Care Home: Cassandra House

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What the care home does well The home provides a warm and clean environment for residents. People spoken with were happy with their home. One person commented, `I have been in two other homes and by far this is the best one. I am staying and going to give my home up. It`s hard but I couldn`t find a better place to end my days`. Another person said, `everywhere is very clean and clothes are washed daily` and a third person commented that the home, `smells nice`. The staff were described as, `always helpful`, `caring` and `friendly` and one person said, `the staff are wonderful in my estimation`. People were happy with the care they received. They also told us that the home had a relaxed atmosphere and visitors were welcomed at any time. People were also encouraged to make decisions about aspects of their lives and how their home is run. People had their needs assessed prior to entering the home so the staff could be sure they were able to look after them properly. The care plans contained the information staff needed to support people and health professionals visited the home to advise staff and treat the residents. Visitors were welcomed at anytime and staff supported people to keep in touch with relatives via e-mails. There were lots of activities on offer and the home employed an activity coordinator to ensure social stimulation was maintained. People liked the meals provided and said they had plenty to eat and drink. The home monitored the quality of the service it provided and treated complaints seriously. The manager tried to look into things quickly and resolve them. Staff recruitment is good and there is a low staff turnover. Some of the core staff team have worked at the home for many years. This helps to maintain consistency for residents and also means the staff team get to know the residents and their families very well. Staff liked working at the home and said there was enough staff on duty so they didn`t feel rushed when supporting people. 58% of care staff have gained a national vocational qualification in care and further staff are progressing through the course. This means that the national minimum standard has been exceeded in this area. The home has a training plan that covers a range of training. These points demonstrate the homes commitment to a trained staff team. The home is well managed with the registered manager on hand to support staff. She also is proactive in thinking of things to try and improve the safety and wellbeing of residents. What has improved since the last inspection? There have been updates to the environment that are completed in an ongoing way such as decorations and new furniture. The ground floor was completely refurbished after flood damage in 2007 in Hull. The upper floor has also been redecorated. More staff have gained national vocational qualifications in care and completed other mandatory and service specific training. The activity coordinator gained the, `Active in Age` award to enable her to provide residents with exercises to music. The home purchased musical instruments to assist in this task. The home has introduced a monitoring system for any residents that have behaviours that could be challenging to themselves or others. This helps staff to look for patterns and provide information to professionals. What the care home could do better: Care plans are completed to meet peoples` needs but they could be personalised even further so that staff have written information about preferences and the way people like to be cared for. Because the staff team know the residents very well some of this information hasn`t always been written down. The way the staff team record medication could be improved to ensure that there is a clear audit trail of medicines received into the home and when they are omitted. There could also be protocols in place to help guide staff in when to give a specific resident their, `when required` medication. Care staff could receive formal supervision more often. This gives them a chance to sit down in one to one sessions with their line manager and discuss issues. New care staff could complete skills for care induction standards to evidence their competence in specific tasks. Senior staff do guide new staff through the homes` induction system but the skills for care standards would prepare them for a national vocational qualification. Key inspection report Care homes for older people Name: Address: Cassandra House 19 Dunswell Lane Cottingham Hull East Riding Of Yorks HU16 4JA     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: Beverly Hill     Date: 2 0 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 32 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 32 Information about the care home Name of care home: Address: Cassandra House 19 Dunswell Lane Cottingham Hull East Riding Of Yorks HU16 4JA 01482876150 01482876111 carol@mellandene.karoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Carol Lesley Olive Murrey care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Cassandra House is a care home situated in a semi-rural area of Cottingham in the East Riding of Yorkshire. The home is registered to provide care and accommodation for 42 older people, including those with dementia. The home is a detached Tudor style property built in 1910, with a modern extension. It is set in quiet surroundings and has an enclosed courtyard that is equipped with tables and chairs for residents to utilise. There are twenty-two single bedrooms and ten shared bedrooms. Ten of the single and two of the shared rooms have en-suite facilities. The home has four bathrooms, one of which is a walk-in shower room. Each of the baths has a chair lift to assist people to get in and out. Care Homes for Older People Page 4 of 32 Over 65 42 42 0 0 Brief description of the care home Communal living space consists of four lounges, a dining room and a conservatory. There is also a seating area in the entrance and a hairdressing salon. Cassandra House is a family run business and is one of two care homes owned and managed by the family. The weekly fees range between £372.04p and £450.20p. There is a top up of between £10 and £30 on the basic local authority rate. There is an additional charge for items such as toiletries, hairdressing, chiropody and newspapers. Information about the home and the services provided can be found in the statement of purpose and service user guide, located in the entrance. Care Homes for Older People Page 5 of 32 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: The quality rating for this service is 2 stars. This means that the people that use this service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 18th March 2008 and a site visit to the home, which lasted approximately nine hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Cassandra House. We also had discussions with the registered manager (who is also the proprietor), a relative, care staff members and the activity coordinator. Comments have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living Care Homes for Older People Page 6 of 32 there. Also examined were, medication practices, risk management, activities, nutrition, complaints, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked to see how residents were consulted with in how the home was run and how privacy and dignity was maintained. We also wanted to be sure that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. The provider had returned their annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Cassandra House, the staff team and management for their hospitality during the visit, and also thank the people who completed surveys and had discussions with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 32 There have been updates to the environment that are completed in an ongoing way such as decorations and new furniture. The ground floor was completely refurbished after flood damage in 2007 in Hull. The upper floor has also been redecorated. More staff have gained national vocational qualifications in care and completed other mandatory and service specific training. The activity coordinator gained the, Active in Age award to enable her to provide residents with exercises to music. The home purchased musical instruments to assist in this task. The home has introduced a monitoring system for any residents that have behaviours that could be challenging to themselves or others. This helps staff to look for patterns and provide information to professionals. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had their needs assessed prior to admission so that staff were sure their needs could be met in the home. Evidence: We looked at four care files during the visit, two of which were for people recently admitted to the home. We wanted to assess the admissions process and check that the home obtained all the relevant information about people prior to admission. The home had documentation that staff completed when they visited potential residents. This in-house assessment identified the reason for admission and covered areas of personal care, health and psychological needs and social interests. There was also evidence that assessments completed by the local authority had been received prior to admission. On one of the care files examined there was also a full handover of information from the persons previous residential service. Care Homes for Older People Page 11 of 32 Evidence: Staff carried out an admissions checklist so they could be sure all areas of the admissions process were completed. The information obtained prior to admission enabled the home to make a decision about whether the persons needs could be met there. The manager had just been advised by a colleague that following the assessment, people should be notified in writing that their needs can be met in the home. The manager is to formulate a standard letter to be used to send to residents or their representatives once their assessment has been completed. The manager told us that potential residents could visit the home at any time or stay for a short break to enable them to get to know the staff and the home. This was confirmed in a discussion with a relative. They told us that the manager visited the person to be admitted at home, completed details and arranged a trial stay at Cassandra House for them, this was over five weeks ago and we have just confirmed they are to stay permanently. The home does not provide intermediate care services so standard 6 does not apply. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had their needs planned for and met in ways that respected privacy and dignity. Some shortfalls in the recording of medication need to be addressed to ensure a clear audit trail and prevent mistakes being made. Evidence: During the day we looked at care plans that had been produced from assessments of need. On the whole they covered the assessed needs well and gave clear tasks for staff in how to care for people. The care plans stated what the resident could do for themselves in some areas and, on occasions, indicated preferences. There was evidence that care plans were evaluated and clear updates noted when significant changes in need had occurred. For example, when medication had been prescribed for one resident for a skin condition and the provision of pressure relieving equipment following mobility issues. The staff also completed separate care plans for care required during the night for each resident. Care Homes for Older People Page 13 of 32 Evidence: The manager also told us they had met with a health professional from the local primary care trust to discuss care plans for people that could be put in place at the end of their life. This was to ensure that people made decisions about where they chose to receive end of life care and how this was to be carried out. Reviews took place with the resident, their family members, staff and care management teams present. To improve the care plans could be signed by the resident or their representative and personalised even further. The staff team were aware of this and had acknowledged it in the annual quality assurance assessment completed by the home. There was evidence that residents had access to health care professional for advice and treatment. Staff monitored residents weight and referred to the dietician when required. During the visit the manager had referred a specific resident to the falls team for an assessment, as there were concerns the risk to them falling had increased. Residents spoken with and surveys received from them told us they were happy with the care they received. All six surveys stated that staff were available and listened to what they had to say, always or usually and also that they received the care and support, including the medical care that they required, always. Comments were, girls are always willing to help when I ask, I was asked what I wanted when I came into the home and how I wanted things to be done, I have my hair shampooed and set every week, the staff arranged for an optician to visit me and I now have new spectacles, I prefer to sit in my wheelchair so I can move around and they put my stockings and cream on. One relative told us, she is always clean and tidy and they cleared up her water problem within the first couple of weeks. We observed that staff were very sensitive regarding one resident with dementia that had dressed themselves but had mistakenly put their jumper on back to front. Staff advised us that reminding the resident of this upsets them and the important matter was that the resident had maintained their skills when attempting to dress themselves. Staff and family members were aware of this and supported the resident as much as possible. Individual risk assessments were completed for areas of concern such as moving and handling and falls. Staff completed a generic risk assessment that covered some individual areas of risk but concentrated more on environmental issues such potential slips in bathrooms. To improve, the home could focus more on individual risk assessments when residents are admitted or significant changes in their condition Care Homes for Older People Page 14 of 32 Evidence: occur, rather than the use of the generic risk assessment form. The manager confirmed they had investigated a tool to look at nutritional risks when residents dietary intake was affected. Daily recording was completed and staff also completed key worker records to evidence that they spent quality, one to one time with residents. Some of the key worker notes had gaps in them but staff confirmed in discussions that they did spend the time with residents. Staff also recorded when professionals visited the residents and any action that was required. They also recorded when medication changes were made. Senior staff told us they maintained diaries for residents if they showed any signs of behaviour that could be challenging or distressing to themselves or others. This was so they could check for patterns, look at how situations were managed and provide information for any health professional that may be involved. The management of medication was generally good but there were some recording issues to address. Not all medication was signed into the home. The signing-in shortfalls happened when medication was delivered mid-cycle and was handwritten onto the medication administration record (MAR). For good practice there should also be a witness signature to handwritten entries on the MAR and when changes in medication occurred to avoid mistakes. Codes were used when medication was omitted but these were not always consistent and there were some gaps noted without any code as to why. On checking, the medication had been given but the staff member had forgotten to sign the MAR. There was also one resident that was prescribed medication, when required for agitation. However, there were no clear protocols to guide staff as to when this should be given. Medication was stored correctly and staff had received medication training. The fridge temperature readings should be recorded. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that residents had a good quality of life by providing social stimulation, nutritious meals and ensuring that they can make as many choices about their lives as they are able. Evidence: The home employs an activity coordinator Monday to Thursday 10am until 3pm. In discussion, they told us that assessments were completed to find out information about residents life histories so that stimulation could be planned to meet their interests. They were enthusiastic about their role and had completed extra training, Active in Age, to enable them to facilitate exercises with residents. Other stimulation provided was the encouragement of small household tasks for those residents that wanted to participate, such as folding linen and polishing their shoes. A weekly activity plan was completed but was subject to change if residents decided to do other things. Records were maintained and residents had enjoyed, baking, bingo, nail care, listening to music and watching DVDs, reminiscence work including the use of local, flashback newspapers, dominoes in groups and one to one work such as word games and ball games. There was a gardening club in the summer and residents helped to fill plant pots, Care Homes for Older People Page 16 of 32 Evidence: entertainers visited and the home had acquired a Wii game for residents to enjoy activities such as virtual bowling. Various outings were arranged although both the staff and residents stated they would like to do these more often. Also the staff put on a pantomime each Christmas. Residents mentioned the pantomime to us during the visit and told us they thoroughly enjoyed it. One person said in a survey, Christmas was so enjoyable. The panto was so good what the girls did and we saw it three times. We had singers, a magic show and carol singers. I would not have had a Christmas like it at home. Other residents wrote, the staff are friendly and we are encouraged to participate in activities - we have singing, dancing, bingo and quizzes and they do Christmas, birthdays and special occasions well. In discussions with residents some comments were, I like the dominoes and games and I am very pleased with the way it is run, Im doing a jigsaw at present. I like my own company, I watch TV and Im doing very very well. All six surveys indicated that there were sufficient activities either, always or usually. People could make choices about aspects of their lives and residents spoken with told us there were no set times for rising or retiring and a relative said they could visit at any time and was always offered refreshments. The home had a kitchenette for residents, staff and relatives to use to make hot and cold drinks. Bedrooms were personalised and people could bring in small items of furniture, ornaments and pictures to make their bedroom look homely. Some residents had installed their own telephones to keep in touch with relatives and friends. One resident was supported by administration staff to keep in touch with relatives overseas via email. Staff said they tried to ensure that people made decisions for themselves, we read care plans so we know how people want to be cared for and seniors pass on any changes and we try to aim for three hours of key worker, one to one time with residents each week. People liked the meals provided and all six surveys had ticked they liked them, always or usually. Some comments from discussions and surveys were, balanced diet and varied meals, she is well catered for, I love the food - it is home-made, which is what I am used to, the food is lovely, they feed us very well, yes we have choices, excellent food and the food is very good - I like a drink of squash and they bring me a jug most days. There were at least two choices for the main meals of the day but alternatives were available. Catering staff received information about likes and dislikes or any special dietary needs and staff told us that the dietician is contacted when they have concerns about nutritional intake or weight loss. The home had gained a, Healthy Heartbeat Care Homes for Older People Page 17 of 32 Evidence: Award in October 2009 from the local authority for ensuring healthy options are available. Care Homes for Older People Page 18 of 32 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 home provides an environment where people feel able to complain, and, by using policies, procedures and staff training, vulnerable people are protected from abuse. Evidence: The home had a complaints procedure on display in the hallway, bedrooms and lounges. The procedure is clear and explains that all complaints however small will be recorded and investigated. There is also a complaint form for people to complete. Staff spoken with confirmed they were aware of what steps to take should people raise concerns with them. Residents and a relative spoken with stated they would tell people should they have any concerns or complaints. Comments were, I would tell Carol (proprietor/manager), I would go straight to Carol if I had any complaints, and If I felt something wasnt right I would most certainly would (make a complaint). All six surveys from residents stated they knew who to speak with if they were unhappy about something and five said they knew how to make a formal complaint. The homes annual quality assurance assessment told us that they had received two complaints in the last year and both had been resolved satisfactorily. The Care Quality Commission has not received any complaints in the last year. The home used the multi-agency policy and procedure for safeguarding vulnerable adults from abuse. There has been three referrals to the local authority safeguarding Care Homes for Older People Page 19 of 32 Evidence: team about incidents between residents. These were investigated and appropriate action taken to protect people. The local authority had also investigated three other safeguarding referrals with no further action required on the part of the home. The proprietor/manager and seniors had completed safeguarding of adults from abuse training specifically for managers and their role in referral and investigation. Staff members had also completed safeguarding training and, in discussions, clearly demonstrated their knowledge of the procedures. When asked what they would do if they witnessed any abuse they said, we would report it to the senior, protect the resident, record it, the staff would be suspended and it would be investigated by the police and social services. The proprietor/manager told us that they did not see referral to the safeguarding team as a negative issue but one of keeping the local authority aware of incidents and being able to gain support and advice from them to improve practice. This is a positive view and will help to keep people safe. Care Homes for Older People Page 20 of 32 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 provides a clean, warm and safe environment for people. Evidence: Cassandra House was clean, warm and well maintained. Communal areas consist of four lounges and a conservatory, a seating area in the entrance and a dining room. All are nicely decorated and well furnished. The home also has a hairdressing salon. The home has two bathrooms on the ground floor, one of which is a walk-in wet room with a shower, and two bathrooms upstairs. There are sufficient toilets throughout the home. The bedrooms examined were personalised to varying degrees dependent on the taste and choices of the resident. All the bedrooms had privacy locks to the doors and lockable facilities to store valuables. The home has twenty-two single bedrooms, ten of which have en-suite facilities and ten shared bedrooms, two of which are en-suite. All the shared rooms had privacy curtains. The laundry was well equipped and there was sufficient domestic and laundry staff employed. People spoken with were happy with their home. Some comments from discussions Care Homes for Older People Page 21 of 32 Evidence: and surveys were, the home is arranged in such a way that she is free to move around at will, its always clean, warm and smells nice, everywhere is very clean and the clothes are washed daily, its my home now and I have a good bed and they look after your clothes - what more could you want. One person, when asked in a survey what the home could do better, did state, more care with washing and ironing and delivery of same to correct rooms and cleaning sticking surfaces more regularly i.e. spilled drinks. Care Homes for Older People Page 22 of 32 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. There were sufficient, well recruited and well trained staff to care for the people living in the home. Evidence: The home had thirty-nine residents on the day of the visit. Rotas, and staff in discussions, confirmed there were always two senior carers and four carers during the morning shift and one senior and four carers in the afternoon. The extra senior in the morning was to allow for any administration, arranging appointments and dealing with professional visitors. The proprietor/manager was supernumerary and worked daily in the home. There were three care staff on duty at night and in discussions staff told us that the manager arranged for shifts to overlap in the morning by over an hour to ensure there were more staff available at the busiest time. This is an example of good practice and putting the needs of residents first. The home also had an activity coordinator that worked Monday to Thursday 10am until 3pm. There were sufficient catering, domestic, administration and maintenance staff to support the service. Surveys received from people and discussions with them on the day highlighted that they were happy with the care they received. Some comments were, the girls are always willing to help when I ask - we always seem to have lots around all the time, Care Homes for Older People Page 23 of 32 Evidence: my mother is well cared for and catered for, the staff are excellent, the majority of staff are caring and affectionate, the staff always ask and tell me what is going on, the staff are always friendly, the staff are very nice but busy and they are wonderful in my estimation - quite honestly they are a darn good lot, always helpful in every way. In discussions and surveys it was clear that staff enjoyed working at the home. There was generally a low staff turnover and a core group of staff had worked at the home for many years. They told us there was plenty of training accessible and the atmosphere was very friendly. The home had a training plan and there was evidence that mandatory and service specific training was included. The manager had completed a train the trainer course for moving and handling and so ensured all staff were up to date, and a senior carer was able to facilitate infection control training. Service specific training included dementia care, Parkinsons disease awareness, continence promotion, nutrition and eating difficulties, dealing with bereavement, equality and diversity, mental capacity legislation and deprivation of liberty safeguards. In discussions staff told us they had also completed training in how to manage behaviour that could be challenging and that they were really encouraged to complete national vocational qualifications in care (NVQs). This was confirmed when documentation was checked as twenty-one out of the thirty-six care staff had completed an NVQ at level 2 or 3. This equated to 58 of care staff trained to this level and exceeded the national minimum standard. Seven additional care staff were progressing through the courses and when completed this figure would rise to 77 . These figures told us the home was committed to a trained workforce. The home completed an induction with newly employed staff. As well as several shifts as supernumerary staff, there was a checklist of tasks, which was signed off by the senior or manager when the person was deemed competent. It was recommended that new staff starting work without an NVQ complete skills for care induction standards. The manager was advised as to where the induction booklets could be obtained from, which help to evidence competence in specific areas. The recruitment system was sound, with application forms completed, references checked and interviews. Checks were made to ensure that new staff were not excluded from working with vulnerable people and criminal record bureau checks were completed. Three staff members started work just prior to the return of the final check but the time spent was in induction and the manager confirmed new staff would Care Homes for Older People Page 24 of 32 Evidence: always work with another staff member until the return of the final check. Care Homes for Older People Page 25 of 32 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 is managed well and people living in the home are consulted about the way the service is provided. Evidence: The registered manager is also the proprietor. She has completed an NVQ in care at level 4 and the Registered Managers Award. She has completed a train the trainers course in moving and handling so is able to train her staff team. There was evidence that she keeps herself up to date with other training such as first aid, basic food hygiene, fire safety, the managers role in safeguarding adults from abuse, personalisation, health and safety and mental capacity legislation. She had a clear sense of direction for the home and staff spoken with were very complimentary about her management style. Some comments were, we have a very supportive manager, you can talk to her about anything, she is here every day, good home with an open-door policy and an approachable manager and they are nice people to work for. Residents and a relative spoken with knew the managers Care Homes for Older People Page 26 of 32 Evidence: name, which told us she was available and out and about the home. One resident wrote in a survey, its very well run. There was evidence that care staff received some formal, one to one supervision with their line manager but to meet the national minimum standard this should be at least six sessions a year. Documentation indicated that at present the number of sessions was two to three. To improve, the staff supervision records could be clearer about the topics discussed, for example, key worker role, training and development needs and the philosophy of the home. Care staff were overseen and supported on a daily basis by the manager and senior care staff. The home had a good quality monitoring system that included audits and questionnaires. These were carried out throughout the year and action plans completed to address any shortfalls. Residents and their relatives were consulted in quarterly meetings and kept informed with newsletters. Senior care staff meetings were held monthly and full staff team meetings every three months. Cassandra House had gained parts 1 and 2 with the local authority quality development scheme for ensuring care planning, key worker systems and quality monitoring mechanisms were in place. They have also been awarded a, Healthy Heartbeat Award for ensuring a healthy option is on the menu. The home completed the annual quality assurance assessment required by the Care Quality Commission and this evidenced that the manager and staff team had thought about how to improve the service for people. For example, the purchase of an ozone sanitiser to help with infection control and training for the activity coordinator so they can provide safe exercises for people. The management of finances was touched upon during the site visit. Individual records were maintained for any monies held in safekeeping for chiropody, hairdressing and minor purchases, and receipts were obtained. Families generally managed peoples monies and the administrator oversees the finances for the home. The home was a safe place for people to live in and staff to work in. The manager advised that the home did not have any bedrails insitu, as they tried to use alternative means to support people. For example, sensor mats by the side of the bed and a quick staff response when they know a person could fall. However, they were also investigating sensor equipment that goes under the mattress and would be a speedier indicator of movement off a bed and also light sensors that would come on when people get out of bed and so help prevent falls. Care Homes for Older People Page 27 of 32 Evidence: Fire equipment was checked routinely and gas and electrical equipment serviced. Staff participated in mandatory training and had policies and procedures to guide their practice. Staff also participated in fire drills to keep their practice up to date. Response times could be indicated on the fire drill log. Care Homes for Older People Page 28 of 32 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 29 of 32 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 7 Care plans could be personalised even further to ensure staff have fuller details of preferences and wishes regarding the residents care. The signing of care plans by the resident or their representative will evidence they have seen and agreed the contents. Medication that is handwritten on the MAR should be signed in and have a witness signature, codes should be used consistently when medication is omitted and care needs to be taken that the MAR is signed after every administration. Fridge temperatures should be recorded. These measures will help to ensure there is a clear audit trail of medication. There should be a protocol in place for, when required medication prescribed for a specific resident for agitation. This will give staff clear direction. New care staff should complete skills for care induction standards to evidence their competence in specific tasks. This will enable management to check they are competent to care for vulnerable people and provide new carers with confidence and information when they are starting out caring for people. 2 9 3 9 4 30 Care Homes for Older People Page 30 of 32 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 5 36 Care staff should receive a minimum of six formal supervision sessions a year and the supervision record should clearly reflect what has been discussed. Care Homes for Older People Page 31 of 32 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 32 of 32 - 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. 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