have the option of having their money managed in the providers residents savings scheme. This is a computerised system with protected password access and is overseen by staff at head quarters, to ensure that proper accounting procedures are followed. Receipts are kept to verify expenditure and people using the service or their relatives can request printed statements if they wish. We saw that a number of items were held in custody for safekeeping. Whilst receipts were being given for money deposited on behalf of service users, this was not the case for items that were held in the safe on peoples behalf. We would advise that a receipt be issued so the person depositing the item has a record of the transaction. Health and safety was being managed effectively at the service. There were a number of policies and procedures available in the duty office to provide guidance to staff, on topics such as fire safety, accident and incident reporting, first aid, infection control, food safety, control of substances hazardous to health and lone working. We saw a letter from the local environmental health department dated July last year, awarding the service five stars for food hygiene practice. There were records to show that hoists had recently been serviced, there was a current gas safety certificate and portable Care Homes for Older People Page 26 of 30 Evidence: electrical appliances had recently been checked. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 12 Peoples changing health 01/02/2010 needs are to be properly monitored and reviewed and actions indicated in these assessments carried out accordingly. This is to ensure that people receive the support they require to promote their well being. Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Peoples changing health 30/06/2010 needs are to be properly monitored and reviewed and actions indicated in these assessments carried out accordingly. This is to ensure that people receive the support they require to promote their well being. 2 29 19 Gaps to peoples working history are to be explored. This is to make sure that full background information is obtained before staff start working with vulnerable adults. 30/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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