Care Home: Charles Lodge

What the care home does well The admission process ensures that only residents whose needs can be met are admitted to the home. Residents` needs are being met with the information provided in the care plans on the assessed needs of individuals. Resident`s routines are to their own choice and preference. Residents` are provided with sufficient stimulation to fulfil their interests and needs. Residents` choice and preferences are catered for with meals. Visitors are welcomed at the home. Residents know how to make a complaint, reassuring those involved that they are being listened to and that action will be taken, if necessary. Safeguarding Adults procedures ensure residents are safeguarded. Residents live in a homely environment and are provided with comfortable indoor communal facilities. Residents` needs are being met with the number and skill mix of staff on duty. Some written comments from residents on what the home does well were: `Most needs are met`, Look after us`, `Everything in my eyes` and `Look after my interests`. Staff wrote what the service does well were: `Everything`, `Safe and friendly environment for residents`, `Approachable manager` and `Responds to staff/clients complaints and needs`. What has improved since the last inspection? Work has been done to ensure compliance with all seven requirements made at the last inspection. Risk assessments have been expanded to provide guidance for staff on how to reduce the risk, ensuring the safety of the residents. More robust medication procedures are being followed in relation to handling and administering of medicines to ensure residents and staff are safeguarded. Confirmation was provided and action taken to ensure the controlled drugs cabinet complies and is installed in line with current legislation. More robust recruitment procedures are being followed to better safeguard residents and to evidence that staff have the skills and experience necessary for such work. A quality assurance and quality monitoring system has been implemented to ensure that the home is run in the best interest of residents and that the aims and objectives of the home are met. Confirmation was obtained from a fire safety office to confirm that fire safety procedures were in place to ensure the health, safety and welfare of all people within the home. An environmental risk assessment was undertaken and action taken where identified as being necessary to ensure the home is free from hazards. Any good practice recommendations made at last inspection have been actioned to better improve the service and further safeguard residents and staff. The AQAA identifies areas that the home has improved within the last 12 months andan example given of changes they have made as a result of listening to residents is following a fete at the home, they have purchased some bird table and a bird bath. What the care home could do better: No requirements have been made as a result of this inspection. Some recommendations were made to the Registered Manager at the site visit and are reflected throughout the content of this report. The AQAA lists some areas that the home has identified in what they could do better and their plans for improvement in the next 12 months. They will continue to monitor the service and be guided by what residents want. When asked what the home could do better, some written comments from residents were: `Nothing`, `Really well run`, `I am perfectly happy here` and `In my eyes nothing`. One comment was `planned, appropriate, stimulating activities regularly provided`. Comments from staff on what the service could do better were: `Nothing`, `Hold regular staff meetings`, `Need an activity budget` and `There could be much more communication between management and staff`. These points are for the home to action if necessary. Whilst the overall outcome for residents is good, work must be done to improve the information provided in the AQAA when we next ask for it. All key standards must be addressed and clearer evidence be provided. It is in the homes best interest to demonstrate clearly that they continue to provide good outcomes when we next use their AQAA to assess the services they are providing. The Registered Manager demonstrates a willingness to improve the service and ensures any requirements made are complied with. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Charles Lodge 75 New Church Road Hove East Sussex BN3 4BB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jennie Williams     Date: 0 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Charles Lodge 75 New Church Road Hove East Sussex BN3 4BB 01273777797 01273777797 Gloria.Draper@njch.co.uk 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) : Nicholas James Care Homes Ltd care home 27 Number of places (if applicable): Under 65 Over 65 0 27 dementia old age, not falling within any other category Additional conditions: 27 0 The maximum number of service users to be accommodated is 27. The registered person may provide the following category/ies of service only: Care home only - (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 (OP). Date of last inspection Brief description of the care home Charles Lodge is a care home registered for twenty-seven (27) places for residents, of either gender, aged sixty-five (65) years or over on admission. The home is registered for personal care only and can accommodate a maximum of fourteen (14) residents with a dementia type illness. No nursing care is provided at the home. The home is not registered to provide nursing care. District nurses will supply nursing input when needed. The home is part of the Nicholas-James Care Homes Ltd company, who own numerous care homes throughout England. The home is located within a residential area in Hove. It is located at the end of a Care Homes for Older People Page 4 of 29 Brief description of the care home private road. There is limited car parking available at the home. There are local amenities in the area and there is nearby access to public transport. Residents accommodation is located over three floors that are all serviced by a passenger shaft lift to ensure residents are able to access all areas of the home. There are seventeen (17) rooms for single occupancy, of which fourteen (14) have en suite facilities. There are five (5) double rooms, of which all have en suite facilities. The Registered Manager confirmed that all rooms are used as single occupancy unless people have made a decision to share. The home has a lounge, dining room and additional sun lounge at the front of the home. There is garden area within the grounds that residents are able to access. There are suitable numbers of assisted bathing facilities and communal toilets located throughout the home to meet the needs of residents. Fees range from 322 pounds to 600 pounds per week. Additional fees are: hairdressing, chiropody, personal toiletries and newspapers/magazines (at cost). This information was provided to us on the 07 May 2009. 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: It has been identified that service users prefer to be called people who use services. People living at this service are called residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced key site visit took place for five and a half hours on the 7 May 2009. Evidence obtained at this site visit and information that we have received since the last inspection forms this key inspection report. An annual quality assurance assessment (AQAA) was sent to us by the service, completed by the home on the 11 March 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave Care Homes for Older People Page 6 of 29 us some numerical information about the service. The last key inspection was undertaken on the 19 June 2008. Fifteen residents were met at lunch time and advised to let us know if they wished to speak individually with us. Three residents were spoken with individually. Ten resident surveys were sent to the home prior to the site visit, of which eight were returned. These identified they were completed independently or with help for someone, either a relative or staff member. One care plan was viewed and specific areas of care observed in a further eight care plans. Ten staff surveys were sent to the service prior to the site visit, of which eight were returned. One staff member was spoken with during the site visit. Four staff files were viewed, along with training records for an individual. A brief tour of the environment was undertaken and some individual rooms were viewed. Medication procedures were inspected. The quality assurance system was discussed and recent results viewed. Procedures for dealing with complaints and Safeguarding Adults were viewed/discussed. There were twenty-three residents residing at the home on the day of the site visit. What the care home does well: What has improved since the last inspection? Work has been done to ensure compliance with all seven requirements made at the last inspection. Risk assessments have been expanded to provide guidance for staff on how to reduce the risk, ensuring the safety of the residents. More robust medication procedures are being followed in relation to handling and administering of medicines to ensure residents and staff are safeguarded. Confirmation was provided and action taken to ensure the controlled drugs cabinet complies and is installed in line with current legislation. More robust recruitment procedures are being followed to better safeguard residents and to evidence that staff have the skills and experience necessary for such work. A quality assurance and quality monitoring system has been implemented to ensure that the home is run in the best interest of residents and that the aims and objectives of the home are met. Confirmation was obtained from a fire safety office to confirm that fire safety procedures were in place to ensure the health, safety and welfare of all people within the home. An environmental risk assessment was undertaken and action taken where identified as being necessary to ensure the home is free from hazards. Any good practice recommendations made at last inspection have been actioned to better improve the service and further safeguard residents and staff. The AQAA identifies areas that the home has improved within the last 12 months and Care Homes for Older People Page 8 of 29 an example given of changes they have made as a result of listening to residents is following a fete at the home, they have purchased some bird table and a bird bath. 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 set out 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. The pre admission process ensures that only residents whose needs can be met at the home are admitted. Evidence: The home has a Statement of Purpose and Service Users Guide that is available at the home and provides prospective residents/representatives with information about the services and facilities provided at the home. These documents advise that they are available in other formats on request. The Statement of Purpose provided was dated May 2006 and some contact details in this needs to be updated. All resident surveys identified that they received enough information about the home prior to moving in to help them decide if the home was the right place for them and they have all received a contract. Care Homes for Older People Page 11 of 29 Evidence: The Registered Manager confirmed that she or the deputy manager undertakes an assessment on all prospective residents to ensure that their needs can be met with the services and facilities provided at the home. Additional information is obtained from social services and other health professionals wherever possible. The home is registered to accommodate people requiring personal care only and people who may have a dementia type illness. The Registered Manager confirmed she keeps in mind the needs of existing residents when assessing any prospective resident. There was a pre admission assessment observed to be in place for a newly admitted resident. The Registered Manager confirmed that there was no one residing at the home from any minor ethnic community, social/cultural or religious groups with any specific needs. Prospective residents/representatives are encouraged to visit the home prior to admission. Of the residents that were asked, all confirmed that they or a representative visited the home prior to moving in. Some written comments received from residents were: I am perfectly happy here, I have been here for years now and I am very happy and I cant think of anywhere else I would want to be. One resident commented to us best place to be in around here. The home does not have dedicated accommodation to provide intermediate care, however respite is available if there is a spare place. Care Homes for Older People Page 12 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. Residents needs are being met with the information provided in the care plans on the assessed needs of individuals. Residents are safeguarded by the medication procedures in place. Evidence: There was evidence of care plans providing information to staff on how to meet the assessed needs of individuals. The home ensures pre populated information in care plans are personalised to individuals and review these on a monthly basis or earlier if the needs of an individual changes. There was evidence of a care plan being in place for a newly admitted resident. Specific areas of care viewed identified that there were guidelines in place for staff. There is documentation in place to evidence where an individual has chosen not to be involved in the reviewing of their care plans. There is no key worker system at the home and management ensure care plans are updated, with input from staff and the resident, where they have chosen to be involved. The Registered Manager confirmed that they have added additional information to care Care Homes for Older People Page 13 of 29 Evidence: plans and risk assessments since the last inspection. Risk assessments provide guidance for staff on how to reduce the risks and these are reviewed regularly with the care plan. Daily notes are improving, however not consistent amongst the staff team. The Registered Manager confirmed she monitors these to ensure that clear information is provided to evidence that care is being provided, as detailed in the care plan. It was observed that care plans contain a brief overview of the individuals preferred routines, such as going to bed, getting up etc. Care plans also identify if an individual prefers a male or female carer. There is currently no male carer working at the home. The Registered Manager confirmed that this has not been an issue to date with the male residents residing at the home. This was also confirmed to us by a male resident. Staff surveys identified that they are always/usually given up to date information about the needs of the people they care for. All resident surveys identified that they receive the care and support they need. The home accesses input from other health professionals when the need arises. Seven resident surveys identified that they always receive the medical support they need. Where it was identified that a pressure relieving mattress was required for an individual, the Registered Manager was advised to check with the supplying professionals that this was being used at the correct setting to ensure the residents well being is promoted. No requirement or recommendation has been made in relation to this as the Registered Manager will address it. Some written comments from staff and residents were: I find it very good and the staff very kind and helpful, I am very happy here and hope that I stay until my time comes, Residents are extremely well looked after.... and respects equality and diversity of all service users and employees. Promotes the wellbeing of service user and employees. It was confirmed that there are policies and procedures in place for all aspects of dealing with medicines. Medication Administration Records (MAR) charts and blister packs viewed identified that accurate records are generally being maintained of medicines administered within the home. There was one incident where an additional tablet had been taken from the blister pack and no records to identify why this had occurred. The Registered Manager will address this with staff. Residents are provided with a choice to self administer, if they wish and a risk assessment identifies it is safe for them to do so. The Registered Manager advised that since the last inspection, the home is receiving a better service from their supplying pharmacist and communication regarding Care Homes for Older People Page 14 of 29 Evidence: medication has improved within the service. These improvements have assisted in addressing the shortfalls noted at the last inspection, ensuring residents and staff are better safeguarded. There were no controlled drugs currently in use at the home. The Registered Manager confirmed that their controlled drugs cabinet complies and is installed in line with current legislation. We were informed by the home regarding missing controlled drugs in August 2008. The home took appropriate action to put in safeguard measures and reported to the appropriate authorities. Staff were observed to have a good professional rapport with residents and were heard calling them by their preferred term. All resident surveys identified that staff always/usually listen and act on what they say. Staff were observed to knock on resident individual room doors prior to entering. Care Homes for Older People Page 15 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. Residents lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. Residents choice and preferences are catered for with meals. Evidence: It was observed on the day of the site visit that there was a relaxed homely environment and residents were seen to move freely around the home, doing what they wished when they wanted. Seven resident surveys identified that there is always/usually activities arranged that they can take part in if they want. One identified there are sometimes activities. Since the last inspection, the Registered Manager confirmed that an additional carer works two or three afternoons a week to facilitate activities for the residents. Some residents go out for walks and the home is working to getting others outside of the home environment. No group outings are arranged. One resident commented to us plenty of activities to get involved in if I choose, I dont want to. Feedback from one resident was shared with the Registered Manager Care Homes for Older People Page 16 of 29 Evidence: regarding them being able to go out into the community. Action was already being taken in relation to this and the Registered Manager followed this up whilst we were at the site visit. For one resident who commented that there was not enough to do, they could not provide us with any suggestions on what else the home could offer. Visitors are welcomed at the home. One resident wrote Access to relatives, personal friends and other visitors is very generous, always a welcome cup of tea/coffee and biscuits. There are no visiting restrictions. There was evidence at the site visit that residents have choice and access to advocacy services if they wish. It was confirmed that some residents attend a church near the home. There is a four week rolling menu at the service. Six resident surveys identified that they always like the meals at the home and two stated they usually like the meals. Menus are on display advising the main meal for the day. Alternative choices are advertised on a board. A written comment was Food, care and cleanliness, Excellent. A written comment from staff was If they do not like a particular diet, they are given some other food to their liking. Feedback is sought from residents regarding meals to ensure they are happy with service provided. Care Homes for Older People Page 17 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. Residents know how to make a complaint, reassuring those involved that they are being listened to and that action will be taken, if necessary. Safeguarding Adults procedures ensure residents are safeguarded. Evidence: There is a complaints procedure available at the home. There have been no complaints made to the service since the last inspection. No concerns have been expressed directly to us regarding the service. One resident advised us that they had constantly complained about doors banging at night time; however nothing had been done about this. There were no records in relation to this, however the Registered Manager confirmed that she will discuss this with the individual and try to resolve their concerns. All resident surveys identified that there is someone they can speak to informally if they are not happy and seven identified that they knew how to make a formal complaint. Seven staff surveys identified that they know what to do if someone raises concerns about the home. There had been two Safeguarding Adults referrals made in the last 12 months. There was evidence that the home takes appropriate action and notifies the relevant Care Homes for Older People Page 18 of 29 Evidence: authorities. These incidents were not related to care issues within the home. Following relevant advice, the home took appropriate action to ensure incidents are not repeated and to further safeguard residents. The home is co-operative with the investigating authority. The Registered Manager confirmed that staff receive annual training in Safeguarding Adults procedures. She is in the process of arranging training with local authority designed for managers. Care Homes for Older People Page 19 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. Residents live in a homely environment and are provided with comfortable indoor communal facilities. Evidence: The home is located in a residential area within Hove. It is located at the end of a private road. There is access to nearby shops and public transport. A brief tour of the environment was undertaken that identified that residents live in a homely environment that is generally well maintained. Rooms visited were seen to be personalised to reflect the individuals choice and character. The AQAA identified and the Registered Manager confirmed that shortfalls noted at the last inspection have all been addressed. Action taken has ensured the environment is cleaner and safer for residents to live in. Following a previous recommendation, the home has sought telephone advice from the Health Protection Agency in regards to good infection control practices when no sluice facilities are available. The Registered Manager confirmed that it was confirmed that they have suitable procedures in place to ensure staff and residents are safeguarded. It was confirmed that minimum people currently residing at the home require using Care Homes for Older People Page 20 of 29 Evidence: commodes. The home appeared clean on the day of the site visit. All resident surveys identified that they find the home always/usually fresh and clean. There is protective clothing located throughout the home for staff to use. Gel is located throughout the home and by the visitors book to encourage people to use, assisting in infection control. A cleaner spoken with confirmed that they have been provided with infection control training. The AQAA identifies that 10 staff have received training in prevention and control of infection and they have an action plan to deliver best practice in prevention and control of infection. Cleaning equipment is stored outside and it was confirmed that some cleaning equipment is taken through the kitchen into the home. This practice needs to be assessed for risk of contamination in the kitchen and action taken to prevent this practice if identified as being needed. A written comment from a resident was ...I know that everywhere is kept lovely and clean and we are all fed well. One staff wrote Need a sluice for bed pans. A team of cleaners (or constant regular cleaner). Often the cleaner will step in to help out if an employee calls in sick. The cleaner is also training to provide care work. This is for the home to assess and action if needed. The AQAA identifies that the home has achieved a four star hygiene rating and they now do an annual infection control audit provided by the Health Protection Unit. The AQAA identifies that they will continue to look for areas that need improving within the environment. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are being met with the number and skill mix of staff on duty and are safeguarded by the recruitment procedures in place. Evidence: Resident surveys were complimentary about the staff with comments being: All the staff are friendly and the manageress always helpful, wonderful staff and the staff very kind and helpful. Written comments from staff also identified that they are generally happy working at the home. Comments were: Promotes the well being of service users and employees, Looks after staff and residents well and Quite relaxed environment which rubs off on the residents and staff. Seven of the staff surveys identified that there is always/usually enough staff on duty to meet the needs of residents. Five resident surveys identified that staff are always available when needed and three identified they are usually available. Staffing numbers are usually three carers in the morning and one carer/kitchen person, two carers in the afternoon and one carer undertaking kitchen duties. The Registered Manager works during the day time. Two staff work a waking night. Care staff undertake laundry duties throughout their shifts. The AQAA identifies that there is 18 permanent care workers at the home, of which six Care Homes for Older People Page 22 of 29 Evidence: have National Vocation Qualification (NVQ) level 2 or above. The Registered Manager confirmed that four staff are just finishing these studies and two staff have just enrolled to undertake these studies. Four staff files were viewed. References are obtained, Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks are undertaken and application forms are completed. One file had a reference missing; the Registered Manager has taken action to address this. Where staff have commenced employment on just a POVA First check, the Registered Manager confirmed that they work supervised until an enhanced CRB is returned. It was recommended that interview notes be maintained when interviewing prospective staff to evidence why they think the candidate is suitable to work at the home and to assist in evidencing good equal opportunities practices. The AQAA identifies that seven staff have left employment in the last 12 months and no agency staff have required to be used in the past three months. Regular staff assists is promoting continuity of care for residents. It was confirmed that staff are kept up to date with mandatory training. Seven staff surveys identified that they are provided with training that is relevant to their role, helps them to understand and meet the individual needs of residents, keeps them up to date with new ways of working and gives them enough knowledge about health care and medication. All surveys identified that staff felt they always/usually have enough support, experience and knowledge to meet the different needs of people who live at the home. There was evidence of training records in a staff file viewed. New staff currently do not have contracts in place, however the Registered Manager advised that the company is currently addressing this. The Registered Manager confirmed that all new staff now complete the Common Induction Standards as set by Skills for Care. If a new staff member has NVQ qualifications, an in house induction is undertaken. Care Homes for Older People Page 23 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 home is generally run in the best interest of residents. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. Evidence: The Registered Manager is registered with us and has the suitable skills and experience to manage the service. She has completed NVQ level 4 in management and the AQAA identifies that she and the deputy manager will be looking into accessing NVQ level 4 in care to undertake. The Registered Manager ensures she keeps herself up to date with current practices and attends training sessions that are provided to staff. The Registered Manager also receives support form a representative within the company when needed. There were information leaflets within the home in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). The Registered Manager has a Care Homes for Older People Page 24 of 29 Evidence: folder with information relating to these subjects that staff have access to. The Registered Manager confirmed she will be looking into accessing training for this. A scenario was provided to us of an incident that occurred a few months ago. The Registered Manager was advised to contact the supervisory body for advice in case a similar incident was to occur again. There is currently no application for authorisation being processed for any resident. Whilst no information was provided in the AQAA in relation to the homes quality assurance and quality monitoring system, the Registered Manager was able to evidence that systems have been put in place since out last inspection. Health and safety checks are undertaken and the Registered Manager/deputy manager monitor medication practices, do reviewing of care plans and observes the environment etc as part of their internal checks. Recent results from the homes own quality monitoring surveys from residents and relatives were overall positive. The Registered Manager proposes to do these twice a year and to do a brief summary of results to display within the home. The home will obtain feedback from visiting health professionals and it was recommended that these actively be sent out to GPs etc. There are currently no surveys implemented for staff. Two staff surveys identified in what the service could do better is to have regular staff meetings. There was evidence of monthly visits being undertaken by a representative of the company, as required by legislation. Reports are provided to the Registered Manager following these visits, who addresses any action that is required. This monitoring assists in evidencing that the home maintains compliance with current legislation and the aims and objectives of the home are met. Whilst the overall outcome for residents is good, work must be done to improve the information provided in the AQAA when we next ask for it. All key standards must be addressed and clearer evidence be provided. It is in the homes best interest to demonstrate clearly that they continue to provide good outcomes when we next use their AQAA to assess the services they are providing. Discussions were had with the Registered Manager on ways this document can be improved. The home does not hold any personal allowances. Residents maintain their own finances or have made their own arrangements if they require assistance. The AQAA identifies that equipment in use has been tested or serviced as recommended by the manufacturer or other regulatory body and that all relevant Care Homes for Older People Page 25 of 29 Evidence: policies and procedures are in place. Since the last inspection, the Registered Manager confirmed that an environmental risk assessment was undertaken and action taken where identified and have addressed shortfalls noted at the last site visit. A fire safety officer, from the local authority, has visited the home and the Registered Manager confirmed that all points raised has been actioned. Additional dorguards have been put in place, an additional smoke detector has been placed in a corridor and the home has implemented individual evacuation plans for residents in the event of an emergency arising. Fire drills are done four times a year and the Registered Manager confirmed that following a previous requirement she consulted with a fire safety officer, who confirmed that there fire procedures within the home are suitable. Care Homes for Older People Page 26 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 27 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 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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