Care Home: Carlton Court Care Home

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What the care home does well The home is modern, spacious and furnished to a high standard, thus providing an attractive home for residents. There is a hair and beauty salon. The landscaped gardens are spacious and well maintained. Residents interviewed were satisfied with their accommodation. The treatment rooms where medication is stored is air conditioned. We note that the reception area was welcoming. Visitors have access to coffee and tea. Residents and relatives interviewed gave positive feedback regarding staff. They indicated that staff were caring and they had been treated with respect. Care records are easily accessible and details are also available on computer. Special attention is given to ensure that residents meal preferences are responded to. Kitchen staff visit residents daily to discuss their meal preferences. they are also involved in serving the meals. The dining rooms are air conditioned. We note that fresh cut flowers were on dining room tables. Staff say they work well as a team and communication is good. Care staff have enrolled on NVQ courses. This was confirmed by staff interviewed. The home has its own newsletter. We note that the Autumn newsletter was well laid out and contained interesting features such as activities provided, local news, the relatives group, a poem and information about new staff. What has improved since the last inspection? This is the first key inspection of the home. What the care home could do better: Some improvements are required in the care arrangements. The pressure area care policy and procedure must be updated to ensure that it is comprehensive.This should be done in conjunction with the tissue viability nurse. This is to ensure that staff are fully informed and residents are well cared for. The intake and output charts of the resident identified to the manager must be reviewed to ensure that the amounts are totalled up at the end of each day. The medication policy and procedure must be updated to include guidance to staff on action to take in the event of medication errors being made by staff. This is to ensure the safety of residents. Care plans of residents should be signed by residents or their representatives. This is to ensure that the plans are appropriate and they agree with the plans prepared. Further improvements are needed in the area of adult protection. The adult protection procedure must be revised to ensure that a parallel investigation by the home is not carried out when the Police are already investigating. This is to ensure that residents are protected and Police investigations are not jeopardised. The home must have a policy and procedure on the close supervision of residents who have challenging behaviour and who present a significant risk to themselves and others. This is to ensure the protection of residents. Improvements are needed in the staffing arrangements. Two references must be obtained for all staff prior to them commencing work at the home. This is to ensure that staff are recruited with care and suitable for employment at the home. A risk assessment must be carried out for any staff who has to work more than two long day shifts. This is ensure that residents can be well cared for and staff are not excessively tired. All care staff must receive training in the management of residents with dementia and challenging behaviour. This is to ensure that staff are fully trained to care for residents. Improvements are needed in the area of health and safety. All staff must receive fire safety training. A minimum of four fire drills must be carried out within a twelve month period. One of these drills must be scheduled after dark. This is to ensure the safety of residents and staff. The emergency lighting must be tested at least once a month or in accordance with the manufacturers guidance and this must be recorded. This is necessary to ensure that they are in working order. The home must consult with the LFEPA regarding the adequacy of their fire evacuation plan. This is to ensure the safety of residents in the event of a fire. Significant incidents must be reported to CQC. This must include incidents involving the Police. Key inspection report Care homes for older people Name: Address: Carlton Court Care Home 112 Bells Hill Barnet Herts EN5 2SQ     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: Daniel Lim     Date: 2 2 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Carlton Court Care Home 112 Bells Hill Barnet Herts EN5 2SQ Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr David Adams Type of registration: Number of places registered: care home 81 TLC Group (Rockley Dene Homes Ltd.) Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Care Home -Code N DE--Dementia LD--Learning Disability MD--Mental Disorder excluding learning disability or dementia The maximum number of service users who can be accommodated is: Eighty one The Registered Person may provide the following category/ies of service only: Care Care Homes for Older People Page 4 of 34 Over 65 0 60 30 60 81 0 0 21 21 21 0 0 Home --Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: OP--Older People DE--Dementia Whose primary care needs on admission to the home are within the following categories: OP--Older Age Date of last inspection Brief description of the care home Carlton Court Care Home is a new care home, which is registered to provide nursing and personal care for a maximum of eighty one older adults who may either have dementia, mental disorders, learning difficulties or general nursing needs. The home is run by TLC Group, Rockley Dene Homes Limited. It also runs care homes in other parts of the country. The homes declared mission is to provide the highest quality of care for its residents and offer them a home from home environment. The home is a new purpose built detached four storey building. The main entrance to the building is on the lower floor. The reception, managers office, laundry and kitchen are on this floor. On the ground floor, first and second floors are located residents bedrooms, communal lounges and dining rooms. All bedrooms have a TV and ensuite facilities. There are communal bathrooms and toilets on each of the floors. All floors are accessible by lifts. To the back of the house is an attractive and spacious garden which is on the same level as the ground floor. The garden has paths which are accessible by wheelchair. Seating is provided. The front of the house has a large parking area parking for cars. The home is located in a residential area adjacent to Barnet General Hospital. It is close to a range of community services such as shops, restaurants, bus and tube services located along the High Road in High Barnet. The fees for residents range from £630 to £950 per week. The provider must make information, including reports about the service available to service users and other stakeholders. Care Homes for Older People Page 5 of 34 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 inspection was carried out by Daniel Lim and Tom McKervey, CQC inspectors on 21st October 2009 and took a total of seven hours to complete. A second visit was made on the 26th October to view documents not examined or available on the first day. We were assisted by the registered manager, Mr David Adams. This home has recently been registered and was not fully occupied. Five residents and a relative were interviewed. The feedback received from them was positive and indicated that they were satisfied with the care provided. Eleven completed residents survey forms were received. These were on the whole, positive and indicated that residents were well cared for. Statutory records were examined. These included five residents case records, the maintenance records, accident and incident records, complaints records and fire records of the home. Care Homes for Older People Page 6 of 34 The premises including residents bedrooms, communal bathrooms, laundry, kitchen, garden and communal areas were inspected. Five staff were interviewed regarding the care of residents and other areas associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. Staff records, including evidence of CRB disclosures, references, supervision and training records were examined. In addition, the minutes of residents meetings were examined. These indicated that residents had been informed of changes affecting the running of the home. The completed Annual Quality Assurance Assessment form or AQAA was received by us. Information provided in the assessment was used for this inspection. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Some improvements are required in the care arrangements. The pressure area care policy and procedure must be updated to ensure that it is comprehensive.This should be done in conjunction with the tissue viability nurse. This is to ensure that staff are fully informed and residents are well cared for. The intake and output charts of the resident identified to the manager must be reviewed to ensure that the amounts are totalled up at the end of each day. The medication policy and procedure must be updated to include guidance to staff on action to take in the event of medication errors being made by staff. This is to ensure the safety of residents. Care plans of residents should be signed by residents or their representatives. This is to ensure that the plans are appropriate and they agree with the plans prepared. Further improvements are needed in the area of adult protection. The adult protection procedure must be revised to ensure that a parallel investigation by the home is not carried out when the Police are already investigating. This is to ensure that residents are protected and Police investigations are not jeopardised. The home must have a policy and procedure on the close supervision of residents who have challenging behaviour and who present a significant risk to themselves and others. This is to ensure the protection of residents. Improvements are needed in the staffing arrangements. Two references must be obtained for all staff prior to them commencing work at the home. This is to ensure Care Homes for Older People Page 8 of 34 that staff are recruited with care and suitable for employment at the home. A risk assessment must be carried out for any staff who has to work more than two long day shifts. This is ensure that residents can be well cared for and staff are not excessively tired. All care staff must receive training in the management of residents with dementia and challenging behaviour. This is to ensure that staff are fully trained to care for residents. Improvements are needed in the area of health and safety. All staff must receive fire safety training. A minimum of four fire drills must be carried out within a twelve month period. One of these drills must be scheduled after dark. This is to ensure the safety of residents and staff. The emergency lighting must be tested at least once a month or in accordance with the manufacturers guidance and this must be recorded. This is necessary to ensure that they are in working order. The home must consult with the LFEPA regarding the adequacy of their fire evacuation plan. This is to ensure the safety of residents in the event of a fire. Significant incidents must be reported to CQC. This must include incidents involving the Police. 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 34 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 34 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. Prospective service users and their representatives have been provided with the necessary information to enable them to make informed choices about the home. Admissions are not made to the home until a full needs assessment has been undertaken by the manager or a sufficiently skilled member of staff. This ensures that the home is able to meet the needs of residents. Evidence: The home has an appropriate and detailed Statement of Purpose and a Service User Guide. These gave essential information about the home and the services provided. The manager informed us that residents are fully assessed by him prior to admission. Details of the assessment are documented in the assessment form and also recorded on computer. He further added that he works to ensure that only residents whose needs can be met at the home are admitted. The three pre-admission assessments which were examined were noted to be appropriate and comprehensive. These Care Homes for Older People Page 11 of 34 Evidence: assessments included details of the personal, physical, mental, cultural and spiritual needs of residents. Risk assessments had also been prepared for residents admitted to the home. Residents in the home were noted to be clean and appropriately dressed. Residents and a relative who were interviewed by us indicated that residents were well cared for and their care needs had been attended to. This was reiterated in completed questionnaires received. Comments made by residents included the following : Kind and caring staff. Staff are friendly and helpful. Manager and staff are always welcoming and answer our questions. Not lonely, not worried because I believe the staff are very accessible, friendly and positive. Comments made for improving the home have also been relayed the manager. The manager stated that the home does not provide intermediate care. Care Homes for Older People Page 12 of 34 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 arrangements for meeting the healthcare and personal care needs of residents are on the whole satisfactory and these are recorded in residents care plans. Residents are protected by the homes satisfactory arrangements for the administration of medication. However, further improvements are needed in the care arrangements. Evidence: Residents interviewed stated that they were well cared for and they had been treated with respect by staff. Case records contained evidence that residents had access to healthcare professionals such as the community nurse and their GP. The homes completed AQAA states : Carlton Court works upon a person centred approach where the user is actively encouraged to choose their pathways of care. We have tailored care plans for every resident providing the best possible care. A sample of five care plans which was examined were on the whole well prepared and Care Homes for Older People Page 13 of 34 Evidence: regular monthly care reviews had been carried out. One completed resident survey form indicated that improvements are needed in pressure area care at the home. This was brought to the attention of the manager. The case records of a resident with a pressure sore were examined. We note that they were appropriate and comprehensive. There was evidence that the local tissue viability nurse had been consulted regarding these plans. Air mattresses were available for those with pressure sores. The senior nurse interviewed, informed us that she had received training in the care of pressure sores. The home has a pressure sore policy and procedure. However, these did not appear to provide adequate information regarding the grades of pressure sores. To ensure that staff are fully informed, the home must have comprehensive guidance regarding pressure area care. This was discussed with the manager who agreed to update the policy and procedure in accordance with guidance from the tissue viability nurse. The case records of a resident with complex dietary needs were examined. We noted that the weight was not recorded weekly as mentioned in the care plan. The manager explained that this should have been changed to monthly instead. He agreed to amend the instructions. The intake and output charts had been provided. However, the amounts had not been added up each day. This is required to ensure that the resident is well cared for. Appropriate risks assessments had been prepared for residents. These were generally of a good standard. The care plan of a resident with dementia contained an appropriate and up to date dementia care plan. Staff interviewed were aware of how to care for such a resident. We note that the care plans had not been signed by residents. Care plans of residents should be signed by residents or their representatives. This is to ensure that the plans are appropriate and they agree with the plans prepared. The manager stated that he will arrange for the plans to be signed. The treatment room was air-conditioned. The temperature records of this room where medication was stored had been recorded daily. They were satisfactory. The medication charts of residents were examined. These indicated that medication had been administered as prescribed and appropriately signed by staff. The arrangements for ordering and disposal of medication were satisfactory. The medication policy and procedure did not contain guidance to staff on action to take in the event of medication errors made. This was discussed with the manager who agreed to update the procedure. Care Homes for Older People Page 14 of 34 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 daily life, meal arrangements and routines of residents are well organised. The views of residents and their relatives are being sought when planning the homes activities and routine. People using the service are given the opportunity to take part in activities that are appropriate and varied. They also have opportunity to maintain important family relationships. Evidence: The AQAA of the home states that the individual needs of residents are being attended to. It states that : There is a social profile for all residents. There is a detailed activity log from all weeks since the home opened. We have set up activity programmes involving all residents consisting of daily activity sessions. All new residents receive a copy of the activities plan on their arrival and an explanation of the activities structure and equipment available. This is also displayed in the main lounges and the foyer. Residents play a role in the creation of Carlton Courts newsletter by writing poems and other material. We have begun building a personal story for each resident in the form of a scrapbook about their lives, families, work and general experiences. At Carlton Court we ensure that new residents have their rights and needs respected and Care Homes for Older People Page 15 of 34 Evidence: adhered to, as well as residents who have been with us for longer. The local vicar visits Carlton Court most weeks to meet with the service users. Our staff are multinational, coming from many different backgrounds. We were informed by the manager that the home has a varied and comprehensive programme of weekly social and therapeutic activities. The programme was available for inspection and on display by the front entrance of the home. The manager indicated that the programme of activities had been carefully planned to suit the preferences and needs of residents. Activities provided included exercise sessions, music, head massage, entertainment sessions, outings and art and crafts. On the day of inspection, the activities organiser was engaging residents in a group activity. A relative suggested that there be one to one sessions for her relative who is a resident. The administrator informed us that one to one sessions take place regularly and are documented in the activities log. In a completed questionnaire received by us, a resident suggested that staff be made more aware of the Jewish culture. This was discussed with the manager. He stated that Jewish and other cultural events are being celebrated in the home. He also informed us that staff had been instructed to treat all residents with respect and dignity. The kitchen was clean and well equipped. A record of fridge and freezer temperatures had been kept. These were satisfactory. Three chef were on duty on the day of inspection. The head chef who was interviewed was knowledgeable regarding her responsibilities and the special dietary needs of residents. She informed us that kitchen staff visit residents daily to ensure that their preferences are noted. Kitchen staff also serve the meals. The menu examined was varied, balanced and there was a choice of main dish. The manager reassured us that ethnic meals can be provided if requested and this includes Kosher meals. The manager informed us of areas of good practice in the catering arrangements. He stated that the menus were in pictorial form. Pictures of meals provided were available for inspection. All new residents were seen by a chef soon after arrival to discuss their dietary needs and preferences. Light snacks were also available after dinner. These can be prepared by staff in the kitchenettes on each floor. Residents interviewed indicated that they were satisfied with the meals provided. This was also noted in the completed surveys received. Care Homes for Older People Page 16 of 34 Evidence: Residents confirmed that they had been visited by friends and relatives. A relative who was interviewed indicated that residents had been well treated and their care needs had been met. The home has its own newsletter. We note that the Autumn newsletter was well laid out and contained interesting features such as activities provided, local news, the relatives group, a poem and information about new staff. Care Homes for Older People Page 17 of 34 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 arrangements for responding to complaints and for adult protection are on the whole, satisfactory. Policies and procedures for safeguarding residents are in place and give specific guidance to staff. However, further improvements are required to ensure that residents are fully protected. Evidence: The residents who were interviewed by us indicated that they were well treated and satisfied with the care provided. The home has an adult protection procedure. It included information on examples of abuse and guidance to staff on reporting allegations of abuse to Social Services and The CQC. The manager and his staff who were interviewed were aware of the homes policy and procedures for the protection of vulnerable adults. The local authority adult protection procedures were also kept in the home. There was evidence in the induction programme that staff had been provided with guidance and information on the protection of vulnerable adults. The manager reassured us that arrangements are in place for all staff to be provided with adult protection training. An allegation of abuse was brought to our attention by the manager. We note that the manager had reported the matter to Social Services and co-operated with the Police. We however, note that the procedure mentioned the need for investigations by the home when the Police are also involved ie. Section 9.6 of the homes procedure. This was brought to the attention of the manager. He agreed to review the procedure to Care Homes for Older People Page 18 of 34 Evidence: ensure that parallel investigations are not carried out when the Police or Social Services are involved as this may jeopardise the investigations. The complaints records were examined. Complaints made had been promptly responded to. We asked if compliments had been received. The manager stated that the home was newly registered and it did not yet have a specific compliments book although verbal compliments had been received. He also added that the home had a comments book in reception. He stated that he would consider keeping a record of compliments. A resident with dementia informed us that he wanted to return home. We discussed this with the manager. He agreed to bring this to the attention of the social worker involved. During our second visit to the home, he informed us that a review of placement had already been organised with the social worker concerned. We note that a completed residents survey form indicated that a resident had entered another residents bedroom and damaged a box of chocolates. We also note from the case records that there was another incident involving a confused resident who entered the bedroom of another resident and caused some injury to the other resident. These incidents were discussed with staff and manager. In view of these incidents, the home must have a policy and procedure on the close supervision of residents who have challenging behaviour and who present a significant risk to themselves and others. This is to ensure the protection of residents. The manager agreed to arrange for the home to have the procedure. Care Homes for Older People Page 19 of 34 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 home is clean, tidy and furnished to a high standard. The provider and manager have ensured that the physical environment of the home provides for the individual requirements of people who live there. The necessary equipment and adaptations for supporting residents are available. Residents are allowed to personalise their bedrooms. Overall, the home provides a pleasant, comfortable and attractive environment to live in. Evidence: The AQAA of the home states : Carlton Courts exterior and interior are well maintained, presenting a homely comfortable enviroment for service users to live in. Service users opinions and choices are taken into account when refurbishment is carried out. Service users are encouraged to personalise their surroundings with their own soft furnishing. The home is new, modern and purpose built. Residents interviewed by us indicated that they were happy with the accommodation provided and their bedrooms had been kept clean. Bedrooms inspected have en-suite facilities and were well equipped. TVs, and lockable facilities are provided in all bedrooms. They had been personalised by residents with Care Homes for Older People Page 20 of 34 Evidence: their own pictures and ornaments and appeared cosy. Various specialist equipment for the care of residents was available. These included hoists, assisted baths, toilet handrails, wheelchairs, and a call bell system. The gardens were well maintained. They were attractive, colourful and seating had been provided. There is direct access to the garden from the ground floor. The laundry was inspected and we note that laundry staff reported that care staff followed procedures for ensuring that soiled linen and clothes are put into the appropriate bags. Soiled laundry items are subject to a special high temperature wash. This ensures effective infection control and protects the health of residents. All areas of the home were clean and tidy. The required safety inspection had been carried out on the gas and electrical installations prior to its registration. We note that the reception area was welcoming. Visitors have access to coffee and tea. The communal lounges were spacious and there was access to the communal balconies. There were fresh flowers on dining room tables. Air conditioning is provided in some of the communal rooms. The manager informed us that the large training room on the ground floor can also be used as a cinema for residents. Care Homes for Older People Page 21 of 34 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. The service has a good recruitment procedure that is generally followed in practice. The manager recognizes the importance of training and tries to deliver a programme that meets statutory requirements. Residents and their representatives are on the whole, satisfied with the staffing arrangements. Evidence: The feedback received in completed surveys and in interviews with residents was generally positive. Staff were well thought of and residents indicated that they had been treated with respect and dignity. The AQAA states : We undertake a robust recruitment process such as obtaining CRBs, references, and employment history. All staff have induction training and regular appraisals and all staff are supervised regularly. The duty rota was examined. It indicated that in addition to the manager there was normally a minimum of eight or nine care staff during the day shift. This includes 2 or 3 nurses. During the night shifts, there are usually four care staff on waking night duty. This includes 2 nurses. The home had 30 residents at the time of this inspection. Care Homes for Older People Page 22 of 34 Evidence: Ancillary staff working at the home comprised three kitchen staff, 1 laundry staff, 2 cleaners, a maintenance person and an administrator. The manager informed us that an additional laundry staff is being recruited. He added that a mental health nurse or RMN is due to be recruited too. This means the home would then have a total of four Registered Mental Nurses. One resident stated that he or she had to wait a long time for staff to respond to her call bell. This was discussed with the manager. The manager stated that staff would be instructed to respond promptly to the call bell. He also reassured us that a call bell response monitoring system involving a printout of response times will soon be installed. The manager indicated that he is aware of the need to keep staffing numbers under review to ensure that the home can continue to meet the changing needs of the people living there. We note from the rota that one staff had worked three long day shifts, from 8 am to 8 pm on three consecutive days. This was discussed with the manager. He explained that staff informed him that they were happy with their work rotas. However, working long shifts continuously may result in excessive tiredness and reduced concentration and this would impact on the care provided. One person who completed a residents survey form indicated that staff had informed him that they were tired as they work long shifts. He also stated that he had to wait 10 to 12 minutes to be let in and he said winter is coming. In view of the concerns we recommend that staff should not work more that two long shifts continuously. This is to ensure that residents are well cared for. Five staff who were on duty were interviewed. They informed us that they worked as a team and communication among staff and from the manager was good. They were noted to be knowledgeable regarding their roles and responsibilities. There was documented evidence in staff records to indicate that staff had been provided with most of the essential training relevant to their area of work. We note that some staff had not received training in Adult Protection and in the care of residents with dementia and in the management of challenging behaviour. The manager agreed that training would be provided. At the time this report was written, we were informed that training on Dementia and in the management of challenging behaviour had been booked for early November of this year. The records of four staff were examined. These indicated that with one exception, the required recruitment standards and procedures such as obtaining satisfactory CRB disclosures and references had been followed. We note that a staff member had started work prior to the second reference being obtained. The manager explained Care Homes for Older People Page 23 of 34 Evidence: that this had been asked for but had not received yet. He agreed to immediately obtain the second reference. We recommended that in such cases, a verbal reference could be obtained and this should then be followed by a written reference. There was documented evidence of regular formal staff supervision. This was also confirmed by staff interviewed. The supervision notes indicated that staff had opportunity to discuss any work related problems, issues related to the care of residents and their training. The issue of equalities and diversity was discussed with the manager and his staff. Staff demonstrated an understanding of the need to treat all residents sensitively and with respect regardless of disability, gender, race, religion or sexual orientation. They were aware that they must not discriminate against residents and they indicated that this was stressed to them during their induction. Care Homes for Older People Page 24 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be assured that the home is generally well run and the manager has skills and ability to deliver a good quality of care and meet its stated aims and objectives. Residents and their representatives are consulted regarding the care provided and the management of the home. Evidence: Feedback received from residents and their representatives indicated that residents were on the whole satisfied with the management of the home. Their AQAA states : The registered manager was found to be knowledgeable regarding his role and responsibilities. He is a nurse with extensive experience in the care field and has received his RMA (Registered Managers Award). He is supported by an administrator. He informed us that he is also supported by his senior nurses. The home has a quality monitoring system. This includes quality monitoring checks carried out by company managers and monthly Regulation 26 reports. These were Care Homes for Older People Page 25 of 34 Evidence: available for inspection. The administrator informed us that residents had been consulted regarding their care and the management of the home. She added that residents meetings had been held monthly. The manager informed us that he is also about to set up relatives meetings. The home had an up to date fire risk assessment. With two exceptions, the weekly fire alarm checks had been carried out and documented. The manager explained that the maintenance person had been away on those two occasions. He reassured us that he will ensure that these are always carried out weekly in the future. No fire drills had been documented. These must be carried out at least four times in a twelve month period. One of these drills must be scheduled after dark. This is to ensure the safety of residents and staff. There were no recorded details of formal staff training in Fire Safety. The manager agreed to arrange these without delay. At the time this report was written, we were informed by the manager that a drill had already been organised. The home has a fire procedure and some information regarding evacuation from the home. We were however, not certain if this evacuation plan was sufficiently comprehensive as it did not detail the different stages of evacuation and location of all the equipment to be used. The home must therefore consult with the LFEPA regarding the adequacy of their fire evacuation plan. This is to ensure the safety of residents in the event of a fire. The accident records were appropriately filled in and we had been informed of significant incidents. We, however, note that the Police were called as a confused resident had gone into the bedroom of another resident and caused some injury to the other resident. This was not reported to CQC. Such significant incidents especially ones involving an injury and the Police needing to be involved must be reported. The manager explained that the injury was minor and he was not aware it needed to be reported. There was no record of the emergency lighting having been tested The emergency lighting must be tested at least once a month or in accordance with the manufacturers guidance and this must be recorded. This is necessary to ensure that they are in working order. At the time this report was written, we were informed by the manager that the emergency lighting had been checked. On a tour of the premises, it was noted that window restrictors were engaged in the bedrooms visited. This ensures the safety of residents. Care Homes for Older People Page 26 of 34 Evidence: The home has a current certificate of insurance. The manager informed us that at the time of inspection, the home did not keep any residents money. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 34 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 The Pressure area policy and 16/12/2009 procedure must be updated to ensure that it is comprehensive. This should be done in conjunction with the tissue viability nurse. This is to ensure that staff are fully informed and residents are well cared for. 2 8 12 The intake and output charts 16/12/2009 of the resident identified to the manager must be reviewed to ensure that the amounts are totalled up at the end of each day. This is to ensure that residents are well cared for. 3 9 13 The medication policy and procedure must be updated to include guidance to staff on action to take in the 16/12/2009 Care Homes for Older People Page 29 of 34 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 event of medication errors made. This is to ensure the safety of residents. 4 18 13 The home must have a policy and procedure on the close supervision of residents who have challenging behaviour and who present a significant risk to themselves and others. This is to ensure the protection of residents. 5 18 13 The adult protection 18/01/2010 procedure must be revised to ensure that investigations by the home are not carried out when the Police are already investigating. 18/01/2010 This is to ensure that residents are protected and Police investigations are not jeopardised. 6 29 19 Two references must be obtained for all staff prior to them commencing work at the home. 18/01/2010 Care Homes for Older People Page 30 of 34 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 This is to ensure that staff are recruited with care and suitable for employment at the home. 7 30 18 The registered person must ensure that all care staff receive training in The management of residents with dementia and challenging behaviour. This is to ensure that staff are fully trained to care for residents. 8 30 18 The registered person must ensure that all care staff receive training in the Adult Protection. This is to ensure that staff are fully trained to care for residents. 31/12/2009 18/01/2010 9 38 37 Significant incidents must be 16/12/2009 reported to CQC. This must include incidents where there has been an injury and the Police are involved. This is to ensure the protection of residents and that CQC is aware of significant incidents. Care Homes for Older People Page 31 of 34 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 10 38 23 The home must consult with the LFEPA regarding the adequacy of their fire evacuation plan. This is to ensure the safety of residents in the event of a fire. 16/12/2009 11 38 23 A minimum of four fire drills 18/01/2010 must be carried out within a twelve month period. One of these drills must be carried out after dark. This is to ensure the safety of residents and staff. 12 38 23 The emergency lighting 18/01/2010 must be tested at least once a month or in accordance with the manufacturers guidance and this must be recorded. This is necessary to ensure that they are in working order. 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 7 Care plans of residents should be signed by residents or their representatives. Care Homes for Older People Page 32 of 34 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 This is to ensure that the plans are appropriate and they agree with the plans prepared. 2 27 Care staff should not work more that two consecutive long day shifts. This is to ensure that residents are well cared forand staff do not become excessively tired. 3 29 A verbal reference can be obtained for a newly recruited staff and this can then be confirmed by a written reference. This is to ensure that staff are carefully recruited. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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