Care Home: Charlotte James Nursing Home

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What the care home does well There is safe and thorough recruitment of staff, this means the service provides safeguards for people who live at the home. We received positive comments about staff being caring and friendly. Peoples` needs are assessed before they come to live at Charlotte James. This gives the staff the information and confidence needed, and demonstrates they are aware of individual`s needs and are able to meet them. People are encouraged to visit the home prior to them deciding to come and live there. The home produces good plans of care offering information on daily routines, choices, likes, dislikes and preferences. This shows the service looks at every individual independently to ensure their needs are met. Comments offered include: "It`s lovely here, friendly and warm." "It is lovely to work here." "The girls are very nice." "They`re great!" "The girls are wonderful, nothing is too much trouble." "There is a nice atmosphere here." What has improved since the last inspection? The last key inspection was undertaken in January 2007, there have been no visits to Charlotte James since then. We have acknowledged that since the last key inspection the home has complied with the one requirement made, this was checked during our visit. The home had been asked to repair the driveway, this had been undertaken. We have reviewed our practice when making requirements, to improve national consistency. Requirements are made when it is considered that people who use service are being put at risk to their health, safety or welfare. No requirements were made on this inspection; consideration of recommendations made will continue to support the ongoing development and maintenance of the home. What the care home could do better: All comments, grumbles, `niggles` and compliments should be recorded to support the home with their internal quality assurance systems and help the management team evaluate any patterns or trends. The home should ensure all training and refresher training is current and up to date. This means the home can demonstrate the staff have the skills and knowledge needed to provide safe and effective support. Information within the home should be tailored to meet the needs of the people who live there. We recommend the home promotes pictorial and easy read literature when assessed as appropriate.The principles of respect, dignity and privacy are put into practice by the staff but there is room for improvement. The home needs to make sure they can evidence that people who use the service have been given the opportunity to contribute to their plan of care. This demonstrates the care provided has been agreed with the person directly. Medication administration charts should be completed on every occasion; this will ensure there is a clear audit trail. Key inspection report Care homes for older people Name: Address: Charlotte James Nursing Home Oakhurst Shobnall Road Burton On Trent Staffordshire DE14 2BB     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: Rachel Davis     Date: 1 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Charlotte James Nursing Home Oakhurst Shobnall Road Burton On Trent Staffordshire DE14 2BB 01283569417 01283542950 charlotte.james@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Name of registered manager (if applicable) Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 28. 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 (OP) 28, Physical disability (PD) 28 Date of last inspection 0 28 Over 65 28 0 Care Homes for Older People Page 4 of 31 Brief description of the care home Charlotte James is a 28 bedded care home providing personal and nursing support to adults. It is part of the Four Seasons Health Care group. The manager is presently re registering with the Care Quality Commission because she has moved from another care home within the company. The home is located off the main road on the outskirts of Burton Upon Trent, there are local amenities nearby. Ground and first floor accommodation is provided, there are single and double bedrooms available and some of these have an en suite. There are a number of communal areas including a conservatory overlooking the gardens. Fees range from £403:00 to £674:30, for up to date information regarding payment we recommend people contact the home directly. 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: This inspection took place over one day and was unannounced; this means the people who use the service and the staff did not know we were coming. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. We rate outcomes for people and these are described as excellent, good, adequate or poor based on findings of the inspection. This process considers the homes capacity to meet regulatory requirements, national minimum standards of practice and focuses on aspects of service provision that may need further development. Before visiting the home on this inspection, survey information was completed and returned to us by people who use the service and the staff. The service also has to complete an Annual Quality Assurance Assessment (AQAA) to tell us how they meet the needs of the people who use, or may use the service. This focuses on what they do well, how they evidence this, and any areas in need of improvement. Care Homes for Older People Page 6 of 31 We look around the home to make sure that it is warm, clean and comfortable. We look to see whether people who use the service are being protected and the arrangements the service has for listening to what people think about Charlotte James. Information is gathered from speaking to and observing people who live at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of the people using the service. 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: All comments, grumbles, niggles and compliments should be recorded to support the home with their internal quality assurance systems and help the management team evaluate any patterns or trends. The home should ensure all training and refresher training is current and up to date. This means the home can demonstrate the staff have the skills and knowledge needed to provide safe and effective support. Information within the home should be tailored to meet the needs of the people who live there. We recommend the home promotes pictorial and easy read literature when assessed as appropriate. Care Homes for Older People Page 8 of 31 The principles of respect, dignity and privacy are put into practice by the staff but there is room for improvement. The home needs to make sure they can evidence that people who use the service have been given the opportunity to contribute to their plan of care. This demonstrates the care provided has been agreed with the person directly. Medication administration charts should be completed on every occasion; this will ensure there is a clear audit trail. 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 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 10 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 are given suitable information about the home to help them decide if they wish to live there. Evidence is available to confirm peoples needs can be met prior to moving into the home. Evidence: We were told by the new manager that the Statement Of Purpose and Service User Guide are given to people who use the service when they move in. These documents were seen during the inspection process and contain all the information necessary. It is recommended that people using the service are informed that the Statement of Purpose and Service User Guide could be made available in a format appropriate to the people who use the service, their individual capacity and language. The home may also wish to consider an audio or pictorial version. Terms and conditions of residence are provided, this means people are clear of what to expect. Care Homes for Older People Page 11 of 31 Evidence: The AQAA tells us: Our Service User Guide is provided to all new residents on admission providing clear information regarding what the resident can expect from our service, with a detailed account of the quality of the accommodation, how to make a complaint and details of fee and payment arrangements which are included in our terms and conditions of residence. Trial periods are offered to those who would prefer short respite before committing to long term stay. The CQC latest inspection report and homes Statement of Purpose is on display in the reception area to provide any visitor with clear information about the home including the range of needs the home is intended to meet, criteria used for admission to the home, the arrangements made for respecting the privacy and dignity of our residents and how to make a complaint. Our inspection confirmed the above to be an accurate account. We can confirm people living in the home are assessed by the manager prior to moving in; this helps to ensure peoples individual needs can be met. Paperwork available and discussion with the manager told us that a full assessment before admission to the home is taken seriously and fully considered. Areas such as health care needs and social needs are discussed along with the individuals ability to live with the current group of people living at the home. We were able to speak with someone who had recently moved into the home they said; It is difficult but the staff have been kind and made me feel better. Standard 6 is not applicable to this home as it does not provide intermediate care. 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. People who use the service receive personalised care and support to meet their needs. Evidence: We are confident that everyone living at Charlotte James has an assessment of their needs from which a plan of care is developed. We found plans of care and care records are clear, informative, updated and reviewed. Care plans fully identify all the persons care needs and these are clearly managed. We checked to ensure paperwork such as fluid and turn charts were in place and completed as required, they were. We have recommended plans of care need to evidence a more person centred approach. This means the plans of care look at people in a very individualised way and offer evidence of peoples involvement and development of the plans. They also could include life histories so staff are able to tailor the way in which care is delivered to meet their specific need. The management team have confirmed this is on their agenda and will be addressed. Care Homes for Older People Page 13 of 31 Evidence: There are care risk assessments in place for potential poor nutrition, pressure sores, falls, and the use of bed rails and we found these risk assessments are regularly reviewed. We were able to see that people are seen by other health professionals such as doctors, dentists, chiropodists, opticians and district nurses when clinically indicated. The home has a key worker system which enables staff to establish special relationships and work with people on a one to one basis. We spoke with a number of staff who told us they really liked working at the home and felt well supported. In some instances they thought communication and relationships between the nursing staff and care staff could be improved. For example: Training on why we do things such as fluid balance charts would be useful as some staff dont know how to fill them in properly, or the reasons for their use. Staffing levels can be stressful and we dont always feel we have enough time to spend with the residents. We observed the nurse administering medication at lunchtime and saw she was following appropriate procedures in handling and recording what she gave to people. The nurse kept the medication secure at all times. We have made two recommendations; this is because there were some gaps in medication administration records. This means there are no assurances the medication was administered. We also noted the medication room has been registering over 25 degrees for a few days. This should be considered to ensure medication is stored at the correct temperature. We checked the records and storage for controlled drugs. These were accurate and well managed the home has the appropriate controlled drugs register to comply with the safe handling and recording of medication. The manager is completing competency checks and she advised us that the staff are receiving updated medication training where needed. We were able to observe staff talking with people who use the service, they were respectful and polite. We noted the staff knocking on doors and people told us the staff were kind and friendly. We heard some language that we felt could be improved upon and saw screening was not used when the bedroom door was open. We discussed these areas with the manager who will address these custom and practice issues directly. We were pleased to see where people remained in bed they had easy access to their nurse call systems. This means they can call for assistance easily and Care Homes for Older People Page 14 of 31 Evidence: as and when required. 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. The people who live at Charlotte James can be confident their social needs are met and they are supported to maintain relationships with friends and family. Evidence: The home has an activities coordinator therefore there is a structured activity programme with evidence of what activities are provided. This was not seen on the day so we have asked the manager to follow this up to ensure they are happy with the records. Questionnaires returned to us stated: There are regular outings to local shops and garden centres. They allow me to have whiskey and tobacco delivered. People we spoke with told us: There is regular entertainment. They provide us with games, quizzes, dominoes. The staff will sit and talk with us. There had been an entertainer the previous day, one lady told me they had had great fun she said, all the staff joined in with the sing-song and we were really enjoying Care Homes for Older People Page 16 of 31 Evidence: the afternoon, we have a good laugh. We could also see that weekly external entertainment was available and a list was placed in the lounge for people to see. This includes religious observance. Staff questionnaires returned said: We have a good rapport with residents and family. We have regular entertainment. We encourage choice and independence. The home provides a range of activities, likes and dislikes are taken into account. The AQAA tells us: Groups from the local community are encouraged to visit the home such as the local school and church choirs, Holy Communion takes place once a month, the mobile library also visits with large print books and listening books, a variety of entertainments are organised weekly. Local school visit at spring, Easter, Harvest and Christmas to entertain our residents. The activities co-ordinator seeks the views of the residents when she is planning forthcoming activities within the home and trips out of the home. Areas available to us are garden centres, waterside walks and feeding the ducks followed by lunch or afternoon tea and various centres of interest. During our inspection process we were able to verify this statement. We did not inspect the kitchen on this visit; the service has a recent five star rating from Environmental Health. The meals are served in the dining room and the delivery of the mid-day meal was observed. Meals are served individually to the people who use the service; some people chose to remain in the lounge, conservatory, outside or in their own room. The occasion was relaxed and pleasurable. Three people we asked told us they enjoyed their meal. Of the five people we asked only one knew what was for lunch, it was chicken pie, presently a recorded alternative is not available. Pureed meals were served to those who required a soft diet and it was pleasing to note all foods were pureed separately. Everyone seen had a glass of juice with lunch and there was a choice. The regional manager has started to work on the menus, choice, an everyday alternative, better visual prompts to assist with understanding, a hot trolley has been Care Homes for Older People Page 17 of 31 Evidence: ordered, and kitchen staffing levels are being improved. These changes will ensure an improved outcome in this area for the people who use the service. We are also informed people who use the service are being involved with these changes. 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. There are adult safeguarding policies and procedures in place but since the last inspection they have not always been followed correctly. Following discussions we are confident the new manager is clear of the procedure to follow. Evidence: People can access the complaints procedure because it is displayed in the reception hall (although difficult to see because it is sited near the office). It is also available within the Service User Guide. The complaints book identified one complaint since the last inspection, this had been dealt with and concluded. Through discussion it was evident other issues, grumbles or concerns had been raised but not recorded. We recommend all comments are evident to support the service with identifying how changes are made to improve the services for the people who live there. We also recommend a complaints/suggestions box where people can offer their views anonymously if they so choose. Safeguarding Adults is a process of identifying and reporting suspected or potential abuse to vulnerable people and provides a framework of consistency to protect those individuals who are at risk. During our inspection we check to ensure vulnerable people are suitably protected. There have been a number of safeguarding referrals Care Homes for Older People Page 19 of 31 Evidence: made since the last inspection. We discussed these at length and our inspection concluded that although some issues were not dealt with as they should have been the manager in post has a clear understanding of the correct procedure to follow. We looked at a recent occurrence and were satisfied that suitable action had been taken. We have liaised with the local authority and fed back our findings. We have asked the home to obtain a copy of the safeguarding of adults policy from the Local Authority. This supports the agency in ensuring they follow procedures correctly. We could see from records some staff still require training in this field and this should be implemented as quickly as practicable. The manager needs to ensure staff are made aware of The Mental Capacity Act Deprivation of Liberty Safeguards. They must be aware of their responsibilities and ensure there are no other less restrictive ways of keeping people safe and well if liberty is compromised. Decisions must always be in the persons best interests and assessments and questions must be satisfactorily answered. We have asked the home to follow this through and ensure records are in place to evidence liberty is not compromised where people lack capacity. Applications should be made to the local authority if necessary. The home have initiated policies and procedures as required, these now need following up and documentation should be available on peoples plans of care to confirm this has been considered where people lack capacity. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is warm, safe and well maintained. Evidence: Charlotte James is clean and homely, there was no mal odour noted during our visit. The home has a variety of aids and adaptations which are suitable for dependent people, there is a staff call bell system throughout the home. We checked with staff and they felt there was enough equipment to support the people living there. Door guards have been fitted to bedroom doors where people wished their door to remain open. We noticed screening was not used when a shared room bedroom door was left open, if this is at their request it should be noted on the plan of care. Toilets are situated throughout the home, are accessible, and have grab rails. We noted two bathrooms upstairs did not have locks or privacy signs, we have asked the manager to ensure people who use the service have the option to maintain privacy in these areas. We saw that bedrooms have been personalised and were individualised to the poeple who use the service. No one has a key to their bedroom again we have asked the manager to ensure they can evidence people have had the choice, this should also be Care Homes for Older People Page 21 of 31 Evidence: addressed regarding lockable storage in bedrooms. Cleaning products and other solutions are locked away reducing hazards to the people who live there. We noted one cupboard was open during our inspection but this was dealt with straight away. A number of people who live at Charlotte James have dementia related conditions. We recommend the home should look at providing information to support people with orientation. This may include some notice boards in key areas offering the date, staff information, symbols and pictures regarding meals and activities for example. Photographs for toilets and bedrooms should also be considered. We found infection control procedures are in place, such as liquid soap, gloves, aprons and paper towel dispensers. We did not inspect the laundry area on this visit. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited and supported appropriately. The home needs to ensure all staff have received their mandatory training updates to confirm the staff have the skills and knowledge necessary to meet peoples needs. Evidence: The AQAA tells us: Four Seasons Health Care take training and supervision of their staff very seriously. The home has an in-house moving and handling trainer, fire trainer and health and safety trainer. All Staff meetings, dignity, clinical governance are minuted and minutes of all meetings are held on file in the managers office. All staff are issued with accurate job descriptions which clearly define their roles within the home. Comprehensive two day induction for all new staff with induction work book. Probation period evaluated Up to date training matrix Twelve of 23 care staff have a National Vocational Qualification in care at level 2 and/or 3. We are able to verify this evidence. During the time we spent at Charlotte James we spoke to a number of staff and observed or heard them supporting people. We found there were very positive and engaging interactions between those people living at the home and the staff members. People told us they like the staff and they undertake the tasks well, they also said the staff are caring and do not rush them. Care Homes for Older People Page 23 of 31 Evidence: Duty rotas were not checked on this visit but we saw enough staff on duty in the morning to meet the needs of people who use the service and we can confirm the home has a consistent staff group. We discussed the afternoon staffing because care staff had to go and prepare the tea. This was due to staff shortages, the regional manager is looking at this shortfall. We looked at the files for two members of staff including the last person to be recruited. The new file contained two written references, identification, a Criminal Record Bureau disclosure and an Independent Safeguarding Authority ( ISA) first check. This means staff have been suitably vetted prior to working with vulnerable adults. We were also able to evidence that staff had worked alongside established staff before working as part of the staff numbers. This is known as shadowing and enables staff to understand their role and ask experienced staff any questions. The files also contained evidence of training that has been completed, this included mandatory training and additional training to support the needs of the service. Not all training is up to date but the home has ensured this will be rectified in a timely way, the company are able to provide all the necessary courses. We also spoke with other staff who confirmed that the transition to the new manager had been brilliant. They considered staff dynamics were improving and communication could be better. An example of this was care staff receiving feedback if the Doctor had visited. Staff told us Charlotte James was a really nice place to work. They also stated on questionnaires the following: The staff know place of work is residents home and keep it homely. Opinions of residents listened to and respected. Care is good. Care staff encouraged to work alongside nursing staff to see the wider picture. We are a friendly home. We pride ourselves in striving to deliver high standards of care. Staff tell us they feel valued and respect their manager. This is what the staff told us they think they can do better, the regional manager has stated she will look at the issues with the manager to see if any of the following can be implemented to improve outcomes for the people who live there. Wider range of meals, choice of meals could be offered. The staff moral gets low sometimes as Care Homes for Older People Page 24 of 31 Evidence: extra workload when people are off sick and there is no cover. An afternoon cleaner to maintain standards. We could do with someone at 7am instead of 8am as breakfast can be late for some. Frequent that staff phone in sick and no cover. Training on why we do things such as fluid balance charts as some staff dont know how to fill them in properly or the reasons for their use. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and being run in the best interests of the people who live there. Evidence: A new home manager is currently managing the home since the departure of the person who was the registered manager earlier this year. We saw and heard evidence to validate the manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The home manager is an experienced qualified nurse and is a registered manager within the company. At the time of this inspection the manager was preparing to apply for re- registration with us. Management policies are effectively implemented and monitored. The manager operates procedures that seek to ensure the quality of the service provided is good. Care Homes for Older People Page 26 of 31 Evidence: Where it is identified as not being up to standard they take appropriate action to rectify the situation. The manager regularly conducts formal audits of various aspects of systems and procedures operated by the home. For example care records are periodically checked to ensure they properly reflect the care and support needed by the people who use the service. The managers area manager visits the home regularly and conducts their own audit of the home. All quality assurance outcomes are made available for people to read and are sited in the reception area. We received confirmation from the homes administrator that no finances or personal allowances are held for people who use the service by the home. Supervision of staff is undertaken but some timescales have slipped the manager is aware of this and will prioritize supervision sessions. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 It is recommended that information is made available to confirm that the Statement of Purpose and Service User Guide are available in a format appropriate to the people who use the service, individual capacity and language. Continue to improve the contents of plans of care to evidence people have been included in their making. This will confirm people who use the service agree with, and have been involved in their content. The home should seek professional advise if the temperature in the medication room remains over 25 degrees. Ensure medication administration records are completed on all occasions. This means there is a clesr audit trail to confirm medication management. The home should continue to work closely with staff to ensure privacy and dignity is maintained at all times. This is to include suitable records pertaining to screening in shared bedrooms. Continue to inform and advise staff on issues pertaining to dignity and respect. Page 29 of 31 2 7 3 9 4 9 5 10 6 10 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 8 15 15 An alternative meal should be recorded on menus. This means choice is available to everyone using the service. There should be daily menus produced in appropriate formats, such as large print or pictorial, suitable for people with dementia or sensory impairments to assist their understanding and help them make realistic choices. The home should provide a suggestions, comments or complaints box which is easily accessible. This is so people may provide information anonymously if they so choose. The home should ensure they have a copy of the Local Authority safeguarding adults procedures. This ensures the service has all the up to date information readily available and is confident they have followed the correct procedure. Appropriate locks and/or signage need to be available on all bathrooms and toilets to promote privacy. Orientation information should be considered to help support the people who live there. The home should ensure they have suitable information available to confirm people who use the service have been offered a key to their room and/or a lockable facility within their room. The home needs to ensure that all products hazardous to health are locked away at all times. This is to ensure the safety of the people who live there. Ensure that staff receive regular supervision so that people know the staff are appropriately managed. Prioritised action must be taken to ensure essential mandatory up to date training is provided for all staff commensurate to their role. 9 16 10 18 11 12 13 19 19 19 14 26 15 16 36 38 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). 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