Care Home: Carrick Lodge

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What the care home does well People who use the service and their relatives were positive about the care and support provided by the staff and said the staff was flexible and responsive to their needs. Some comments include `staff are helpful`, `staff are excellent` and `staff look after dads needs excellently`. People who use the service also stated they were always treated with dignity and respect. Good arrangements are in place to meet individuals health needs and people who use the service were confident that medical services are promptly accessed when required. The district nurse said that the registered and deputy manager was prompt at identifying any health issues referring them to her and would follow any advice that she gave to ensure that health needs were met. Flexible visiting arrangements are in place. People who use the service are positive about the varied and nutritional menu that reflects their preferences and choices. Some saying the `food is good`, `excellent` and `the portions are big`. The kitchen is suitably equipped and good standards of cleanliness are maintained. Relatives of and people who use the service said in the main they felt there was enough to do in the home and that it was their choice if they joined in the activities or not. An activities coordinator undertakes individual and group activities which were observed during the inspection. People who use the service and their relatives said that if they had any concerns they felt able to discuss them with their family, or with any member of staff and in particular the registered manager or deputy manager. They felt confident that the registered provider and manager would listen to them and act upon any issues raised. The environment is homely, clean and comfortable and the people who use the service said they were satisfied with the accommodation provided. People who use the service and their relatives said they were satisfied with the care provided and that staff are `marvelous`, `nothing is too much trouble for them`, `staff are kind supportive and helpful`. It is clear that positive and trusting relationships have been established between the staff and people who use the service. The home is maintained to a good standard ensuring that all health and safety and fire checks are carried out as per legislation. What has improved since the last inspection? The registered provider has complied with all the previous requirements identified at the last inspection. These are as follows: the registered provider has reviewed the homes safeguarding procedure so that staff are now more aware of how to refer any cases of suspected abuse to the relevant agencies. The registered provider has made tremendous changes to the homes environment for example redecorated communal areas such as bedroom corridors, bathrooms, staff room and the reception area. Also redecorated individual bedrooms, new carpets fitted, stair lights are now on automatic sensors, automatic closing devices have been fitted to fire doors and call bells are connected in all rooms seen. The registered provider stated that there is a ongoing maintenance program to ensure that the home is kept decorated and furnished to a high standard and in a good state of repair. Repairs to the impermeable flooring were present in the laundry area and are satisfactory. Staff have had greater access to training so that all mandatory training has been provided. The majority of staff have attended all mandatory training courses such as infection control, food hygiene, fire training, manual handling, first aid, medication and No Secrets training. This means that there is always a first aid member of staff on duty. The registered manager stated that she is aiming to cascade dementia training to her staff team. The management team are in the midst of their quality assurance process and have agreed to send the findings and any actions to address issues identified to the Commission. The home does now check the hot water temperatures for bathing. They have ensured that relevant health and safety checks for examples to the electrics have been gained and have reviewed their health and safety risk assessments. In respect of the recommendations identified at the previous inspection, the management team have with the catering team and with people who use the service reviewed the menus which are now displayed. From discussion with people who use the service they commented that the quantity and quality of food was `good`. They did not feel any further improvements to this were needed. The complaints policy has been reviewed and is satisfactory. The management team informed us on the day of inspection they have reviewed the staffing levels and told us that starting the next day they will be increasing the staffing level to four carers a day. This is due to peoples dependency needs increasing and will also allow staff to spend more individual time with residents. What the care home could do better: It has been noted that there have been marked improvements to the service that Carrick provides which has resulted in no statutory requirements being identified at this inspection. Some recommendations to improve practice further have been identified as follows. It should be evidenced more clearly that pre admission assessments state who was present during this process so that all views of those involved in the admission are aware of what the home can offer the prospective resident. In addition a similar process should occur in the care plan reviews so that the views of those involved and the decisions made are recorded. We discussed with the registered provider and registered manager the need to be more specific in directing staff in the management of some health care needs in the persons care plan i.e. the management of pressure sore care and dietary needs which they agreed to address. The home has suitable storage facilities for Controlled Drugs. However staff wage slips and cash was stored in the controlled drug cabinet and this is not in line with legislation. These items were removed immediately. It is recommended that one of the catering staff undertake the intermediate food hygiene course to increase their skill and knowledge base in this area. In addition the presentations of soft meals should be improved so that they appear more appertising to people. The registered provider stated he has consulted with health and safety executive regarding the fitting of window restrictors and was advised as to which windows needed them. We recommended that he undertakes a risk assessment on windows where no restrictors are placed i.e. landing windows. In addition the hot water in peoples hand basins was very hot (in one room it exceeded 50 degrees centigrade) and again we recommended that a risk assessment regarding the hot water must be undertaken. We observed that the fire doors had a stopping device so that the doors could not be opened easily. These were immediately removed as the registered provider acknowledged that fire doors must be accessible to all persons at all times in case of fire. Due to their immediate action no requirement was made at this time. A policy and procedure in the management of people who use the service monies should be implemented to ensure protection form abuse. Recording a minimum of six formal supervision sessions of staff should occur so that there is a record of staff accountability and that issues such as care practice or training needs are identified and addressed accordingly. The findings of the quality assurance process should be forwarded to the Commission. The inspectors would like to thank people who use the service, relatives, staff and the management team for their kind assistance and cooperation during this inspection process. Key inspection report Care homes for older people Name: Address: Carrick Lodge Belyars Lane St Ives Cornwall TR26 2BZ     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: Lynda Kirtland     Date: 1 0 1 2 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 31 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 31 Information about the care home Name of care home: Address: Carrick Lodge Belyars Lane St Ives Cornwall TR26 2BZ 01736794353 01736798621 carricklodge@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Ronald James Cottam care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 38. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Olda age, not falling within any other category (Code OP) - maximum 20 places Dementia (Code DE) - maximum 18 places Mental disorder, excluding learning disability or dementia aged 65 years and over (Code MD(E)) - maximum 18 places Date of last inspection Brief description of the care home Carrick Lodge provides care and accommodation for up to 38 older people of which 18 of whom may be diagnosed with dementia and or mental disorder. The registered provider is Mr R Cottam and the registered manager is Lizabeth Rutherford Ainley. Care Homes for Older People Page 4 of 31 Over 65 0 18 20 18 0 0 3 1 0 3 2 0 0 9 Brief description of the care home Carrick Lodge is situated near the centre of St. Ives and is in an elevated setting with views of the bay. The house is a large three floor property with a two storey extension. There are two communal seating areas, a conservatory, the dining room, kitchen area, laundry and two offices. Two lifts and a stair lift are provided to assist access to the upper floors. A fenced garden is situated at the front of the home. At the time of the last inspection fees range from £300 to £400 per week. We have not received updated information for this inspection report. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the homes management or the Care Quality Commission website. Care Homes for Older People Page 5 of 31 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: Two inspectors undertook an unannounced key inspection at the home on 10 December 2009 that lasted for eight hours. Information about the home received by the Care Quality Commission since the previous inspection was taken into account when planning the inspection. The purpose of the inspection was to ensure that the care needs of people who use the service are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved interviews with people who use the service, observation of their daily life and care provided. Interviews with relatives/representatives also occurred. There was an inspection of the homes premises and of written documents concerning the care and protection of the residents and the ongoing management of the home. We talked to staff who were on duty and at times during the day were able to observe their care practices. We also spent time in discussion with the registered provider and registered manager. Care Homes for Older People Page 6 of 31 The principle method used was case tracking. This involves examining the care notes and documents for a select number of people who use the service and following this through including talking to them and the staff working with them. This provides a useful, in-depth insight as to how their needs are being met in the home. At this inspection, five people who use the service were case tracked. In talking with some of the people who use the service they said that they were happy staff were kind and would do anything for you and said that the food is good. In discussion with relatives they were satisfied with the care that their relative received and the caliber of the staff team. The Care Quality Commission received the Annual Quality Assurance Assessment, which is a questionnaire that the registered provider completed. This was completed satisfactorily. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The registered provider has complied with all the previous requirements identified at the last inspection. These are as follows: the registered provider has reviewed the homes safeguarding procedure so that staff are now more aware of how to refer any cases of suspected abuse to the relevant agencies. The registered provider has made tremendous changes to the homes environment for example redecorated communal areas such as bedroom corridors, bathrooms, staff room and the reception area. Also redecorated individual bedrooms, new carpets fitted, stair lights are now on automatic sensors, automatic closing devices have been fitted to fire doors and call bells are connected in all rooms seen. The registered provider Care Homes for Older People Page 8 of 31 stated that there is a ongoing maintenance program to ensure that the home is kept decorated and furnished to a high standard and in a good state of repair. Repairs to the impermeable flooring were present in the laundry area and are satisfactory. Staff have had greater access to training so that all mandatory training has been provided. The majority of staff have attended all mandatory training courses such as infection control, food hygiene, fire training, manual handling, first aid, medication and No Secrets training. This means that there is always a first aid member of staff on duty. The registered manager stated that she is aiming to cascade dementia training to her staff team. The management team are in the midst of their quality assurance process and have agreed to send the findings and any actions to address issues identified to the Commission. The home does now check the hot water temperatures for bathing. They have ensured that relevant health and safety checks for examples to the electrics have been gained and have reviewed their health and safety risk assessments. In respect of the recommendations identified at the previous inspection, the management team have with the catering team and with people who use the service reviewed the menus which are now displayed. From discussion with people who use the service they commented that the quantity and quality of food was good. They did not feel any further improvements to this were needed. The complaints policy has been reviewed and is satisfactory. The management team informed us on the day of inspection they have reviewed the staffing levels and told us that starting the next day they will be increasing the staffing level to four carers a day. This is due to peoples dependency needs increasing and will also allow staff to spend more individual time with residents. What they could do better: It has been noted that there have been marked improvements to the service that Carrick provides which has resulted in no statutory requirements being identified at this inspection. Some recommendations to improve practice further have been identified as follows. It should be evidenced more clearly that pre admission assessments state who was present during this process so that all views of those involved in the admission are aware of what the home can offer the prospective resident. In addition a similar process should occur in the care plan reviews so that the views of those involved and the decisions made are recorded. We discussed with the registered provider and registered manager the need to be more specific in directing staff in the management of some health care needs in the persons care plan i.e. the management of pressure sore care and dietary needs which they agreed to address. The home has suitable storage facilities for Controlled Drugs. However staff wage slips and cash was stored in the controlled drug cabinet and this is not in line with legislation. These items were removed immediately. It is recommended that one of the catering staff undertake the intermediate food Care Homes for Older People Page 9 of 31 hygiene course to increase their skill and knowledge base in this area. In addition the presentations of soft meals should be improved so that they appear more appertising to people. The registered provider stated he has consulted with health and safety executive regarding the fitting of window restrictors and was advised as to which windows needed them. We recommended that he undertakes a risk assessment on windows where no restrictors are placed i.e. landing windows. In addition the hot water in peoples hand basins was very hot (in one room it exceeded 50 degrees centigrade) and again we recommended that a risk assessment regarding the hot water must be undertaken. We observed that the fire doors had a stopping device so that the doors could not be opened easily. These were immediately removed as the registered provider acknowledged that fire doors must be accessible to all persons at all times in case of fire. Due to their immediate action no requirement was made at this time. A policy and procedure in the management of people who use the service monies should be implemented to ensure protection form abuse. Recording a minimum of six formal supervision sessions of staff should occur so that there is a record of staff accountability and that issues such as care practice or training needs are identified and addressed accordingly. The findings of the quality assurance process should be forwarded to the Commission. The inspectors would like to thank people who use the service, relatives, staff and the management team for their kind assistance and cooperation during this inspection process. 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 10 of 31 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 11 of 31 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. The needs of prospective residents are assessed so that they can be assured that the home can provide adequate care. Evidence: Carrick has a Statement of Purpose and Service Users Guide which explains the services that Carrick provides to its residents. These documents are satisfactory but need updating to reflect the current management arrangements, which the registered manager agreed to do. On the day of inspection 31 people were living at Carrick. The registered provider stated that they encourage the prospective resident and their family to visit the home so that they can make an informed choice as to if the home is suitable for them. Documentation evidenced an assessment had occurred taking into account prospective residents physical, emotional, social and diverse needs. The homes assessment does not make clear who was present at the assessment. This would provide evidence that Care Homes for Older People Page 12 of 31 Evidence: the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. People who use the service however, feel that the home involved them in their care arrangements. Assessments from sponsoring authorities were present on the file and the care needs identified were included in the pre admission assessment process. Copies of a contract of care/ statement of terms and conditions of residency were contained in the files for people using the service. These are satisfactory. Care Homes for Older People Page 13 of 31 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. Written care plans direct and inform staff about peoples health and personal care needs so that these can be consistently met. The health care needs of people are monitored and addressed so that their needs are met. People who use the service stated they are treated respectfully at all times so that they retain their dignity and enjoy a good quality of life in the home Evidence: Each person who uses the service has a care plan that covers the individuals physical, emotional, and diverse care needs. The care plans in the main guide and inform staff in specifying what caring interventions are needed, this then allows consistent care to be provided. The night time care plan provided specific direction for staff so that the individuals wishes in how they their receive care can then be put into practice. We discussed with the registered provider and registered manager the need to be more specific in directing staff in the management of some health care needs i.e. the management of pressure sore care and dietary needs for a person who has diabetes. We also recommended that when an assessment or review has taken place that the Care Homes for Older People Page 14 of 31 Evidence: assessor signs and dates the document so that staff are aware who has undertaken the assessment and that this is the current document to work too. There was confusion as old care plans were also present on files, the registered manager agreed to archive these immediately. The registered provider stated that they review the care plans every three months, unless a concern arises in the meantime and then this is reviewed immediately. Relatives stated that they were aware of the care that their relative received and that if care needs changed this would be discussed with the registered manager or staff and would be addressed. It was noted that in some cases when a review occurred the person using the service, their relative or relevant professional was present. However no details of the discussion or the outcome of the review was recorded. People who use the service, and their relatives who we spoke to, said they were happy with the care provided. They said care was delivered according to their wishes and needs. All people living in the home looked clean, well dressed and well cared for. People who use the service spoke positively regarding the attitude of staff. Risk assessments in respect of mobility are completed when an issue of mobility has arisen and identify what equipment if any, is needed to assist in the moving of an individual. From discussion with people who use the service and their relatives it is clear that positive relationships are established with staff and that individuals who use the service feel that they are treated with dignity and respect at all times. Some comments from individuals who use the service describe staff as very kind, marvelous and I get spoilt here. Health care support appears to be to a good standard. People who use the service said they could see a doctor or other medical practitioner when this is necessary. People who use the service are registered with local GP practices. They felt that their health care needs were monitored and attention obtained promptly when needed. In discussion with the district nurse who was visiting the home, she confirmed this and said that the registered manager and deputy manager consulted them appropriately, and how they then followed through medical treatment with the individual to a good standard. The medication policy inspected is satisfactory and appears to contain appropriate information. The medication system was inspected. Records regarding the operation of the system are to a good standard. A medication round was observed and staff were competent in administering medication and its recording. Staff responsible for administering medication has been suitably trained and clear records are maintained. Care Homes for Older People Page 15 of 31 Evidence: The home has suitable storage facilities for Controlled Drugs. Records for the storage, administration and disposal of all medication was satisfactory. However staff wage slips and £40 in cash was stored in the controlled drug cabinet and this is not in line with legislation. These items were removed the registered manager and deputy manager have received formal training from Edward Haines PCT in the area of peg feeds which has been cascaded to staff. People who use the service and their relatives made positive comments on the skills and caring qualities of staff. People who use the service felt well cared for and reported that staff delivered care sensitively, respected their privacy and dignity and listened to their concerns. People who use the service said that staff were lovely and kind. Examples of staff providing skilled and sensitive care were observed during the inspection. People who use the service and relatives found it difficult to identify any area where the home could improve. Care Homes for Older People Page 16 of 31 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 who use the service are supported in a lifestyle which, accords as far as possible with their own expectations and preferences. A range of activities takes place that meets peoples social, religious and recreational interests. The diet provided is varied and nutritious with attention to individual preferences. Evidence: People who use the service felt that they had control over their daily lives and said they were supported to make choices about their routines and activities. They felt that there was enough to do. Some individual care plans detail their social and activity interests this should be recorded in all care plans. The home provides a range of planned activities. This includes outings music crafts singing and painting. People who use the service were observed during the inspection to join in planned group activities read the paper have visitors and generally socialising. In the completed AQAA by the registered manager states that she aims to have a minimum of two outings for the residents a year e.g. Christmas lights and summer garden visit. An activities organiser was present and was observed to socialise with the people who use the service in both a group and individual bases. Singing ball games and making Christmas decorations were occurring plus a PAT dog visited. Residents also help run Care Homes for Older People Page 17 of 31 Evidence: the in house shop which sells sweets and other small items. The activities coordinator told us she is a qualified masseur and undertakes nail and hand care. The activities coordinator maintains records of what activity an individual has participated in. People who use the service have said they could make choices for example where to spend their time in the home what they could wear etc. People can look after their own money. It was evident people who use the service could bring their own furniture and belongings into the home. For example bedrooms are individualised with peoples personal belongings such as photographs and ornaments. Relatives and friends can visit people who use the service when they wish. People who use the service were complimentary about the quality and quantity of food provided, comments such as excellent, good, very tasty and big portions were given. Some were aware of the meal to be provided for that day and menus are being developed. Each persons preferences and choices of food are recorded. Breakfast can be taken in the dining area or in the residents room and people were very happy with the choices available. A mealtime was observed to be a relaxed and unrushed occasion with staff providing sensitive support in a pleasant manner. Staff knew residents likes and dislikes. Hot and cold drinks are served between meals. Kitchen staff are aware of individual dietary requirements and caters for this. Kitchen staff have relevant qualifications in food hygiene but it is recommended that one of the catering staff undertake the intermediate food hygiene course. Kitchen staff are available daily and therefore undertakes the preparation of the main meal and tea in the home. Kitchen staff demonstrated an awareness of a persons likes dislikes of food and any special dietary requirements. It is recommended that with soft foods that the presentations of these meals are improved. The environmental health inspection occurred March 2007 and all work recommended has been addressed. The carers serve breakfast; the cook asks the people who use the service if they are happy with the lunch for the day and will provide an alternative if asked and asks for their preferences for tea i.e. either sandwiches or a hot alternative. The cook has menu planning records and completes the Safer Food Better Business guidance. Care Homes for Older People Page 18 of 31 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 registered provider has a suitable complaints and adult safeguarding procedure to ensure that people who use the service are protected from poor and abusive practice. Evidence: Information regarding what people can do if they have a concern or complaint is in the service user guide. There are also notices in the communal part of the home stating how people can make a complaint. The registered provider has received one complaint since the previous inspection which he is in the process of investigating. People who use the service and their relatives said that if they had any concerns they would be able to raise these with the registered provider or staff. They stated that they believed that any concerns raised would be listened too and acted on. The registered provider has reviewed the Safeguarding policy and procedure in line with the requirement identified at the last inspection. This is now satisfactory. Staff were aware of how to raise concerns or safeguarding issues and stated they felt confident to raise any issues with the registered manager. Staff have attended formal safeguarding training. The registered provider stated all staff have seen the safeguarding video. The registered provider said no allegations of abuse had been made. No ex- staff had been referred to the Protection of Vulnerable Register list - A list of people who are Care Homes for Older People Page 19 of 31 Evidence: considered unsuitable to work with the vulnerable. All staff currently employed have received a POVA First check and or a full CRB POVA check (Criminal Records Bureau/ Protection of Vulnerable Adults check which help to check the person is deemed as suitable to work with vulnerable adults). Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is accessible, well maintained and safe. A homely, clean and comfortable environment is provided that is maintained to the required standard. Evidence: The building was inspected. The building was warm, clean and hygienic on the day of the inspection. Decorations, fixtures and fittings are generally in good condition. Facilities consist of two lounges and a conservatory, all of which were being used by people who use the service throughout the day. A kitchen and dining room are situated at the rear of the home. Toilet and bathroom facilities are suitable in size and there is now a walk in shower on the ground floor. There is an assisted bath on each floor. The bathrooms have been redecorated to a good standard. The home was clean throughout. Bedrooms are individualised and comfortable and are of a satisfactory size. Some bedrooms have recently been redecorated to a high standard. People are able to bring their own furnishings and belongings with them when they move in to the home. Some rooms do have locks on them, the registered provider said that if a person requests a lock this will be fitted dependent on the persons risk assessment. A shaft lift is provided to assist people to go upstairs. Care Homes for Older People Page 21 of 31 Evidence: Further improvements were observed as follows: redecorated communal areas such as bedroom corridors, bathrooms, staff room and the reception area. Also redecorated individual bedrooms, new carpets fitted, stair lights are now on automatic sensors, automatic closing devices have been fitted to fire doors and call bells are connected in all rooms seen. The registered provider stated he has consulted with health and safety executive regarding the fitting of window restrictors and was advised as to which windows needed them. We recommended that he undertakes a risk assessment on windows where no restrictors are placed i.e. landing windows. In addition the hot water in peoples hand basins was very hot (in one room it exceeded 50 degrees centigrade) and again we recommended that a risk assessment regarding the hot water must be undertaken. We observed that the fire doors had a stopping device so that the doors could not be opened easily. The registered provider and registered manager said staff knew how to open the doors. However they immediately removed the stopping device at our request as we stated that fire doors must be accessible to all persons at all times in case of fire. Suitable kitchen and laundry facilities are provided. Domestic staff are employed, and felt that they had sufficient support and training to assist them in their work. They demonstrated knowledge in the areas of infection control and COSHH. The home was clean and hygienic at the time of inspection. Repairs to the impermeable flooring were present in the laundry area and are satisfactory. Care Homes for Older People Page 22 of 31 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. Staff are qualified and competent to work with the residents. They are recruited on the basis of fair, safe and effective recruitment and selection policies and practices. They have good access to ongoing training to maintain their knowledge and skill Evidence: From discussion with people who use the service relatives and staff it was noted that all felt that there were sufficient staff on duty at all times. People who use the service commented that staff respond quickly when they ask for assistance, and some acknowledged that at times there is a little wait but that is because staff are dealing with someone else. No one found this to be an issue. On the day of inspection four care staff were on duty from 8am to 12pm, three care staff from 12pm to 2pm, 3 care staff from 2pm to 8pm and then two waking night staff. The registered manager is on call. In addition domestic and catering staff plus an activities coordinator were present. The rotas confirmed this level of staffing. In discussion with the registered provider and registered manager they have reviewed the staffing levels and told us that starting the next day they will be increasing the staffing level to four carers a day. This is due to the home recently admitting two respite placements and have noted that as care needs have increased the staffing levels need also to increase. The registered provider stated this will also allow staff to spend more individual time with residents. This level of staffing appears to be Care Homes for Older People Page 23 of 31 Evidence: satisfactory to meet the current care needs, as outlined in the individuals care plans for the people who are currently using the service. People who use the service and the relatives were very positive about the staff and it is clear that positive and trusting relationships have been established. People who use the service said they felt in control of the care and support provided which they viewed as sensitive, positive, reliable and flexible. Five staff files were inspected. The registered manager acknowledged that she is behind on introducing the skills for care training with staff but is addressing this. Seven staff have achieved a minimum of the NVQ level 2, with other staff either in the process of or enrolled on the course. Therefore they meet the national minimum standard of 50 of staff having a minimum of NVQ level 2 This enabled staff to gain more knowledge in their role and ensure they are sufficiently qualified to undertake their work. Residents and relatives can then too be confident of the competency of the people looking after them. Of the files inspected, staff have completed training in first aid, medication, safeguarding, infection control, fire, basic food awareness and manual handling courses. It was encouraging to see that staff have recently attended training. It is recommended that the registered provider complete a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. In the AQAA the registered manager stated that she aims to commence in house dementia training with staff team. From inspecting staff recruitment files it was evident that relevant recruitment checks are undertaken prior to a person commencing work and that no one starts work at the home until they have received their CRB clearance. Interview notes need to be kept as currently this does not occur. Staff at the home said they were well supported and were clear about their roles and responsibilities. It is clear the staff group are committed to helping people maintain their independence as far as possible. Staff said they enjoyed working at the home. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an experienced and qualified management team who have a sound understanding of their responsibilities and managed for the benefit of the residents. Records are maintained and handled appropriately Evidence: The registered provider Mr Cottam employs a registered manager. She has the registered manager award and Leadership and management award in care. The deputy manager is in process of completing her NVQ level 4. Senior staff have either achieved or completed their NVQ level 3. In talking with people who use the service and staff, the management team are viewed positively by staff and people who use the service. Some comments from people who use the service and relatives include very supportive, good listeners and will do anything to help. This inspection has identified that the management team have complied with all the requirements identified at the previous inspection. A quality assurance summary was completed in December 2008 and therefore this Care Homes for Older People Page 25 of 31 Evidence: process is now due to be undertaken again. We recommended that following this process the findings are sent to the Commission for consideration. In addition it is recommended that an action plan from the findings of the quality assurance in how they aim to meet the suggestions identified is made. It was explained by the administrator accountant that the only monies received is from relatives who ask for small amounts of money to be kept safe for their individual family member i.e. to pay for hairdressing etc. However it was noted that some monies kept are substantial. There is a record of money received and transactions made in a book but there are no receipts to back up the entries in the book. Therefore there is not a clear audit trail of moneys the home receives or spends on behalf of individual residents. In addition there is no policy. To protect the registered provider or staff from possible allegations of receiving depositing spending monies on peoples behalf a robust record of all transactions must be kept. The registered provider agreed to address this immediately therefore a statutory requirement has not identified at this time. A range of measures has been put in place to promote safe working practices and the equipment and services to the care home are regularly maintained and serviced. The risk assessment and risk management arrangements for individual people are satisfactory. The registered persons are aware of the need to notify the Commission under Regulation 37 of incidents that occur in the home. The providers have established a policy and procedure for fire detection and prevention. This has been reviewed by the fire authority who were satisfied with the documentation, which also evidence that equipment is regularly serviced and monitored. The staff at the home are appropriately trained and a regular program of refresher training is in place. The registered manager acknowledged that formal supervision has not been occurring a minimum of 6 times a year, or recorded. This must occur so that there is a record of staff accountability and issues such as care practice or training needs are identified and addressed accordingly. Staff confirmed that they meet with the registered provider and that he is available to meet with them when they need to discuss issues as they arise. But they confirmed this is not officially recorded and hence a recommendation to this effect has been identified at this time. Likewise staff annual appraisals need to be recorded. Records reviewed at this inspection indicate that they are appropriately maintained and held, to ensure the welfare and safety of people who use the service. There are Care Homes for Older People Page 26 of 31 Evidence: suitable storage facilities and records are kept in ways that protect their confidentiality. In addition we observed that the daily logs do not reflect the actual care that we saw on the day of inspection, staff were observed to spend time talking with residents, offering positive patient care and this is not recorded and therefore staff are not evidencing the positive care that they are providing to its residents. The registered provider has a health and safety policy. An accident book is maintained. Records of accidents were kept in peoples individual files and cross referenced with daily logs. In respect of health and safety from records inspected it was evident that regular fire, gas, electric, Pat, equipment checks are carried out on a regular bases. It is recommended that with the new heating system boiler that a check on water temperatures is undertaken in the wash basins as the water was very hot on the day of inspection -unable to keep hands under water as too hot (refer to environment section). It was noted that bath water temperatures are taken. Care Homes for Older People Page 27 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 The pre admission assessment should evidence who was present during this process so that all parties are in agreement that the home is able to meet the persons assessed needs. A persons care plan needs expanding to inform direct and guide staff so that they are aware of how to provide consistent care at all times, especially in the management of health issues. The controlled drugs cabinet should be used solely for the purpose of storage of controlled drugs at all times. The presentation of soft foods should be reviewed so that they app[ear more appertising to people who use the service. The catering staff should have the Intermediate Food Hygiene certificate to expand their knowledge and skills in this area. Windows that do not have a restrictor fitted should have a risk assessment undertaken so that it can be evidenced that the level of risk has been considered and any appropriate control measures are taken. Page 29 of 31 2 7 3 4 9 15 5 15 6 19 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 7 25 the hot water from the washbasins should be risk assessed to ensure that its use will not place people at unnecessary risk staff inductions should be completed and records of this kept to evidence staff are aware of their role and responsibilities. The findings of the homes qualtiy assurance process should be sent to the Commission wiht a action plan setting out how they will address any actions identified. The register manager should ensure that a policy and procedure in managing service users monies should be implemented so that all staff, service users and relatives are aware of the process to be followed. The registered manager should ensure that a minimum of six formal recorded supervision sessions are conducted with staff to enable staff to review their care practices and identify any training needs. 8 27 9 32 10 35 11 37 Care Homes for Older People Page 30 of 31 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. 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