Care Home: Carlisle Dementia Centre (Parkfield)

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What the care home does well The home provides good care and support for people suffering from dementia. Admission arrangements were good with people undergoing a thorough assessment of their care needs before being offered a place in the home. This allowed the manager and staff to be fully prepared for the persons` arrival, and enabled them to help people settle in quickly. Delivery of personal care was planned well, taking into account people`s wishes whilst being alert for and sensitive to their mood changes. Staff gently encouraged people to accept the help and support they needed, but accepted at times people would refuse their input. People had good access to health care services and staff supported people in using these services to their benefit. There was a very good programme of social activities designed to keep people entertained and occupied. These included large and small group work, individual sessions and outings. People had free access to secure garden areas with raised beds and seating areas. Meals in the home were popular and we saw that staff encouraged people to eat and ensured they had plenty to drink. The home was clean and well equipped for those people with mobility problems. Bedrooms had been individually laid out and equipped according to each person`s needs and wishes. There were plenty of lounges and sitting areas for people to use and space to walk around. The home was well staffed and the majority of care staff had completed substantive training courses in dementia care. Recruitment practices were thorough and staff received ongoing training and support to do their jobs well. A high proportion of the staff had gained a National Vocational Qualification in care at level 2 or above. The service was well managed and the manager consulted with service users and their families about any changes and sought their views and ideas for improvement. What has improved since the last inspection? A number of improvements had been made since the last inspection. Care plans had been kept updated more frequently and risk assessments were recorded in greater detail. Nutritional risk assessments had also been introduced to help identify those people who needed additional help with maintaining a healthy weight. The management of medicines had improved, with a new secure storage cupboard and a new medicines trolley being provided. Medicine records had been tightened up and staff had received some additional medicines training which had helped improve their practice. Activity staff had been appointed, and a new `activity flat` created, where people could visit to make tea, have meals, bake and do the washing up. This was proving very popular and provided a good contrast to the larger organised crafts and games sessions that took place. Staff had received further training on safeguarding procedures and were now making referrals appropriately, and keeping much better records of any accidents and incidents that occurred. They had also got better at reporting these things to the commission and keeping us up to date with what was happening in the home. There had also been some environmental improvements to the home. Two additional bedrooms had been created, and five bedrooms now had en suite showers. The main dining lounge had been altered to provide a much larger space for social events. There was new dining room furniture, new flat screen televisions, and new kitchen extractors and fly screens. Some corridors and a bathroom had been decorated and the shower room had an overhead tracking hoist fitted. What the care home could do better: The home was providing a good service to people and no statutory requirements were made as a result of this inspection. We recommend that the lower ground floor corridor carpet, and the old wooden shelving in some bathrooms be upgraded, to provide a cleaner and more pleasant environment for people, and that the lift be cleaned more thoroughly for better infection control. Key inspection report Care homes for older people Name: Address: Carlisle Dementia Centre (Parkfield) 256 London Road Carlisle Cumbria CA1 2QQ     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: Jenny Donnelly     Date: 2 4 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 27 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 27 Information about the care home Name of care home: Address: Carlisle Dementia Centre (Parkfield) 256 London Road Carlisle Cumbria CA1 2QQ 01228818933 01228595173 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hometrust Care Limited Name of registered manager (if applicable) Mr Brian McCubbin Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of people who can be accommodated is: 42 The registered person may provide the following category of service only: Care home only - Code PC To people 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 Dementia - Code DE Physical disability - Code PD Date of last inspection Brief description of the care home Parkfield provides care and accommodation for up to 42 older people, some of who may also have dementia or a physical disability. The home is a three storey detached property quite close to the centre of Carlisle. The accommodation for service users is provided on the ground and first floors. There is a passenger lift, handrails, grab rails, Care Homes for Older People Page 4 of 27 1 8 0 8 2 0 0 9 42 0 42 Over 65 0 42 0 Brief description of the care home and ramps to assist people in moving around the home. All of the bedrooms are for single occupancy and have en-suite toilet and washbasin facilities; five bedrooms also have an en suite shower. There are additional toilets, communal bathrooms and a shower room, which are equipped to assist people to access these facilities. There is a secure, sheltered garden area and car parking facilities at the home. A variety of information has been produced. This includes a brochure and service user guide. These documents are available on request from the manager who is also able to provide information regarding fees. Weekly fees at the time of this inspection ranged from £398.00 to £462.00 Care Homes for Older People Page 5 of 27 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 was the main or key inspection for the year. The lead inspector Jenny Donnelly asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the last inspection and for the plans for the coming year. This was fully completed and returned to us by the date we asked. We also sent surveys to some of the people who live in the home and to the staff. We received ten completed staff surveys and six from people living in the home. Jenny Donnelly made an unannounced visit to the care home on 24th May between the hours of 09.30 and 16.15. During this visit we (the Care Quality Commission) toured the building, spent time in the lounges, and dining rooms where we watched lunch being served. We spoke with people living in the care home and their visitors. We also spoke with the manager and the staff on duty. We looked at files and documents that backed up what we were told and what we saw. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? A number of improvements had been made since the last inspection. Care plans had been kept updated more frequently and risk assessments were recorded in greater detail. Nutritional risk assessments had also been introduced to help identify those people who needed additional help with maintaining a healthy weight. The management of medicines had improved, with a new secure storage cupboard and a new medicines trolley being provided. Medicine records had been tightened up and staff had received some additional medicines training which had helped improve their practice. Activity staff had been appointed, and a new activity flat created, where people could visit to make tea, have meals, bake and do the washing up. This was proving very popular and provided a good contrast to the larger organised crafts and games sessions that took place. Care Homes for Older People Page 8 of 27 Staff had received further training on safeguarding procedures and were now making referrals appropriately, and keeping much better records of any accidents and incidents that occurred. They had also got better at reporting these things to the commission and keeping us up to date with what was happening in the home. There had also been some environmental improvements to the home. Two additional bedrooms had been created, and five bedrooms now had en suite showers. The main dining lounge had been altered to provide a much larger space for social events. There was new dining room furniture, new flat screen televisions, and new kitchen extractors and fly screens. Some corridors and a bathroom had been decorated and the shower room had an overhead tracking hoist fitted. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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. There is good information available about this service, and people are able to visit and look around. New people undergo a thorough assessment of their health, personal and social care needs, to check if the home will be able to meet their needs, before they are offered a place. Evidence: The home has produced a statement of purpose and other brochure information for people interested in the services provided. Hometrust Care Ltd who operate the home, also have a web site that gives lots of information about the care home. We looked at the care records of two people quite new to the home, and saw that the manager had completed a full assessment of their needs, prior to them being offered a place. The assessments followed a set format and had been completed with a good level of detail, covering peoples personal, health and social care needs. Where applicable there were copies of social work assessments, information from other care Care Homes for Older People Page 11 of 27 Evidence: homes or hospitals people had been in, and information from peoples family. This helped the manager put together a good picture of the persons needs, so staff were prepared for their arrival. One person was due for admission on the day of our visit and we saw the bedroom had been made ready and was welcoming. Relatives had been able to bring in some personal belongings the previous day to make the room appear homely. We saw other peoples bedrooms had also been prepared to meet their particular needs, such as the placing of furniture for people with physical needs, and additional fire safety measures for people who smoke. The home is registered to provide care for people with dementia. The manager is a registered mental health nurse who attends national dementia care conferences to keep up to date with current practice. Six staff had completed a six month dementia awareness course through Stirling University and nine had completed a 12 week dementia care course locally. This means the majority of staff have received some substantial specialist training in caring for people with dementia. People were welcome to visit the home to look around, or stay for a day, before deciding to move in. One person we spoke with, had visited the home several times, and brought various representatives along to help them decide. Other people had not been well enough, and had left their relatives to decide for them. The surveys we received indicated that people had been given enough information about the home before they moved in. The home does not provide intermediate care, but they do provide short term respite care, where occupancy allows. Care Homes for Older People Page 12 of 27 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. People were receiving a good standard of personal and health care and the management of medicines in the home had improved and was safe. Evidence: We looked at the care records of four people with different types of care needs, who had lived in the home for different lengths of time. We saw risk assessments and care plans were in place and had been reviewed and updated to reflect changes in peoples circumstances. Risk assessments were detailed and covered peoples behaviour and any risk to themselves or to others. Nutritional risk assessments were now being used to identify those people who needed extra support to make sure they were eating and drinking enough. We saw that some underweight people had gained weight since coming to live in the home. The plans gave staff clear instructions on how best to support people and meet their individual needs. Records showed that people had good access to health care services including their doctor, the district nurse, chiropodist and optician. There was evidence that people had periodic reviews by their consultant and records showed the changes Care Homes for Older People Page 13 of 27 Evidence: recommended for peoples care and treatment had been implemented. Staff were guided by the district nurses in skin care and continence care. We observed care staff going about their duties, working positively with people, using humour to good effect and showing respect for peoples wishes. We saw one person liked to keep their bedroom door open whilst they were in bed, so they could watch the staff passing by and chat with them. This was recorded in the care plan and we noticed that staff always looked in and shared a pleasant word on their way past. Other people liked to lock their bedroom door when they left the room, and had the key so they could do so. We saw that most people had been helped with their personal hygiene and were dressed appropriately. One person had declined to get dressed and was walking around in nightwear. Staff said they would try again later to help this person, as they recognised further intervention at this time would cause an unnecessary disturbance. The management of medicines had improved since the last inspection. Storage had improved with the purchase of a new medicines trolley that secures properly to the wall when not in use. There was also a new storage cupboard for any controlled drugs (those liable to mis use) that meets with legislative requirements. The use of as required medicines was being managed better, with clear information now available for staff to say what these medicines were for, and when to use them. In the case of calming / sedative type medicines, care plans directed staff to try other methods first before administering these to people. We saw that medicines due at odd intervals such as alternate days or once a week were well managed, and those given in variable doses were also clearly recorded. Medicines with a short shelf life such as eye drops, had mostly been marked with the opening date so staff would know when to dispose of them. No residents were looking after their own medicines at this time, but the manager said there was a risk assessment document in place should this be needed. We saw that the manager conducted supervised medicine rounds with staff each week to ensure they worked in accordance with the homes policies and procedures for handling medicines safely. Care Homes for Older People Page 14 of 27 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. The home was enabling people to have a choice in how to spend their time and was providing a good range of purposeful occupation and activities. People were happy with the meals provided and were getting enough to eat and drink. Evidence: We saw that people had some choice in how to spend their days, either staying in their bedrooms or using the communal lounges and secure garden areas. People were able to get up early or lie in bed later as they preferred. A small number of people were able to lead fairly independent lives, going out with their family and friends. Others went out regularly with staff to the pub or for shopping trips. The home hired a local community bus for larger outings and had recently visited Keswick and Morecambe for day trips. There was a communal smoking room and some people had an agreement to smoke in their bedroom, with suitable fire precautions in place. Since the last inspection the manager had increased the provision of in house activities, and now employs two activity staff. One works three afternoons a week, organising large group activities such as games and crafts. The other works five days a week including weekends, running a visiting service in the newly created activity flat. The flat comprises of a small sitting room with a domestic style kitchen diner. Care Homes for Older People Page 15 of 27 Evidence: The activity organiser invites small groups of up to three people to visit the flat, where they can make cups of tea, bake cakes, have a meal together and wash up. This new service was proving very popular and was well organised, with staff making sure everyone had the opportunity to visit if they wanted to. On Mondays, when the hairdresser comes to the home, the flat is open to a larger number of visitors for coffee while people wait their turn in the salon next door. The manager hopes to install a washing machine in the flat so people can be involved in laundering the tea towels and table cloths. Providing this type of practical activity so people can maintain their skills and feel usefully occupied is good practice, and we were pleased to see this new initiative working so well. We looked at the homes menus which showed a variety of traditional meals. Breakfast was cereal, toast and some hot items. Lunches were primarily roast dinners, fish, mince and sausages with a hot dessert, and the evening meal was a hot dish such as welsh rarebit, tuna pasta, plus soup and sandwiches and a cold dessert. People who completed our surveys indicated they were happy with the meals provided, and the manager told us the menu had been updated recently to include some special requests such as fish fingers. We saw lunch being served and saw that soft meals were provided for those people who needed or preferred them. Staff were around to support people who needed help or encouragement to eat and drink. Drinks were served regularly throughout the day and we saw staff offering people top ups and second helpings. Staff monitored how much people ate, so anyone not eating could be offered something extra at a later time when they were more in the mood. We saw that some people had gained weight since coming to live in the home. Care Homes for Older People Page 16 of 27 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. The manager and staff understood and followed the complaints and safeguarding procedures. This meant people were listened to, and safeguarding referrals were made to the appropriate authority as necessary. Evidence: The home has a complaints procedure in place and people who completed our surveys confirmed they knew how to make complaints and had someone they could talk to if they were worried. The manager told us about one complaint in the last year made by a relative. We discussed this and felt the manager had responded appropriately and the matter had been resolved. The commission had received one telephone call from a person saying they had visited the home and found it dirty, people were walking around in nightclothes and had their bedrooms doors open when they were in bed. We looked out for this during our inspection and found one person chose to keep their bedroom door open and another had declined to get dressed. We found the home was clean and comment further on this in the environment section of this report. Further to our last inspection staff have received updated training in safeguarding procedures and the home has obtained a copy of the Cumbria multi-agency guidelines on this. The manager is now correctly referring untoward incidents, such as altercations between residents, to the safeguarding team for advice or investigation. This approach gives people access to care plan reviews and to input from external professionals to make sure people are getting the level of treatment and support they Care Homes for Older People Page 17 of 27 Evidence: need. The manager and staff were keeping good records of such events and of any follow up action. Care Homes for Older People Page 18 of 27 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. The home provided a comfortable environment and was suitably equipped to meet the needs of the people living there. Evidence: The home was well maintained and provided suitable accommodation for the people who live there. Bedrooms and living space were provided on the ground and upper floors, with service areas, the hair salon and activity flat on the lower ground floor. There was a passenger lift that reached all floors. Changes had been made to the main dining lounge, to create a larger open space for social functions, and new dining furniture and a large flat screen television had been purchased. There were four dining lounges in total and some smaller seating areas in corridors, where people liked to sit and watch. There was open access to secure garden areas with paved pathways suitable for wheelchairs and a new raised bed which residents had planted. The corridors had been decorated, and pictures of Carlisle were on display providing a focal point for discussion and memories. There were pictorial signs on doors to help people identify bathrooms and dining areas. There was a smoking room. There were some air conditioning units to help keep the home a comfortable temperature on this warm day, and there was plenty of natural light. Care Homes for Older People Page 19 of 27 Evidence: The home had three bathrooms with assisted bathing facilities and one shower room with a new overhead tracking hoist. One bathroom had been nicely decorated, but there was some old bare wooden shelving in the other bathrooms that was in need of attention, to make it easier to clean. There were plenty of spacious toilets situated around the building. To assist people with mobility problems there were handrails in the corridors, grab rails in the toilets, a passenger lift, bath seats, and five free standing hoists. Some people had their own personal equipment and some had specialist nursing beds on loan. There was a nurse call system with a buzzer in every room. Since the last inspection an additional two bedrooms had been provided, increasing the homes occupancy to 42 people. All bedrooms were single with an en suite toilet and hand basin. Five bedrooms also had a shower. People had been able to personalise their bedrooms with their own belongings, pictures, and in some cases furniture. Bedrooms were furnished in accordance with peoples needs and wishes. The lower ground floor housed the kitchen, laundry, hairdressing salon and activity flat. The corridor decoration and carpets in this area were very worn and shabby, and need to be upgraded. The lift which was being used to transport people, food and laundry was not clean, and we asked the manager to ensure this was thoroughly cleaned every day. Since the last inspection a new cooker extractor hood with gas safety shut off valves had been installed in the kitchen along with new fly screens. The latest environmental health inspection awarded the home four stars for food safety. The remainder of the home was clean and fresh with no bad odours. We saw that carpets had been vacuumed and bathrooms and toilets were clean. Laundry was handled with care to prevent cross infection and staff had aprons and gloves, and good hand washing facilities. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by a competent and caring team of staff who were suitably trained to do their jobs well. Evidence: We saw the home was well staffed with enough carers on duty to meet peoples needs. There are generally six carers each day who work solely with residents, plus the activity organiser. The manager told us care staff do not carry out any domestic or kitchen duties nor do they make beds. There were sufficient domestic, catering, administrative and maintenance staff for the home to run smoothly, and for care staff to concentrate on caring for people. We saw that staff were evenly distributed around the building and were able to give people their time and attention. Staff we spoke with, and those who completed our surveys, told us they were provided with good training and felt supported to do their jobs well. New care staff completed a three day induction training off site, and this was followed up with regular refresher training in fire, moving and handling and safeguarding people. Some staff had also completed first aid and medicines training. There was no recorded evidence of care related training such as continence and skin care, the manager said this was provided by the district nurse, and agreed to include this in training records. Sixty five percent of the care staff had completed a National Vocational Qualification in care at level 2 or above, which is very good. Care Homes for Older People Page 21 of 27 Evidence: The manager is a registered mental health nurse who attends national dementia care conferences to keep up to date with current practice. Six staff had completed a six month dementia awareness course through Stirling University and nine had completed a 12 week dementia care course locally. This means the majority of staff have received some substantial specialist training in caring for people with dementia. We looked at recruitment records for new staff and saw that all necessary preemployment checks, including written references and criminal records bureau checks were obtained before people started to work in the home. We saw that all staff worked positively and engaged well with people. A number of residents enjoyed the company and companionship of non care staff, who also took time to speak with people. This broadened service users social contact and was good practice. Care Homes for Older People Page 22 of 27 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 home was well managed and the manager sought out and listened to the views of service users, so as to act in their best interests. Evidence: The registered manager is suitably qualified and competent to run the home. He was well supported by his senior staff in the home and externally by the company who operate this service. A company representative visits at least monthly to carry out quality monitoring checks and offer support to the manager. Other quality monitoring includes the managers regular checks on care plan records and medications. The manager periodically gives out satisfaction surveys to residents and relatives but said he has a very low response rate. The responses received did show people were satisfied with the service. The manager also holds meetings with residents and relatives to inform them of any changes, and to listen to their views. People had been consulted recently on the homes change of name, and contributed their ideas to the menus, outings, and the new raised garden bed. Care Homes for Older People Page 23 of 27 Evidence: The home did hold some peoples money for safekeeping, and we saw this was well managed and individual account records were kept for each person. People knew how to access their money and could see their account records. Staff received regular supervision from the manager, mostly in the form of group supervision where current issues in the home, policies, procedures and training needs were discussed. The manager said individual sessions were held as necessary where there was a performance issue. The homes maintenance man was also the health and safety officer for the company, and we saw that he dealt with all the servicing and equipment checks, as well as being the fire warden and providing staff with fire safety training. We looked at a sample of maintenance and safety records and found these were fully completed and up to date. There were accident records which staff completed for even minor incidents, which is good practice. The manager followed these up, to see if any changes were needed to reduce the risk to people. The manager reported untoward incidents to the commission and reported safeguarding concerns to the local authority. Recording and reporting in this area had improved greatly since the last inspection. There was one person living in the home under a Deprivation of Liberty Safeguard order, we saw the paperwork to support this deprivation was available, and a date had been arranged for a future review of this persons needs. Care Homes for Older People Page 24 of 27 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 25 of 27 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 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 19 We recommend some areas of the homes decor be upgraded, including the lower ground floor corridor area, and the bare wooden shelving in some bathrooms which is difficult to clean. We recommend the passenger lift, which is used to transport food and laundry, be cleaned thoroughly each day to reduce possible risk of infection. 2 26 Care Homes for Older People Page 26 of 27 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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