Care Home: Cedar House

What the care home does well Prospective residents are assessed prior to admission to ensure the home is able to meet their needs. Residents healthcare needs are being met with evidence of good input from the multi-disciplinary team. Medications are being well managed throughout the home, with clear auditing and review processes in place. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. Work was ongoing regarding ascertaining the wishes of residents and their families in respect of health deterioration and end of life care, and the manager had identified this as an area to be progressed. The home has an open visiting policy and visiting is encouraged, with visitors being made welcome. Contact information regarding advocacy services is available and on display in the home. The food provision at the home is good, offering variety and choice. The home has clear procedures for the management of complaints and safeguarding adults issues, and these are adhered to.The home has a refurbishment and redecoration plan in place and the manager had identified which areas require attention within the home. Procedures are in place and being followed for infection control. The home is appropriately staffed to meet the needs of the residents. 50% of care staff have obtained their NVQ 2 or equivalent. There is a training programme in place, which includes induction training and training relevant to the needs of the residents. Shortfalls in dementia care training are commented on below. The home is being well managed and the manager has a good understanding of the areas within the home which require improvement, which had been clearly identified in the AQAA. The Manager is approachable and listens to people, and works with the staff to maintain good standards throughout. The home has a comprehensive quality assurance system in place and this is followed, thus providing an ongoing system of auditing and review to improve standards in the home. Monies held on behalf of residents are well managed. We received several positive comments from residents and their representatives. These included the good impact on the home of the new manager and the quality of care being provided by the staff to the residents. What has improved since the last inspection? The home has worked hard to recruit more staff, and this is ongoing. Staff were seen to be conversing well with residents. Some comments around communication were received and fed back to the manager, who is very aware of the importance of effective communication. The carpets in the dining areas have been replaced with flooring much more suited to the dining areas. What the care home could do better: We found some shortfalls with the updating of service user care plan documentation, plus there needs to be evidence of more involvement of residents and their representatives in the formulation and review of the service user plans, so that their wishes are included. The home does have an activities programme in place, with evidence of activities taking place, however work is needed to look at the needs and interests of the residents in this area, and also to provide activities that are based on dementia research and good practice guidance, to effectively meet the needs of the residents. Systems for the recruitment and vetting of staff are not robust and could place residents at risk. Few staff have completed dementia care training, and this was a shortfall the manager had already identified, with work to be progressed in this area. The fire risk assessment must be reviewed annually and the up to date documentation available at the home for inspection. Several pieces of equipment were out of order and their appeared to be delays from the senior management team in authorising repairs. Whilst it is acknowledged that action was taken at the time of inspection to repair or replace the items, Southern Cross must ensure that any requests for repair or replacement of equipment are dealt with promptly. We received comments regarding the lack of maintenance of some items of equipment, comment on the activities provision to include local outings and also some other general comments that were fed back to the manager. Key inspection report Care homes for older people Name: Address: Cedar House 39 High Street Harefield Middlesex UB9 6EB     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: Clare Henderson-Roe     Date: 2 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Cedar House 39 High Street Harefield Middlesex UB9 6EB 01895820700 01895820600 cedarhouse@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd care home 42 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Five of the beds currently registered can be used for service users of 55 years of age and over, as agreed by the Commission for Social Care Inspection, on 1st February 2005. To comply with the Minimum Staffing Notice required by the previous regulator as at 31st March 2002. Date of last inspection Brief description of the care home The home is situated in Harefield village. The village centre is within walking distance of the home and public transport, that being bus services, are available. It is a purpose built care home with resident areas on two floors and services and staff areas on the third floor. The floors are interconnected by a lift, which also accesses the third floor. There is parking to the front and an enclosed garden to the rear. The home is entered and exited by a keypad system. The administrators office is sited near the reception area. There is a designated person who oversees leisure activities. There is one GP Care Homes for Older People Page 4 of 29 Over 65 0 0 42 42 2 7 0 4 2 0 0 9 Brief description of the care home who visits the home weekly and the home also has regular input from the Community Psychiatric Nurse. The fees range from £635 to £1063 per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection carried out as part of the regulatory process. A total of 27 hours was spent on the inspection process, and was carried out by 2 Inspectors. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Several residents and staff plus 2 social care professionals were spoken with as part of the inspection process. The CQC Annual Quality Assurance Assessment (AQAA) document completed by the manager, plus comment cards from residents, representatives, staff and health and social care professionals have also been used to inform this report. Comments and suggestions received via the surveys were fed back to the manager in general terms and are included below. It must be noted that it is sometimes difficult to ascertain the views of residents with dementia care needs. CQC carried out a Random Inspection of the home on 27th April 2009. A separate report of this inspection is available upon request. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: We found some shortfalls with the updating of service user care plan documentation, plus there needs to be evidence of more involvement of residents and their representatives in the formulation and review of the service user plans, so that their wishes are included. The home does have an activities programme in place, with evidence of activities taking place, however work is needed to look at the needs and interests of the residents in this area, and also to provide activities that are based on dementia research and good practice guidance, to effectively meet the needs of the residents. Systems for the recruitment and vetting of staff are not robust and could place residents at risk. Few staff have completed dementia care training, and this was a shortfall the manager had already identified, with work to be progressed in this area. Care Homes for Older People Page 8 of 29 The fire risk assessment must be reviewed annually and the up to date documentation available at the home for inspection. Several pieces of equipment were out of order and their appeared to be delays from the senior management team in authorising repairs. Whilst it is acknowledged that action was taken at the time of inspection to repair or replace the items, Southern Cross must ensure that any requests for repair or replacement of equipment are dealt with promptly. We received comments regarding the lack of maintenance of some items of equipment, comment on the activities provision to include local outings and also some other general comments that were fed back to the manager. 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are assessed prior to admission to ensure the home is able to meet their needs. Evidence: A pre-admission assessment is completed for each prospective resident. Those viewed were comprehensive and gave a good picture of the resident and their needs. Copies of the Social Services and/or Primary Care Trust assessments were also available, plus discharge information from hospital. Care Homes for Older People Page 11 of 29 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. Service user plans are in place, however further work is required to ensure information is kept up to date, to ensure residents needs are being fully identified and met. There is input from healthcare professionals, thus maintaining residents wellbeing. Medications are being well managed at the home, thus protecting residents and ensuring their medication needs are met. Staff care for residents in a gentle and professional manner, thus respecting their privacy and dignity. Work is actively ongoing in respect of ascertaining residents and representatives wishes for health deterioration and end of life care, to ensure that their wishes are known and can be met. Evidence: We viewed 4 service user plans. Care plans had been formulated for identified needs, however more information in respect of mental health and dementia care needs must be included. Care plan documentation had been reviewed monthly, however changes identified in the review had not always been included in the actual care plan. The majority of care plans had been audited by the manager, and action was taken to review a service user plan that had not yet been audited, to bring the information up Care Homes for Older People Page 12 of 29 Evidence: to date. Risk assessments for falls and other identified risks were in place. There was some evidence of input from residents representatives and the need to ensure that, where able, residents are involved in the formulation and review of their plan of care, and where it has been established that a resident does not have the capacity to be meaningfully involved in such processes, then their representative should be consulted and involved, to provide the home with a history of the resident and be involved in ongoing planning and review of the residents care. We viewed wound care documentation. Assessments for pressure sore risk were in place, and care plans for each wound had been formulated. In addition photographs, wound assessment records and clear records to evidence the dressing changes and progress of each wound were in place and up to date. Pressure relieving equipment was in use and the management of the equipment in use had been identified in the service user plan. In most cases pain assessments and pain monitoring charts had been completed and any gaps identified at the time of inspection were addressed. There was evidence of input from the tissue viability nurse specialist. Continence care assessments were in place and care plans for continence management were in place. Moving and handling assessments were in place and identified the equipment to be used for each individual. Nutritional assessments had been completed and there was evidence of weekly weight checks being carried out. There was evidence of input from health care professionals to include GP, dietician, speech and language therapist, optician, chiropodist, physiotherapist, psychiatrist and community psychiatric nurse. We sampled the medication records and management on both floors. Information sheets about each resident were in place and the manager was aware that for new admissions some photographs needed to be obtained. Allergy information had been clearly recorded. Receipts, carried forward balances, administration and disposals had all been clearly recorded, to include medications received mid-cycle. The home uses a monitored dosage system (MDS) along with some boxed medications. We carried out stock balances for a number of medications and these were correct and tallied with the medication administration record (MAR). The controlled drugs register was viewed and had been correctly completed. Stock balances of controlled drug medications checked were correct. Approved lancing devices for blood glucose monitoring for diabetics were in use. The medication fridge and clinical room temperatures are checked and recorded daily and were found to be within safe range. Due to the lift being out of order the medication trolley for the ground floor was being stored in a locked empty bedroom and a risk assessment to address this was formulated. It was clear from viewing the medication audits carried out by the manager that where shortfalls in medication recording had been identified, action had been taken to address this and improve the standard of medication management in the home. Care Homes for Older People Page 13 of 29 Evidence: Staff were seen caring for residents in a gentle, patient and professional manner, respecting their privacy and dignity. We saw notices on the bedroom doors to identify when staff were providing care and were not to be disturbed. Residents were well groomed and dressed to reflect individuality. There were no equality and diversity matters identified within the care needs of the residents. The home has a Dignity Champion and work had been taking place to integrate dignity into every aspect of daily life. The manager was clear that further work is required in this area to ensure that residents receive person centred care. Staff were seen communicating with residents and there was a good atmosphere in the home. We did receive some comments regarding general communication issues, and these were fed back to the manager. We viewed some care plans for death and dying, however these were quite general and did not address the wishes of residents and their representatives in the event of health deterioration and their wishes for end of life care. The manager had already identified this shortfall and was taking action to address it, to include arranging training in palliative care. There was evidence of input from the palliative care nurse in the home and it was clear that the manager has a good understanding of the needs of residents in respect of end of life care. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has activities taking place, but more input is needed to provide research based activities that are meaningful to the residents and meet their needs. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Advocacy service information is available, thus ensuring the residents right to independent representation is respected. The food provision at the home is good, offering variety and choice to meet the needs of the residents. Evidence: The home has an activities co-ordinator and there was evidence of in-house activities taking place. Information about the activities organised by the home was available to view, and showed that work is ongoing to provide residents with activities and some outings. Comments were received regarding the lack of use of the garden, the need for more trips out of the home, even just for a short walk locally, and also the fact that at times residents seemed to be seated in front of the TV and there is a lack of social stimulation. Although it was clear that the activities co-ordinator works hard to fulfil the activities programme, it is important to review the activities management in line with current dementia research and good practice guidance, so that activities are meaningful as well as something to do. It was clear that the manager was already aware of the need to promote more activities and local outings for residents. Care Homes for Older People Page 15 of 29 Evidence: The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are always made welcome and offered refreshments. Comment was also received that they are kept up to date with any issues, and that the manager is approachable and listens to any issues and takes action to address them. Information regarding advocacy services was on display in the home. This included details for Age Concern, Hillingdon Social Services and financial advocacy contact information. We viewed the kitchen and this was clean and tidy. Records were up to date with the exception of daily cleaning records for 2 consecutive Saturdays, and this was to be discussed and addressed. On the first day of inspection some issues were identified with kitchen equipment being out of order and this is commented on under Standard 38. The meal provision is good and residents are offered a choice, plus the catering staff have information about each residents likes and dislikes. Menus are now on display on the tables, and also written up on the whiteboard in the dining rooms. Tables are being attractively laid up, to include linen table cloths and napkins. The home has introduced a protected lunchtime in order that staff and residents can concentrate on the lunchtime meal and make it an enjoyable experience, ensuring all residents receive the assistance they require. Only emergency calls are put through to the floors during this time. Care Homes for Older People Page 16 of 29 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 clear policies in place for the management of complaints and safeguarding adults, and these are adhered to, thus protecting residents. Evidence: The home has a clear complaints procedure and this is followed. We viewed the complaints file and there was evidence of complaints being acknowledged, investigated and responded to. Representatives spoken with said that any issues raised with the manager are responded to. The home has procedures in place for safeguarding adults, plus they follow the Hillingdon Safeguarding Adults documentation. Staff spoken with confirmed that they have received training in safeguarding adults and were clear to report any concerns, to include a knowledge of external authorities that can be contacted if the need should arise. Southern Cross Healthcare have introduced a free, confidential helpline to Action for Elder Abuse, which offers information and support to anyone who has any concerns regarding abuse. Posters with the contact details and information were on display throughout the home. Care Homes for Older People Page 17 of 29 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. Improvements to the environment have been made, and the manager is aware of further work necessary to provide a good environmental standard throughout for residents to live in. Infection control procedures are in place and are adhered to, thus protecting residents, staff and visitors. Evidence: We carried out a tour of the home. The home has a redecoration and refurbishment plan in place and there was evidence of work being carried out, for example, replacement of the dining room carpets with appropriate flooring, and replacement of one corridor carpet. We did identify further areas in need of replacement, for example, the second corridor carpet plus some bedroom carpets that are marked and old. The dining room windows have been reviewed and now open, so that fresh air can be introduced. The garden was being maintained and there is a good amount of garden furniture available for residents to sit out in good weather. We did discuss the possibility of a path, as several residents are in wheelchairs and this would assist with their access to the garden. The AQAA evidenced that the Manager is aware that ongoing work is needed to maintain a good standard throughout. We viewed the laundry and overall the laundry was being kept up to date. The roller iron was out of order on the first day of inspection and the steam facility on the hand held iron was not functioning. The roller iron was repaired promptly and the manager Care Homes for Older People Page 18 of 29 Evidence: said that she would purchase a new hand held iron also. We were informed that Southern Cross had introduced alternative continence care products, and these had not been effective in the management of continence care needs. The manager reported that this had been fed back to Southern Cross and they were reviewing the situation. On the first day of inspection we did note that some areas of the home, specifically the activities room, kitchenettes and one linen room were in need of cleaning. This was discussed with the manager and action was taken promptly to address these areas. It is acknowledged that in all other areas the home was clean and fresh throughout. The manager has introduced additional domestic care hours, and this has helped to ensure the laundry work is being kept up to date, and also to help out where necessary in areas where additional cleaning is required at times.We did discuss the domestics hours of work, and it was clear that although they start work at 6am, they carry out work in non-resident areas at this time and do not go into resident areas until after 8am, and only then once the resident is up and about. Procedures are in place for infection control and are being adhered to. Protective clothing to include gloves and aprons were available in the home. Care Homes for Older People Page 19 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being appropriately staffed, thus ensuring that the needs of the residents and the home in general can be met. Staff receive training and the need for additional training in dementia care had been identified, in order for staff to have the skills and knowledge to fully meet residents needs. Shortfalls in staff employment records were identified, which could place residents at risk. Evidence: At the time of inspection the home was appropriately staffed to meet the needs of the residents. The manager has been actively recruiting both qualified nurses and care staff, and this process was ongoing at the time of inspection. We identified problems where staff ring in sick with very short notice to the home, and this can cause problems with being unable to replace them. We also identified issues with staff arriving late for shifts. It was clear from speaking with staff that both these issues cause staff morale to be low at times, and staff feel that at these times they are not able to meet the full needs of the residents effectively, as they end up rushed in their work. The home does have enough ancillary staff to meet the needs of the home. The AQAA evidenced that over 50 of the care staff have completed NVQ in care to level 2 or above. We viewed 3 sets of staff employment records. CRB checks had been carried out. Care Homes for Older People Page 20 of 29 Evidence: References had been obtained but the last employer had not always been used as a referee. Photographs were not available. Healthcheck questionnaires had been completed. The manager clearly understood the information that was required to be available in staff employment records, and arranged for the Regional Administrator to visit the home to carry out a full audit of the staff employment records, and this was taking place on the third day of inspection. The Regional Administrator explained that the audit would be completed and corrective action taken to bring the files up to the required standard. Southern Cross have an induction programme that includes the Skills for Care common induction standards. Staff spoken with confirmed that they had undertaken induction training and also received training in other topics. Information provided on the AQAA showed that the manager had already identified the need for more staff need to complete training in dementia care, as the majority of staff had not as yet undertaken such training, and this is essential to provide them with the skills and knowledge to care for the residents effectively. Care Homes for Older People Page 21 of 29 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 manager has the skills and experience to manage the home and does so effectively with a range of leadership skills to enhance resident care, plus has an open and supportive approach for staff, residents and visitors. There are clear systems in place for quality assurance and these are followed, thus ensuring an ongoing process of audit and review for all aspects of the home. Monies held on behalf of residents are being well managed, thus protecting residents interests. Systems for the management of health and safety are in place, however some shortfalls identified could place residents at risk. Evidence: The manager is a first level nurse with a degree in nursing education plus several post-graduate qualifications relevant to her role. Prior to becoming a manager, she had worked as a deputy manager for 4 years in nursing homes. Staff spoken with said that the manager is approachable and is implementing good improvements in the home. The positive impact of the manager on the home was also commented on in several of the CQC surveys returned. The manager confirmed that she was Care Homes for Older People Page 22 of 29 Evidence: commencing the process of applying for registration with CQC. Southern Cross has a comprehensive system in place for quality assurance, and it was clear that this is followed by the manager. Audits are carried out, and it was possible to see the improvements made in certain areas as a result of these audits, for example, medication management has shown a good improvement since robust systems have been put in place to address shortfalls identified in audits carried out in previous months. It was clear that the manager is very aware of what the areas are in the home that require improvement, and is working hard to address them and raise standards in a timely manner. There are several areas that are monitored, to include care planning, falls, pressure sores, health & safety checks and a full home audit, covering all aspects. Regulation 26 inspections are carried out on behalf of the Registered Person and reports from these visits were available to view. Staff meetings take place and minutes are clear and identify the areas requiring work. A relatives meeting had been planned for the second day of inspection, in the evening, and there were notices advertising this on display. The home has a computerised system for the management of residents personal monies. Each resident has a separate account and clear records of income and expenditure are maintained. We checked the records for 3 residents and these were clear and up to date. Receipts were available for all income and expenditure, and where a listed invoice is received for several residents, for example, chiropody payments, then the invoices and receipts are clearly cross-referenced. We sampled the servicing and maintenance records for the home and those viewed were up to date. The fire risk assessment was identified as having last been completed in August 2008 and during the inspection action was taken to arrange to have this reviewed and updated in November 2009. Fire drill records were viewed and regular day fire drills do take place. We found records for 2 night drills for 2009 and discussed the importance of ensuring these are carried out at intervals to ensure all staff are involved in drills at the required intervals. Risk assessments for equipment and safe working practices are in place. There was an issue with equipment being out of order or in need of replacement on the first day of inspection, to include the potato rumbler, one moving and handling hoist, the roller and hand held irons and a set of scales. It was identified that some items had been awaiting repair or replacement for some months, and this is not acceptable. We discussed this with the Registered Person on the first day of inspection and action was taken promptly to address the findings. The home has one passenger lift and there had been a series of issues with this, leading to 2 periods of it being out of order. On the last day of inspection the lift engineers were present and addressing the problem. It is acknowledged that replacement parts can Care Homes for Older People Page 23 of 29 Evidence: take some time to be delivered, however the impact on residents, visitors and staff in the event of a lift being out of order is significant, and this must be considered. The manager did place clear information throughout the building so that visitors were aware of the problems with the lift. The photocopier was also identified as not always functioning adequately, and we were informed that a new one had been ordered. Southern Cross Healthcare need to ensure that when equipment is reported as faulty or out of order, action is taken without delay to repair or replace the item, so that equipment is being reviewed and maintained in good order at all times. The home does not currently have an in-house trainer and we met the Regional Trainer who spoke with us and clearly understood the importance of ensuring all staff undertake training in health & safety topics at the required intervals. The manager had already carried out a training audit and training sessions were taking place at the time of inspection, with further sessions planned to ensure all staff are up to date with their training. Care Homes for Older People Page 24 of 29 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 25 of 29 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 7 17 Residents and their representatives must be involved in the formulation and review of the service user plans, unless it is impracticable to do so. This is so that the wishes of residents and their representatives are known and can be respected. 01/01/2010 2 7 17 Service user plan documentation must be accurate and up to date, to encompass all the needs of each resident, and how these are to be met. To ensure residents needs are identified and being met. 01/01/2010 3 12 16 The activities programme must be reviewed to meet the interests, abilities and needs of the residents. 01/01/2010 Care Homes for Older People Page 26 of 29 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 So that there is an activities programme that reflects the residents interests and wishes. 4 29 17 Staff employment records must contain all the information required under Schedule 2 of the Care Homes Regulations 2001. To protect residents. 5 30 18 That all staff receive training 01/03/2010 in dementia care. To provide staff with the skills and knowledge to care for residents effectively. 6 38 23 All equipment in use in the 01/12/2009 home must be maintained in working order. Any repairs or replacements identified must be carried out without delay. To ensure that the needs of the residents can be met at all times. 7 38 23 The fire risk assessment 01/12/2009 must be updated annually. There must be evidence that all staff have been involved in fire drills within the required timescales. To protect staff, residents and visitors. 01/12/2009 Care Homes for Older People Page 27 of 29 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 12 It is strongly recommended that work be carried out so that the management of activities can be based on dementia research outcomes, to ensure they are meaningful to the lives of residents with dementia care needs. Where assessed as appropriate, residents should be given the opportunity to go out into the garden and for walks locally, with staff to accompany them. That a path be created in the garden to provide ease of access across the garden for residents in wheelchairs. 2 12 3 19 Care Homes for Older People Page 28 of 29 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). 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