Care Home: Carr Hall Care Home

Similar services:

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

What the care home does well The home was being run by a team of staff who were keen to provide a good service, the residents said, "Everything is run alright"- "I am quite happy here"-"Its okay I don`t want to go elsewhere". A comment from one relative was - "First class place and first class staff. well done to Carr Hall". One staff member made the following comment on what they felt the home did well - "It offers a home from home feeling where residents are cared for and all their needs are catered for, the staff work as a team which in turn reflects on the residents" Good arrangements were in place to manage the home for the wellbeing of the residents. There was a low turnover of staff at Carr Hall, which meant the residents benefited from continuity of care and support,with positive relationships having been developed. People living at Carr Hall were mostly happy with the care and support they received, they were getting attention for their health care needs, they were being treated with dignity and respect. Visitors were being made welcome and daily routines at Carr Hall were flexible. Positive comments were made about the homes catering arrangements, people`s likes and dislikes were known, choices were routinely offered and specific diets could be catered for. To help make sure staff provide good care, arrangements were in place to provide ongoing training and development. The residents expressed an appreciation of the staff team, describing them as, "Very kind" and "Very helpful" The home was warm, clean and fresh smelling, most furnishings and decor were of a good standard, providing a comfortable place for people to live. What has improved since the last inspection? This was the first inspection since the change of ownership. What the care home could do better: Some improvements were needed in finding out about peoples` individual needs and wishes, before they moved into the home and assuring them that their needs can be met. Progress was needed with the residents care plans, to make sure staff know exactly what to do in order to provide people with individual care and attention. To make sure people are properly and safely supported with their medication, some medication practices needed attention. To ensure people receive good quality care, staffing levels should be continually monitored to make sure there are enough staff on duty.To make sure people using the service are properly protected, better recruitment practices were needed. To help provide a safe environment, some matters needed attention to reduce risks to the residents and show any alterations have been approved and checked. To make sure the home is run in the best interests of the residents, Carr Hall needs to introduce better ways of reviewing the service and making plans for improvement. Key inspection report Care homes for older people Name: Address: Carr Hall Care Home 54 Carr Hall Road Barrowford Nelson BB9 6PY     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: Jeffrey Pearson     Date: 1 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 30 Information about the care home Name of care home: Address: Carr Hall Care Home 54 Carr Hall Road Barrowford Nelson BB9 6PY 01282602362 01282611972 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jontell Ltd care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE (maximum number of places: 4). Old age, not falling within any other category Code OP (maximum number of places: 19). The maximum number of service users who can be accommodated is: 23. Date of last inspection Brief description of the care home Carr Hall is a detached residence located in a semi rural area on the outskirts of Barrowford and Nelson. The home has attractive and well maintained gardens which are accessible to the residents. The home is registered to provide personal care and accommodation for 19 older people and four older people with dementia. The accommodation is separated into two areas. The lower floor provides self-contained living space for older people with Care Homes for Older People Page 4 of 30 Over 65 0 19 4 0 Brief description of the care home dementia and includes 2 single bedrooms, a twin room, lounge area, conservatory bathroom and toilets. The upper accommodation has a large lounge with dining areas. There are 15 single and 2 twin rooms, bathrooms and toilets. Some bedrooms at Carr Hall have en-suite facilities. Various aids and adaptations, including hand rails, grab rails and raised toilet seats are provided. Staff are available to provide assistance with personal care and support. At the time of the inspection visit the range of fees was between £360.00 and £426.00 per week. There were extra optional charges for hairdressing, specific newspapers and private chiropody. The home had a Statement Of Purpose and Service User Guide providing information about the care and services available. Copies of this information and the most recent inspection report were available at the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced inspection which included a visit to the service was conducted at Carr Hall on the 14th January 2010. The visit took over 8 hours and was carried out by one inspector. This was the first inspection since the home had changed ownership in April 2009. Prior to the inspection visit, people using the service were invited to complete surveys, to tell the Commission what they think about the support and care provided at the home, 3 were returned to us. We also received completed surveys from 3 relatives and 5 staff. Before the visit the manager was asked to complete and return to us an Annual Quality Assurance Assessment (AQAA). This was to enable the service to show how they were performing and provided details about arrangements, practices and procedures at the Care Homes for Older People Page 6 of 30 home. The files and records of 2 people were examined as part of case tracking, this being a method of focusing upon a representative group of people using the service. We spoke with people living at Carr Hall, relatives, the manager and staff. Various documents, including policies, procedures and records were looked at. Parts of the home were viewed. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Some improvements were needed in finding out about peoples individual needs and wishes, before they moved into the home and assuring them that their needs can be met. Progress was needed with the residents care plans, to make sure staff know exactly what to do in order to provide people with individual care and attention. To make sure people are properly and safely supported with their medication, some medication practices needed attention. To ensure people receive good quality care, staffing levels should be continually monitored to make sure there are enough staff on duty. Care Homes for Older People Page 8 of 30 To make sure people using the service are properly protected, better recruitment practices were needed. To help provide a safe environment, some matters needed attention to reduce risks to the residents and show any alterations have been approved and checked. To make sure the home is run in the best interests of the residents, Carr Hall needs to introduce better ways of reviewing the service and making plans for improvement. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process did not always ensure peoples needs, abilities and preferences were known and planned for before they moved into the home. Evidence: The manager said that the homes guide and statement of purpose had been updated to include the details of the new owners. The homes previous inspection report was seen to be on display in the entrance hallway. There was an indication in the AQAA (Annual Quality Assurance Assessment) that systems were in place to support an effective admission process, for example, mention was made of obtaining information from Social Services and carrying out a pre-admission assessment. The AQAA also indicated that the homes paperwork had been updated to provide a more in-depth assessment. Some residents indicated in surveys they were not aware of their contracts of Care Homes for Older People Page 11 of 30 Evidence: residence, it was therefore suggested this matter be given attention. Prospective residents and their families were being encouraged to visit the home, to see the accommodation available and meet with current residents and staff on duty. One resident explained her family had looked around the home on her behalf. A relative spoken with said they had been impressed when they visited to look around, describing Carr Hall as Homely and comfortable. We looked at assessment information of two people who had recently moved into the home and found assessments had been completed, with information about peoples needs being obtained from Social Services. The manager had assessed peoples personal and social care needs and wishes using a tick box check list. This covered matters such as communication, hearing, sight, basic hygiene, mental ability, social skills, disposition, sexuality, dexterity, mobility and risk of falls. The assessments seen were lacking in detail and did not describe specific needs and care responses, this meant it was not clear all needs were known or properly considered, to make sure they could be met at the home. Also, this lack of detail means peoples care needs may not be effectively communicated to the staff team. Health/medical care needs had not been included in the homes assessment. However, the manager explained she had taken into consideration the information from Social Services, also, further details from the residents and their families and included this in their initial care plans. However, we found some health care needs had not been included in care plans. At the time of this inspection visit, Carr Hall did not provide intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most health and personal care practices helped to ensure peoples needs are sensitively met. Evidence: Two residents completing surveys, said they usually get the care support they need, one indicated they sometimes did. People spoken with during the inspection visit made positive comments about the care and support provided at Carr Hall, they said, I am very well looked after - I am being very well cared for - The staff are very helpful. The relative of one resident spoken with expressed an appreciation of the staff and the care provided at Carr Hall, another indicated in a survey that they didnt think their relative could receive any better care. The care plans seen provided a fair amount of good information and detail and they were sensitively written, night time care care plans were being devised and introduced for each person. However, we found care plans did not always give clear directions for staff to follow to ensure peoples needs were met, in the way the person preferred. We found some needs in relation health care had not always been included. The manager Care Homes for Older People Page 13 of 30 Evidence: and staff spoken with were aware of peoples individual needs, however, having detailed care plans in place ensures all members of staff have the information they need in order to provide person centered care for people living at the home. Systems were in place to review peoples care needs. Residents completing surveys indicated they always or usually get the medical care and attention they need. Records and discussion showed people were getting attention as necessary from health care professionals such as GPs and District Nurses. One visiting health care professional told us they worked closely with the managers and staff at Carr Hall saying, We work together really well, they ask for advice and are very vigilant on pressure area care and continence matters. The manager said they were in the process of changing the specific assessments for health care needs, for example in relation to falls, nutrition, pressure areas and continence. Some had not been completed as staff were yet to be trained in appropriately completing the assessments. The manager was advised all residents should have the basic health care assessments carried out, as specified in the national minimum standards, these then being reviewed and updated accordingly. We noted bed rails were in use on one bed, however, there was no risk assessment or care plan in relation to the use of this equipment. Having a detailed risk assessment and care plan in place helps to ensure that bed rails are used safely. The manager said she would take action to address this matter immediately. Staff responsible for medication administration were currently receiving training which was to include a competence based assessment. Medication administration policies and procedures were available. Medication storage was seen to be clean and secure, a new lockable trolley had been obtained which the manager said had improved practices. There were some discrepancies in medication administration records, one item was being offered when necessary which was at variance to the prescribed instructions, this meant it was not clear if the person had been offered their medication or not, the manager agreed to review this with the resident and their GP. None of the current residents were managing their own medication, however, it was suggested each persons ability and choices about self administering be formally assessed, this would show proper consideration had been given to promoting their rights and independence. The manager said medication practices and systems were being regularly checked, but there were no records being kept to guide this process and show the action taken. Observations of care practices, showed peoples privacy needs were respected, personal care was carried out in the privacy of the persons own bedroom, or Care Homes for Older People Page 14 of 30 Evidence: bathrooms. Staff were seen to provide support and interact with people in a very friendly and courteous manner. One relative commented, The staff here are very compassionate and genuine in their approach. A key worker system was in place, which linked residents to a specific staff member to provide a more personal service. The AQAA (Annual Quality Assurance Assessment) showed Carr Hall supports the Dignity In Care Charter which specifies what people can expect from the service. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Carr Hall had lifestyles which generally matched their expectations and plans were being made to improve social activities. Evidence: People spoken with during the inspection were generally satisfied and content living at Carr Hall, comments made were, Everything is run alright- Its not like home but I feel safe here- Its very nice - I am quite happy here, we do more or less as we please Routines at the home seemed very flexible, it was apparent people could spend time in their bedrooms as and when they wished. People spoken with said they could get up and go to bed whenever they wanted. They are not bothered about routines here and You can please yourself what you do, were comments made. The residents had been enabled to personalise their rooms with their own belongings, such as, photographs, pictures and ornaments which had helped create a sense of home and ownership. Residents spoken with mentioned the contact they had with relatives and friends. Visiting arrangements were outlined in the homes guide, people could visit at any Care Homes for Older People Page 16 of 30 Evidence: time. One relative commented that they liked the flexible visiting times and that they had been able to stay at the home for long periods. Representatives of various religions were making occasional visits to the home and the home had retained links with a local school who visit Carr Hall at harvest time. The residents families had been invited to attend the parties held at Halloween and Christmas. One resident explained that they sometimes go to the park and go on errands with staff. Residents meetings were being held approximately every month, staff spoken with said they try to get everyone involved, records showed the Christmas celebrations and meal requests had been discussed at the last meeting. It was suggested meetings could also be used for keeping people informed of forthcoming events, also the more general day to day matters which affect them. Arrangements were in place to provide, group and individual activities, including local and national newspapers, talking books, hand massage, visiting pets, manicures and occasional visiting entertainers. The manager said a small group of residents play games each evening. Some people were being encouraged to help out around the home with folding linen, dusting and helping with setting tables. However, social and spiritual care, also family relationships needed to be properly included in the care planning process to promote a more effective response to peoples individual needs and preferences. Some people completing surveys indicated they considered activities at the home needing some improvement, one relative commented that there was nothing for the residents to do. The AQAA (Annual Quality Assurance Assessment) showed consideration was being given to an activity coordinator at the home, the manager explained that the carers did not always have time to arrange activities, but this matter was in hand. People spoken with indicated they liked the meals at Carr Hall, they said, The food is good - They feed us very well, we get a choice of two meals at dinner and at teatime, its all eating and drinking! - They ask what choice we would every day, the food is fine The cook spoken with was aware of peoples specific, likes and dislikes, specific diets could be catered for. Breakfast was offered flexibly, in response to individual preferences. The four week menus showed a variety of meals were being offered, the cook said fresh produce was being used and home baked cakes, bread and biscuits made. Promoting further choices and independence at mealtimes, was discussed with the cook. The days menu was displayed in the dining area, it was suggested further details be noted to further encourage choices and discussion. At the time of the inspection there was not always cook on duty at teatimes, with managers Care Homes for Older People Page 17 of 30 Evidence: having additional responsibilities for some cooking and meal preparation, managers were also working extra hours to cook at weekends, however, the manager said another cook was being recruited. The dining areas and conservatory provided pleasant places for people to eat and socialise. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most polices, procedures and practices supported the complaints process and provided safeguards for people living at Carr Hall. Evidence: Most people completing surveys indicated an awareness of the homes complaints procedures. They commented, I have not had any great need to complain about anything- No complaints - If I have any complaints, I go to the management. People spoken with also expressed an understanding of how they could raise concerns, one said, I would go to the office if I was not happy about anything, they would sort it out. The complaints procedure was displayed in the homes hallway, the manager said it was also included in the homes guide and in peoples individual terms and conditions of residence. The procedure explained how to raise concerns and included a telephone number of the new owners, also contact details of Social Services and the Commission. It was advised CQC National Headquarters details be included, the manager agreed to add this information. All staff completing surveys said they knew what to do if someone had concerns about the home. There had not been any formal complaints at Carr Hall in the last 12 months. The AQAA (Annual Quality Assurance Assessment) told us all staff had received Protection Of Vulnerable Adults training, also dealing with challenging behaviour Care Homes for Older People Page 19 of 30 Evidence: training. The manager had also devised an informative in house training pack on safeguarding and protection, which included a questionnaire for staff to complete in order to verify their understanding. The AQAA showed the homes safeguarding adults and prevention of abuse policies had been reviewed and updated in June 2009. The staff reporting bad practice policy provided some good information, however, the contact details of the Commission and Social Services were not included, the manager agreed to rectify this matter. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation at Carr Hall provided people with a clean and comfortable place to live. Evidence: People spoken with were generally happy with the accommodation provided at Carr Hall, they said their bedrooms were Okay. The new owners had made several improvements at the home, the lounge in the area for people with dementia had been extend to provide more space, some bedrooms had been refurbished and en-suite toilets had been provided. One bathroom had been upgraded to provide better facilities and a wheelchair storage area had been created. The new fixtures and fittings and decorations were seen to be of a good standard. Although it was apparent the Fire Authority had been consulted about the improvements at the home, there was no evidence available to indicate the alterations had been carried out in accordance with the local authority requirements, or that any new electrical installations had been inspected as safe. The manager agreed to pursue these matters with the owners. The laundry facilities had been improved and new equipment provided, new floor covering hand been fitted and there was a hand wash basin provided with liquid soap Care Homes for Older People Page 21 of 30 Evidence: dispenser. The manager explained that an appropriate lock was soon to be fitted to the laundry door, to promote the residents health and safety. Action had been taken to minimize the risk of access into the boiler room. However, this door also needed a more suitable lock fitting, the manager said this matter was being addressed and risk assessments had been carried out in relation to the current residents accommodated. Residents completing surveys said the home was usually, or always fresh and clean. Hand sanitizers were available around the home for visitors and staff. The home was found to be clean an free from unpleasant odours. There were suitable arrangements in place for cleaning the home and general maintenance. Infection control polices were available and all staff had received training in the prevention and control of infection. Several positive comments were received from staff and relatives about the improvements being made at the home. The AQAA (Annual Quality Assurance Assessment) provided a clear indication that improvements at the home were to continue, including a proposal for an extension with improved facilities and further ensuite bedrooms. This could result in the home needing to apply for a variation in their conditions of registration. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most staffing arrangements ensured people received effective care and support. Recruitment practices needed attention for the protection of people using the service. Evidence: The residents spoken with expressed an appreciation of the staff team at Carr Hall, they said, The staff are very kind - They come when I ring for them they dont take long to answer - They are all nice really, we get on fine. A comment from a relative was - These people deserve recognition for the work they do. First class place and first class staff. One staff member wrote in a survey - The staff work as a team which in turn reflects on the residents Staffing levels seemed to be mainly good, records and discussion showed there were usually three care staff and a manager on duty throughout the day, with one carer being based in the dementia unit, two staff were on duty each night, with a manager being on call on the premises. Two residents completing surveys said their were usually enough staff available, one said there sometimes were. Most staff completing surveys considered there were always enough staff on duty to meet peoples individual needs. The manager said additional staff could be brought in to work when required, in response to the residents changing needs. Staffing levels were discussed with the manager, in particular that currently staff dont have time for activities and managers were covering in the kitchen, it was advised staffing levels be continually monitored, Care Homes for Older People Page 23 of 30 Evidence: reviewed and adjusted accordingly. Records and discussion showed there is a low turnover of staff at Carr Hall. The AQAA (Annual Quality Assurance Assessment) showed that residents were being involved with the staff selection process. The staff recruitment records seen indicated that most of the required checks had been carried out. However, applicants had not been requested to provide statements on their physical and mental health, also dates of previous employment had not always been recorded and checked. Applicants had not been asked for details and evidence of registration with, or membership of any professional organisation. It was also advised, further consideration be given to the suitability of the information requested in references. It is important to thoroughly check all new staff prior to employment, to ensure they are suitable to work with vulnerable people. New staff had been given initial training, records showed an induction programme was been completed which included a comprehensive range of training topics. Most staff completing surveys considered their induction training had covered everything well. It was noted, one induction programme had not been fully completed, it had been signed off by supervisor but not by the employee, which meant it was not clear that the carer had received and understood the training. The manager agreed to rectify this matter. Staff training and development was on going at Carr Hall. All the the carers had NVQ (National Vocational Qualifications) level 2, some staff had progressed to NVQ level 3. The manager explained that training and development was ongoing. Various courses and updates were being arranged and planned for, including safe working practices such as moving and handling and health and safety. The manager had produced training handouts for staff on safeguarding, communication and confidentiality. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most management and administration practices were effective in ensuring the home is run for the benefit of people using the service. Evidence: Carr Hall had a change of ownership in April 2009, since then improvements have been made to the home (See Environment). The manager said good working relationships had been established with the new owners who were making regular visits to the home. Reports were available showing the owners had carried out some unannounced monitoring visits at the home. We received several positive comments from staff about the changes at Carr Hall, they said - The new owners are making it a much better environment and doing up various parts of the home - The new owners listen more and appreciate staff more which is good for staff morale - They are hands on asking staff opinions, suggestions etc, their much more involved with the staff which boosts their morale, they show their appreciation The manager has been registered with the Commission since 2007, having previously Care Homes for Older People Page 25 of 30 Evidence: been deputy manager at Carr Hall for eleven years. She has relevant recognised qualifications in care and management and was updating her skills by attending relevant training courses. There is a defined management team structure at Carr Hall, which ensures there is always an experienced person on duty to lead each shift. The manager said quality assurance surveys were due to be sent out to people using the service and others. The last responses had all been positive, a news letter had been produced to convey the outcomes. The manager said any issues arising in surveys would be appropriately dealt with. The AQAA (Annual Quality Assurance Assessment) completed by the manager, included some relevant information, but did not provide a very comprehensive evaluation of the service. It was lacking in detail and some sections, such as, what the home could do better and plans for improvement in the next 12 months had not all been completed. We were therefore unable to fully rely upon the content of this document as a credible source of evaluation and development planning at the home. As previously indicated, training in safe working practices was ongoing or being arranged. Information in the AQQA showed the servicing and checking of equipment and installations. Health and safety and fire safety risk assessments had been carried out. It was noted the gate on the stairs leading down to the downstairs accommodation was on occasion left open, the manager agreed to address this matter. Some matters which could compromise peoples health and safety have previously been highlighted within this report (See Environment) Care Homes for Older People Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 All relevant recruitment 19/02/2010 documentation must be collated in line with legal requirements. This is to show that staff are fully checked, to protect people using the service, before the commence work in the home. 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 3 A way of more effectively assessing and recording peoples needs, abilities and preferences should be introduced, this will ensure all needs are identified, known and planned for before they move into the home. Care plans should be sufficient in detail to provide clear instructions to staff, of the actions to be taken to meet the residents, personal, health and social care needs. This will ensure that members of staff know what they need to do in order to meet the needs of each person. To ensure medication is appropriately and safely managed for the well being of the residents, action should be taken Page 28 of 30 2 7 3 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations to ensure the auditing system effectively identifies and resolves inappropriate practices. 4 19 Action should be taken to ensure and show, that any changes in the accommodation comply with the requirements of all the relevant agencies. The AQAA should be sufficient in detail to provide a clear indications of the current systems and practices at the home. It should be reflective of the outcomes of consultation surveys and quality monitoring audits. The AQAA should clearly identify aspects of the service which could be better and any subsequent plans for improvement. 5 33 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!