Care Home: Cedar Grange Residential Home

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What the care home does well The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. What has improved since the last inspection? The person in charge of the home and those who work there have put in a lot of time and effort to make things better for the people living at the home. The food and menus give people a wide choice of things to eat and activities are good. The environment in the home is being re-painted and new furniture and soft furnishings are being supplied to the bedrooms and living areas. This is making the home look better and gives those living in the home a homely and comfortable place to live in. What the care home could do better: The home has worked hard to meet the standards within this report. We have made two requirements around the heating and ventilation within the home and a small number of recommendations around good working practices. These will be followed up at the next visit to the home. We would like to thank everyone who completed a survey or spoke to us during this visit. Your comments are very important to us and ensure this report includes the views of people who use the service or work within it. Key inspection report Care homes for older people Name: Address: Cedar Grange Residential Home Main Street Cherry Burton East Yorkshire HU17 7RF     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: Eileen Engelmann     Date: 2 1 0 7 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: Cedar Grange Residential Home Main Street Cherry Burton East Yorkshire HU17 7RF 01964551580 01964551025 cedargrange@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Healthcare (Focus) Limited Name of registered manager (if applicable) Ms Sally Anne Mowforth Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 31. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 31. Dementia - Code DE, maximum number of places 31 Date of last inspection Brief description of the care home Cedar Grange is located in the village of Cherry Burton, two and a half miles from the historic market town of Beverley. The home is set in well-stocked and well-tended grounds and provides pleasant Care Homes for Older People Page 4 of 31 Over 65 0 31 31 0 Brief description of the care home accommodation for up to 31 older people some of whom may suffer from dementia. The home consists of two buildings; the main house is a large period building offering accommodation to 23 residents and the Lodge is a purpose built bungalow offering accommodation to a further 8 residents. Both buildings provide pleasant views across the well-kept gardens. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the manager on request. Information given by the manager during this visit indicates the home charges fees from 362.04 GBP to 463.90 GBP a week depending on the source of funding and the dependency needs of individuals. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager and can be found in the Service User Guide. 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: Information has been gathered from a number of different sources over the past 23 months since the service had its last key inspection visit (29/8/07), this has been analysed and used with information from this visit to reach the outcomes of this report. We completed an Annual Service Review (ASR) for Cedar Grange on 24 July 2008. We only do an annual service review for good or excellent services that have not had a key inspection in the last year. An ASR is part of our regulatory activity and is an assessment of our current knowledge of a service rather than an inspection. The published review is a result of the assessment and does not come from our power to enter and inspect a service. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and peoples files, and records relating to the service. Care Homes for Older People Page 6 of 31 Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was good. We received 7 back from staff (70 ) and 8 from people using the service (80 ). Informal chats with a number of people living in the home took place during this visit and comments from the questionnaires and face to face conversations have been put into this report. The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. We have not received any formal complaints about the service in the 23 months since our last visit. Eleven safeguarding referrals have been made in 2009, the majority of these related to altercations between two individuals with dementia. These were investigated by the East Riding of Yorkshire Council safeguarding team and one person was moved to a more suitable placement. 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 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 31 What the care home does well: What has improved since the last inspection? 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 8 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 9 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. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. Evidence: At our last visit to the home (August 2007) a requirement was made that The responsible person must ensure the homes statement of terms and conditions meet the criteria of Regulation 5 of the Care Home Regulations and includes the information asked for in The Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2006 (for Regulation 5), which came into force on 1st September 2006. Checks at this visit found the requirement has been met. People who are interested in moving into the home are given a pack of information including the statement of purpose and service user guide, which are written in a Care Homes for Older People Page 10 of 31 Evidence: clear, large print. Survey responses show that everyone was satisfied that they received sufficient information about the home to help them make their decision about accepting a placement if offered. Four peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. Each person has their own individual file and four of those looked at had a need assessment completed by the funding authority or the home before a placement is offered to the person. The home develops a care plan from the assessments, identifying the individuals problems, needs and abilities using the information gathered from the person and their family. People and their relatives are very pleased with the care and support given by the staff. The majority of those who responded to the surveys said the home met the needs of people living there and one person commented that being relatively new into the home, the staffs supportive approach and attitude have helped enormously in making the difficult transition to residential care. Two relatives who spoke to us during our visit said the staff have a very positive and caring attitude, they know our relative inside out and let the family know of anything happening to them. At our last visit to the home (August 2007) a requirement was made The responsible individual must make sure that staff, individually and collectively, have the skills and experience to deliver the services and care which the home offers to provide. Checks at this visit found the requirement has been met. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the files and matrix indicates that staff have access to a wide range of training subjects including basic mandatory safe working practice training, and the majority of staff are up to date with their training or booked to attend courses in 2009. Staff who completed our surveys said that their training was good and that they felt they provided a high quality of care, which promoted peoples rights to individuality, privacy and dignity. Information from the Annual Quality Assurance Assessment and discussion with the manager and people living in the home indicates that all of the people using the service are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the Care Homes for Older People Page 11 of 31 Evidence: local community, although placements are open to individuals from all areas. The home is able to offer a choice of staff gender to people who express preferences about care delivery, as they employ 4 male care staff. Discussion with people indicated that they have a good relationship with the staff and are comfortable in asking for specific individuals to deliver their personal care. Preferences for staff gender or age group when giving personal care should be documented in the individual care plans. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Care Homes for Older People Page 12 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. The health, personal and social care needs of the people living in the home are being met by the service and staff. The medication at the home is well managed promoting good health. Evidence: Information given to us in peoples surveys, and during discussions on this visit with people using the service, indicates that individuals are satisfied with the care they receive and enjoy life in the home. People told us that staff treat me with respect and dignity, staff are very kind and caring and the staff are very friendly, totally involved in their work and caring. Eight people said that staff listen to us and take action when needed. The care of four people was looked at in depth during this visit and included checking of their personal care plans. Three of the four people we case tracked have dementia and one has had a lot of behaviour problems in the past six months. These three individuals have detailed dementia assessments and corresponding care plans in place, and where an individual has known challenging behaviour needs there are risk Care Homes for Older People Page 13 of 31 Evidence: management plans in place and behaviour charts, which record all incidents. One person is receiving 1:1 funding from social services for specific staff input, but there were no records of how this time was being used. The manager told us that she would start to record the 1:1 input immediately. The manager told us that she is in the process of making all the care plans more person centred, and one of the plans we looked at had been up dated and was very clear about the needs of this individual. Overall the plans are satisfactory, but there are some areas which could be improved and these are including more equality and diversity information within them around a persons preferences of staff gender and age for personal care and recording a persons ethnicity/race. The recording of activities attended by each person is poor and there is little information about family and friends within the plans. It was very clear from talking to staff and observations made during the visit that staff had a good understanding of peoples needs. Care staff clearly described what they did to help different people and it was evident they treated them as individuals. We spoke to two people who are in the home on respite care (temporary stay), they were extremely satisfied with the care they received and said they were enjoying their stay. Two relatives told us our father has settled well into the home, his key worker is very good and communication between the staff and us is excellent. The service meets his needs and since being here his depression is lifting and he is enjoying life again. People have good access to their GPs, chiropody, opticians and other external services. Responses to the surveys indicated that people and their relatives are satisfied with the level of medical support given to the people living at the home. Nutritional risk assessments are completed for everyone in the home and entries in the care plans specify where individuals have dietary needs, including supplement drinks and thickened or pureed diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses and seat cushions. Checks of the medication show the home is using Boots the Chemist as their pharmacy supplier and their MDS system of medication is in use. Observation of the medication records show these are audited monthly by the manager/deputy manager and the records are up to date and well managed. Checks of the controlled drugs and register showed that these medicines are monitored carefully, stored correctly and records are accurate. All staff responsible for administration of medication have received basic medication training and they are now doing a distance learning course Care Homes for Older People Page 14 of 31 Evidence: with York College on safe handling of medication. People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Comments from individuals were this is a lovely home, staff are wonderful and I enjoy living here. Care Homes for Older People Page 15 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 using the service are provided with choice and diversity in the activities and meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. Evidence: The home has an activities co-ordinator who is employed for 8 hours a week and another person (newly employed) for 12 hours a week. Together they will be organising and running the weekly programme of social events; information about this is on display in the reception area. Meetings for people using the service and their relatives are held on a regular basis; these are used as an opportunity for individuals to express their ideas of what activities and trips out they want and to give their feedback on events that have taken place. Entertainers are booked to come in and perform for people every other month and the home has organised three trips out ( 2 in August and 1 in September) for those who wish to join in. The mobile library visits once a month and people are able to choose large print books or talking books as well as selecting from a wide range of reading books. A bookcase outside of one dining room contains a number of picture books from the Alzheimers Society, which are suitable for a number of people using the service. Care Homes for Older People Page 16 of 31 Evidence: There are monthly in-house church services from the Church of England, and the catholic priest will visit anyone, wishing to take communion, on request. There is a Gospel Choir who visit once a week to hold a session of music and songs and the home encourages people to celebrate all Christian festivals such as Easter, Harvest Festival and Christmas.The home provides special meals and cakes for birthdays and families/friends are invited to come along and join in the celebrations. Six out of the eight people who answered our surveys said there was always something for them to do within the home. People told us that I am always busy, I enjoy playing scrabble, and I like to spend time in my room and staff understand this. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the village. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Two relatives told us that since coming into the home our relative has started to join in with others, he enjoys chatting to staff and people living here and takes part in activities. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to us showed a high level of satisfaction. Individuals said there is a friendly and happy atmosphere amongst the people and staff, staff are patient, kind and polite to people and visitors, good atmosphere and my relative is kept involved and has a good rapport with the staff. Information about advocacy services is on display in the home and discussion with the manager indicated that no one at the home is currently using an advocacy service, although Best Interest Meetings are being held for two individuals who do not have capacity to consent to care. There is information leaflets available for staff, visitors and people using the service around the Mental Capacity Act (MCA) and Deprivation of Liberty (DOL). The manager told us that she has attended training on current legislation around MCA and DOLs and this knowledge is to be cascaded to other staff members through meetings and supervision. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. People spoken to are satisfied that they can access their personal allowances when needed. Comments from the people living in the home and their relatives were on the whole very positive about the meals and kitchen service provided. Five people said the food is lovely, the pork just melted in my mouth, lots of choice if I dont like what is on the Care Homes for Older People Page 17 of 31 Evidence: menu, everything tastes delicious and the fish cakes are the best thing going. The lunchtime meal was well presented and offered a good choice of food, menus were available and the two dining rooms were welcoming and spacious. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to people who needed help with eating and drinking. The kitchen in the home is in need of refurbishment, this is an ongoing project and the provider is slowly making improvements. 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 home has a satisfactory complaints system with some evidence that people feel that their views are listened to and acted upon. Visitors and people using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. Evidence: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. The policy was only seen in a normal print document and we recommended that the manager explore what different formats the service could provide, such as large print, audio or easy read versions, to meet the needs of people living in the home. Peoples survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said I would speak to the staff or the manager if I had a problem. Checks of the complaints record showed that there has been one formal complaint in the past 12 months and this was investigated and responded to in a timely and appropriate manner. Records show that the manager deals with minor niggles/grumles on a daily basis. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs.The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about Care Homes for Older People Page 19 of 31 Evidence: reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. At our last visit to the home (August 2007) a requirement was made The responsible individual must make sure that the staff attend appropriate training in Safeguarding of Adults procedures, management of challenging behaviour and dementia care. Checks at this visit found the requirement has been met. Information from the staff training matrix given to us during this visit (July 2009) indicates that 86 of staff have attended safeguarding of adults training, management of challenging behaviour and dementia awareness. These training sessions are part of the homes rolling programme of staff development. Southern Cross Healthcare (the provider company) has specialist training around dementia management for homes who have people with this care need, the training is called Yesterday, Today, Tomorrow and all of the staff at Cedar Grange are doing this, but at the time of our visit only two had completed the training. We have been notified of eleven safeguarding allegations in the home in the past 12 months, the majority of these related to a clash of personalities between two individuals with dementia, resulting in a number of altercations. The local councils safeguarding team have been out to investigate all the allegations and have funded 1:1 time for one individual and another person has been placed in a more suitable care facility. The manager keeps a record of all the safeguarding incidents, and their outcomes. 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 provides a physical environment that meets the specific needs of the people who live there. The home is comfortable, and has a programme to improve the decoration, fixtures and fittings. Evidence: At our last visit to the home (August 2007) a requirement was made The responsible individual must make sure that all repairs and renewals as highlighted in this report are carried out. Checks at this visit found the requirement has been met. We walked around the building and found it satisfactory and suitable to meet the needs of the people using the service. The home has an ongoing maintenance and refurbishment programme and the manager was able to show us the work that has been completed in the past 12 months and discuss work that is planned for this year. People commented that I like my new room it is bright and sunny and it is lovely living here, nice food and I like how my room has been decorated. Areas of the home that still need some attention include the medication room, which is small and cramped and the upstairs bathroom which has been fitted with a new bath but still needs a new floor covering and decoration. We understand that the home is a listed building, but the windows in rooms 16, 17, 18, 19 and 20 (downstairs), 14, 12, 11 and 10 (upstairs) need replacing or repairing. The window glass in room 16 has a Care Homes for Older People Page 21 of 31 Evidence: gap to the outside at window sill level, a perspex sheet has been fitted to the inside to prevent a draft, but this is not suitable as a long term solution. Room 17 has a sash window that was propped open by a block as the sash does not work properly and the window will not stay open unless the block is in place. Other windows mentioned are in a state of disrepair and discussion with the manager indicated that the provider is aware of the problem. Since our last visit in August 2007 the home has created an outdoor piazza patio and work is underway to create a secure, garden area for those with dementia to sit out in during the summer months. At the moment the home has large, well-tended gardens that are enjoyed by the more able bodied people, but these are not secure and people could wander from the grounds. The home has created a hairdressing salon, which was in full use during this visit, by utalising an old storage area on the ground floor. At our last visit to the home (August 2007) a requirement was made The responsible individual must make sure that radiators are fitted with thermostatic valves. Checks at this visit found the requirement has not been met and it will stay on this report. During this visit it was noted that the temperature within the home was excessively hot and this has been a problem in the past for people living in the home. A number of radiators in the home, including those in bedrooms, do not have thermostatic valves so people are unable to alter the temperature of their rooms. Discussion with the manager indicated that work on the heating system was due to start within a week of our visit. Plans were in place to move the environment thermostats to more suitable locations and put thermostatic controls on every third radiator (this is due to how the heating system works). The environment is clean, warm and comfortable and few malodours were present. Comments from the day of this visit indicate that the people using the service find the home to be clean and tidy and they are satisfied with the laundry service provided by the home. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. The staff training matrix supplied to us on 21 July 2009 indicates that infection control training is part of the rolling programme of training and that 25 staff (86 ) attended this in the last 12 months. 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. The staff induction, training and recruitment practices are good, resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. Evidence: Checks of the staffing rotas and observation of the service showed that the home employs two staff from overseas. Staff members told us that they work as a team and this includes covering shifts when others are on leave or sick. Staff feel that their induction and training helps them meet the needs of people who use the service. We spoke to two people who use the service during this visit, and they were satisfied with the care they receive and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us that staff are friendly, helpful and supportive. At the time of this visit there were 23 people in the home (8 in the lodge and 15 in the main home) and the staffing levels were as follows, in a morning from 7:30am to 2pm there are 3.5 to 4 care assistants (this includes one staff in the lodge), in an afternoon from 2pm to 9pm there are four care assistants plus 1:1 hours for one service user (this includes one staff in the lodge) and at night from 9pm to 7:30am there are three care assistants (includes one staff in the lodge). We recommended that the staffing rota should indicate which staff are carrying out the 1:1 hours with the person funded Care Homes for Older People Page 23 of 31 Evidence: for this. Information from the Annual Quality Assurance Assessment (completed 9 June 2009 by the manager) about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the service, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the minimum hours asked for in the recommended guidelines. Over 50 of care staff at the home have an NVQ 2 or above in care and all new starters have to complete an induction which meets Skills for Care criteria. Staff have access to a mandatory training programme, as well as a wide range of specialist subjects which reflect the diverse needs of the people using the service. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of three staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. 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 management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: The registered manager is in the process of completing her Registered Managers Award and hopes to have this finished by the end of September 2009. She has extensive experience of looking after elderly people and keeps her skills and knowledge up to date with regular training sessions pertinent to her role. The manager came into post after our last inspection in August 2007 and feedback from staff, visitors and people using the service is very positive about the changes she has made to the service. Individuals told us since the new manager took over, the home has become a friendlier, happier place to work, and the new manager has provided a lot more support to both the residents and staff, there is a fresh approach which has brightened the home and boosted morale. Care Homes for Older People Page 25 of 31 Evidence: The home has achieved the local councils quality award (QDS) parts one and two. Continuous monitoring and assessment of the home and its practice/service by the Councils Quality Assurance Team is an essential part of the process leading to the awards being reaffirmed year after year. Meetings for people using the service are held on a regular basis and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager completes in-house audits of the home and its service on a monthly basis, and the responsible individual does spot checks and completes the regulation 26 visits. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires, and the manager is aware of the need to produce an annual development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Changes already made in the home from peoples feedback is the introduction of a fish tank in the entrance hall, the provision of a snug room/bar in one of the dining rooms, the creation of a secure garden facility (ongoing), and the change in hairdressing facilities. Re-decoration of bedrooms is one more change people have asked for and 13 rooms have been done in the past 6 months. Checks of the finance systems within the home found that computerised records are kept for peoples personal allowances; the administrator on a daily basis up dates these. Information from the Annual Quality Assurance Assessment indicates the majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the persons individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk Care Homes for Older People Page 26 of 31 Evidence: assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. The local Fire Officer visited the home in March 2009 and his report says all is okay in the home, the Environmental Health Officer visited the home in January 2009 and issues raised in their report were new flooring for the kitchen (now completed), tiles needed resealing (completed) and the manager said the kitchen is now ready for redecoration. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 25 23(1)(a),(2)( The responsible individual p) must make sure that radiators are fitted with thermostatic valves. So people can alter the level of heat in their bedrooms themselves to find a suitable temperature, which is comfortable for them and their visitors whilst in their rooms. 01/03/2008 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 1 25 23 The responsible individual 31/10/2009 must make sure that radiators are fitted with thermostatic valves. Given timescale of 01/03/08 was not met So people can alter the level of heat in their bedrooms themselves to find a suitable temperature, which is comfortable for them and their visitors whilst in their rooms. 2 25 23 The responsible individual must make sure that windows in the home conform to recognised standards and are kept in a good state of repair. So people can enjoy natural ventilation in their own rooms from windows that meet relevant environmental health and safety 01/12/2009 Care Homes for Older People Page 29 of 31 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 regulations and are fit for purpose. 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 4 The manager should ensure that information about peoples preferences regarding staff age and gender for giving personal care, is recorded in the individual care plans. The manager should ensure that equality and diversity information such as race, ethnicity and peoples preferences regarding staff gender and age for personal care is included in all plans. The manager should ensure that where 1:1 funding is being received for a person, then a detailed record of how this is being implemented is kept on that persons file. The manager should ensure that the social aspect of care is improved within the care plans with details of activities undertaken and information on families and friends being recorded by staff. The manager should consider producing the complaint policy and procedure in different formats to meet the needs of people using the service. The responsible individual should ensure the medication room is fit for purpose, the upstairs bathroom is refurbished to meet the needs of the people using the service and the outcomes of the environmental health officers report for the kitchen is fully actioned. The manager should ensure that the staffing rota indicates which staff are carrying out the 1:1 hours with the person funded for this. The manager should complete the Registered Managers Award by the end of September 2009. 2 7 3 7 4 7 5 16 6 19 7 27 8 31 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. 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