Care Home: Charlton House

What the care home does well Charlton House continues to update and maintain the decoration of the home and upgrade the environment for the comfort of the people who live at the home taken into consideration. All food is freshly prepared on site and a choice of meals is always available. The people spoken to during the inspection stated that the care and support provided by the home was very good. Observation throughout the inspection showed the staff to be being kind gentle and very caring towards people living in the home. The home benefits from having a long serving staff team to promote continuity in care. One relative, on behalf of someone living in the home, in a survey returned to the Commission, under what does the home do well wrote, "Make you feel at home and treat you individually". The Expert by Experience wrote in their report, "The overall impression was that Charlton House is a well-managed, clean, comfortable and caring establishment without the institutional feeling to be found in some similar places of this size". What has improved since the last inspection? The owners continue to invest in the home to provide a pleasant environment for everyone living there. Ongoing updates were being carried out during the inspection and included a large extension to increase the number of people who will be able to live in the home, providing en-suite facilities for some of the bedrooms and adding a new toilet to the ground floor. The home has also converted 2 double rooms to single rooms with en-suite facilities. What the care home could do better: The home must record the actual dose administered when a medicine is prescribed with a variable dose. The home must store all medicines securely and in accordance with current regulations. Key inspection report Care homes for older people Name: Address: Charlton House 55 Mannamead Road Mannamead Plymouth Devon PL3 4SR     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: Kim Fowler     Date: 0 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Charlton House 55 Mannamead Road Mannamead Plymouth Devon PL3 4SR 01752661405 01752661405 charltonhouse.residentialhome@me.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Gill Boyes,Mrs Tonya Gerry care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 43 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Charlton House is a large Victorian property, which is owned by Mrs Gill Boyes and her daughter, Mrs Tonya Gerry who is also the registered manager. Charlton House is registered as a care home for forty-three older people and include up to 5 people who may have dementia. The home is a large and spacious with 5 lounge rooms which gives the feeling of living in a much smaller home. Thirty rooms have en suite facilities. A limited amount of respite or short stay care is available when vacancies permit. A ramp at the main entrance, stair lifts and a passenger lift facilitates easier access for Care Homes for Older People Page 4 of 31 0 8 0 1 2 0 0 9 43 0 Over 65 0 43 Brief description of the care home people with restricted mobility. The home is well situated in a residential area of Plymouth with local amenities and shops nearby. Information regarding the services provided at Charlton House can be obtained directly from the home. The current weekly fees range from 329 pounds to 405 pounds. Although these may vary depending on peoples individual needs. 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: The inspection was unannounced and took place between 9:45am and 2:40pm on the 21st October 2009. The Registered Manager, Mrs. Tonya Gerry assisted throughout the inspection. The inspector made a tour of the building and spoke to most of the people living at the home and the staff on duty at the time of the inspection. Documentation relating to the care planning process and the management of the home were examined. Also assisting with the inspection was the Commissions National Pharmacist Manager. This was to inspect the medication procedures used within the home and included the administration, recording, storage and safekeeping of all medications held. An Expert by Experience was also available for part of the inspection. An Expert by Experience is a person who, because of shared experience of using services and/or Care Homes for Older People Page 6 of 31 ways of communicating, visits the service with an inspector to help them get a picture of what it is like to live in the service. The Expert by Experience spoke with 11 residents during their time in the home and one visitor and the inspector spoke to a further 3 visitors. Prior to the inspection surveys had been sent to the care home to allow people who live there to comment upon their experiences. Two surveys were returned to the Commission along with two staff surveys. Any comments are in the relevant section of the report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Thorough pre-admission assessment processes ensure that prospective residents can be confident that care staff are aware of their care needs and are able to meet those needs. Evidence: The files of the last 2 admissions were examined and held completed pre-admission assessments. Several files held care plans from the placing authority to support these assessments. The home pre-admission assessment process and forms hold detailed information on individuals. These completed assessments ensure that the care staff are aware of peoples needs and the home is able to meet those needs. Several staff were spoken with during the inspection and were fully aware of the needs of each persons currently living at the home. Some of the people spoken with said they had been able to visit the home before their Care Homes for Older People Page 10 of 31 Evidence: admission to aid them in making a decision to move in. One person thought thier relative had visited the home on their behalf before admission. Some people said they said that they had been made very welcome by everyone. Charlton House accepts people under the RITA (Rapid Intervention Treatment and Assessment) scheme and holds a number of beds that are contracted to continuing care. These people are usually admitted via the local authority and come with a completed assessment of care. The homes AQAA returned to the Commission states, The home ensures an individual care plan implemented and evaluated from pre-admission throughout the service users stay. Care Homes for Older People Page 11 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 living in Charlton House have their health, personal and social care needs met and people stated they have their privacy and dignity maintained. The homes practices relating to medication administration do not fully protect people. Evidence: The home has introduced a new computerised system to store all the information on each person living in the home. This has included new admission forms and a new format and lay out of individuals care plans. This system is currently being used along side the old paper system until staff are fully trained to undertake all tasks required competently. Three paper files were examined during this process and we were shown how the new computer system currently works along side these three files. One paper file was not available for examination as had been mislaid by the home. The computer system was seen and contained all the relevant information on this individual care needs. Care Homes for Older People Page 12 of 31 Evidence: The last inspection made a Requirement that all care plans must be competed in full, this was due to one care plan not being fully completed at the last inspection. Though one care plan could not be found in paper format all the information was held on the new computer system with full details available for staff. Therefore this requirement is now met. The computer system has a Home Status page which includes daily tasks for individuals. The daily task maybe a hospital appointment, re-ordering of medications or peoples birthday. This highlights to staff all daily tasks they are required to complete and the system will flag any task not completed. Care plans are the documents that detail each persons care needs and the action required by staff to meet those needs in a consistent manner. All individual care plans provide instructions to staff to carry out personal care needs in a manner that meets individuals approval. This is important if people have limited communication skills. People living in the home are involved in the review of their care plan each month if possible. All peoples assessment and daily care plans are easy assessable for staff on duty and risk assessments are held on individual files for the protection of all people living at the home. The risk assessments held cover all aspects of a person daily live including and history of falls. The manager stated that the risk assessments are reviewed regularly and updated as and when needed. Everyone has access to health care services and information was recorded onto a medical visit record sheet in each persons file that there was input from other professionals including GPs, chiropodist and consultants based at the local hospital. Most people living in the home were spoken with and some were able to confirm that their health care needs were met and one person confirmed that they had seen the District Nurse when needed. One person attended a hospital appointment with a staff members assistance and staff were observed discussing and making a appointment for another person who was unwell. The Expert by Experience, after asking people about the level of care they receive from staff, wrote in their report, People said they were very pleased with the care received. Comments included, No complaints about the staff, OK but I look after myself, Some are excellent, the older ones are better, the younger ones tend to go through the motions, They are helpful, and The care is excellent. There was no evidence of personal care being given other than behind closed doors. Staff were seen Care Homes for Older People Page 13 of 31 Evidence: and heard to knock on bedroom doors and wait prior to entering. Residents appeared relaxed, clean and well groomed attired in freshly laundered clothes. Our National Pharmacist Manager was present at this inspection and in particular looked at the medication procedures used within the home, including the administration, recording, storage and safekeeping of all medicines held. We found that for some people that medicines were not available to administer in accordance with the directions of the prescriber. We were told that these medicines were out of stock and whilst there was a record to indicate that a replacement supply had been ordered there was no system in place to order replacement stock before the existing supply ran out. This means that people cannot be certain that they will receive their medicines as prescribed. We found that not all medicines were stored in accordance with current regulations. For some of these medicines, steps were taken during the inspection to correct his. However we also found that medicines requiring refrigeration were not stored securely and that it was not possible to determine if they had been stored within the correct temperature range. This means that people in receipt of these medicines cannot be certain that these medicines will work in the way intended by the manufacturer. We found for some people that their medicines were prescribed with a variable dose. The records made only recorded that some medicine had been given, but not the actual dose given. When spoken to the carer administering the medicine was able to tell us what dose had actually been administered. She agreed to make arrangements to record the actual dose administered in future. We found that people are supported to look after their own medicines within a risk assessed framework. However we found that there are no complete records of the medicines supplied to the individuals. This means that it is not possible to audit and monitor a persons use of the medicine. Most of the people who were spoken with during the inspection confirmed that the staff respects their privacy and dignity at all times. The staff were observed during the inspection knocking on peoples doors to promote privacy and shutting the bedroom door when attending to peoples personal care needs. The Expert by Experience wrote in their report about the number of staff around to assist them, The general feedback from the residents and relative was that there were sufficient staff most of the time. Comments included, Yes probably enough, I Care Homes for Older People Page 14 of 31 Evidence: think so, and Yes enough. Call bell response time was generally said to be good i.e. within five minutes both day and night. Occasionally a carer may respond and advise that they would return shortly. Everyone was satisfied with the showering or bathing regime. People were of the opinion that they chose the time they retired and rose with or without assistance. The homes AQAA returned states under how they have improved over the last 12 months wrote, New computer system for care plans/risk assessments/ staff files and other general systems for the running of the home. And goes onto say, Work with senior staff to ensure that those accountable for medication are adhering to the medications policies and procedures, and assessing any further needs for training. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are managed well and provide daily interest for the people living in Charlton House. People living in this home can be confident that the home offers good meals. And meals and mealtimes are not rushed making them an enjoyable, social occasion for people. The home welcomes and encourages families and friends to visit. Evidence: Everyone was observed moving freely around the home with some people confirming they chose to remain in their own room. One visiting relative said that their relative mainly stays in their own room and will only occasionally go to one of the communal lounges with staff encouragement. The staff were seen interacting with people and discussing everyday topics and included assisting individuals when needed showing staff were aware of the needs of people living in the home. Displayed in the homes main entrance was a notice showing this month activities and visiting entertainment professionals as well as other planned activities. Care Homes for Older People Page 16 of 31 Evidence: The manager also stated that the staff team carried out activities when possible. Also several people go out on their own to the local shops or to church. The new computer system is able to print of a monthly Events Diary to show what activities and events each person has attended. The Expert by Experience asked people living in the home about the activities offered and the response recorded into their report stated, The manager co-ordinates the activities which are then delivered by either the carers or people brought in from outside. The list of events was very comprehensive with several activities happening most days. Contact is maintained with the outside world through coffee mornings and periodical trips in a hired minibus to places of interest such as Looe, Mount Edgecombe Country Park, Plymouth Hoe and the preserved railway at Buckfastleigh. One person volunteered that until she no longer felt able to do so she had often visited the City Centre accompanied by a carer. A hairdresser visits every week using the in-house salon. Other activities shown booked included a fashion show and Breast Cancer coffee morning. Visitors are welcome at any reasonable time and can visit their friend/family in the privacy of their own room. Four visiting relatives were spoken with during this inspection and both were able to confirm they were able to visit at any reasonable time. Observation showed three visitors visiting their relative in the privacy of their bedroom. All visits are recorded into individuals care plans. The Expert by Experience recorded into their report, Everyone was of the opinion that their visitors were made welcome and usually were offered refreshments. The home AQAA records our plans for the next 12 months states, New Activity programme. All bedrooms visited contained personal possessions and items and a relative visiting the home said that the home encouraged them to bring in items from home. The Expert by Experience wrote in their report after talking and observing the food in the home, Comments about the food varied, Excellent, They do this very well indeed, I enjoy the fresh vegetables and the puddings are very good, Mostly good, Quite good on the whole, and Could be better. Everyone said they had more than enough to eat and several added, Seconds are always on offer. Many of the people spoken with were seemingly unaware of the choices available, saying there was a set meal but if this was not to their liking something else would be found. In fact there is a daily choice of two main courses at lunchtime and a choice of a hot Care Homes for Older People Page 17 of 31 Evidence: meal or sandwiches at teatime. In the evening hot drinks, sandwiches and cakes are available at frequent intervals. A person who chooses to eat in their bedroom complained that when a certain carer delivers the lunch it is frequently cold. A check on the day of the visit revealed that a hot meal was delivered on a cold plate by a carer taking meals to three rooms on an upper floor some distance from the kitchen The meal served at lunchtime consisted of Cottage pie or chicken pie with fresh vegetables and potatoes. With a choice of rice pudding or yogurt for dessert and was well presented. The meal was freshly prepared and the duty cook was spoke with and confirmed that the home has all the required fresh ingredients needed and has 4 weekly menus available and displayed for all to see and this showed a varied and nutritional diet. 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. Complaints and suggestions from people living in the home, relatives or other visitors to the home, are treated seriously, listened to and issues resolved promptly. Evidence: The home has a copy of the complaints procedure in the main entrance accessible to people living in the home and any visitors. The manager is available most days and felt that any concerns raised would be dealt with immediately. The manager has also completed Mental Capacity Act training. The home has not received any complaints however the Commission received one. This complaint was dealt with by a Random Inspection. A Random Inspection is a short focused review of the service. The complaint raised concern that people using the service are made to get up very early in the morning and are returned to bed in the afternoon. The evidence found at the inspection showed that peoples choice and preferences are noted and people are supported to maintain personal preferences for the times of getting up. Some of the people spoken with were aware that the home had a complaint procedure in place and some stated they have never needed to use it. Care Homes for Older People Page 19 of 31 Evidence: Two relatives also confirmed they were aware the home had a complaints procedure but had not needed to use it and also said the owner was available most days to discuss any concerns. Mrs. Gerry confirmed that most staff had completed the local safeguarding training and no safeguarding alerts had been made. Staff spoken with and staff files examined confirmed this training had been completed. One staff survey returned to the Commission when asked, do you know what to do is someone has concerns about the home, ticked no. The Expert by Experience wrote in their report, A relative said she was very satisfied with the way her parent was being cared for. She added that a few issues or concerns had been quickly dealt with by the manager and brought to a satisfactory conclusion. The homes AQAA records that, All service Users are informed of the concerns/complaints procedure and would be fully supported by staff in making their complaints. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Charlton House live in a very pleasant, well-maintained home that is comfortable and warm and which provides sufficient facilities to meet their needs. Evidence: A tour of the home showed it to be warm, safe and well maintained therefore suitable for its stated purpose. Many people were able to confirm that the home is clean and warm. Several visitors stated that the home was, Excellent and A lovely place to live in. The tour of the home confirmed that it was clean, hygienic and free from offensive odours and the process of the removal of clinical waste was discussed and well dealt with. The Expert by Experience wrote in their report, The home was clean and free from unpleasant odours. The decor was in a good state of repair. The lounges were homely without being cluttered and the furniture looked comfortable. Bedrooms had been personalised to a greater or lesser degree by the occupant. Residents said they were pleased with the standard of cleanliness and that their bedrooms and bathrooms were cleaned every day. There are four lounge areas with very different environments thus giving people a choice of places to relax in. Care Homes for Older People Page 21 of 31 Evidence: The home has made several alterations to the building since the last inspection and included fitting en-suite facilities to some bedrooms with more planned in the near future. The home has altered the lay out of some of the bedrooms to include en-suite facilities with a large extension currently being undertaken in the rear of the property which will increase the number of beds the home currently has. At the last inspection the home had a small kitchen area for people to make drinks and snacks. This area has been improved and updated. However this kitchen houses a domestic washing machine and the standards state that laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten. The owners agreed to look at this area. The Expert by Experience recorded in their report, Several people mentioned dissatisfaction with the laundry claiming that certain items of clothing had gone missing either temporarily or permanently. It was also said that coloured items had been washed with white undergarments thus causing discolouration. The homes main office has also been relocated and the old office converted into a bedroom to enable to home to reduce the number of double rooms. Observation showed staff wearing protective clothing and several staff spoken with confirmed that the home provides gloves and aprons and many had now updated and completed infection control training. The Expert by Experience wrote in their report, The consensus of opinion was that Charlton House was a good place to live. One gent said, I visited nine other places before deciding on this one and I have no regrets at all. Another said, its marvelous here, a wonderful home. The homes AQAA records under how we have improved in the last 12 months, internal decor to bedrooms and lounges, 6 new lounge chairs and new bedroom furniture and beds. 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. People living in Charlton House are cared for by a caring and motivated staff team in sufficient numbers to meet the needs of those currently living in the home. All staff files containing all required pieces of information would protect the people living at the home. Evidence: On the day of the inspection it was noted that on duty caring for 42 people living in the home were the registered manager, 1 assistant manager, 1 officer in charge, 1 deputy, 6 care assistants, 1 cook and 4 cleaners. This provided evidence that the home had sufficient staff on duty to support the number of people currently living in the home. Some of the staff spoken with during the inspection were able to confirm that they hold an NVQ qualification and the homes AQAA confirmed that at least 50 of staff delivering personal care holding NVQ level 2 or above. The AQAA records that the plans for the next 12 months are, To continue to work within the National Minimum Standards. Examination of the staff files showed that most staff had the required pre-employment checks, including CRB (Criminal Record Bureau Disclosure) in place. Care Homes for Older People Page 23 of 31 Evidence: However one staff file was for a staff member who left the service and was reemployed 18months later. This file held the original application form, CRB and references. However a new induction had been completed. It is recommended that new employment checks be obtained for all newly employed staff to protect people using the service. One staff survey form returned to the Commission when asked, did your employer carry out checks, such as your CRB and references before you started work wrote, yes to CRB but no to references. Many of the care staff employed at the home are long serving staff members having worked at the home for a number of years therefore have a great deal of experience working with older people. The Expert by Experience wrote in their report, Comments about the staff were generally very complimentary, Lovely - a great help, Some are very good indeed, Yes alright, They vary, Fine, they work very hard, I get on with them quite well, The staff listen and are very attentive, They are all good and yes they listen to me, No complaints, I get on well with the staff and the manager and On the whole we get on fairly well. The fact that English was not their first language for some of the staff was not seen as a problem and communication between staff and residents was seen and heard to be good. Staff were seen to display a good caring attitude throughout the visit. A Requirement at the last inspection stated that all staff must have regular and updated training to meet the needs of people living in the home. The files examined showed that training has now been updated and this requirement is now complete. Updated training included Fire safety, 1st Aid, manual handling and health and safety. The new computer system discussed in previous standard is also used to keep the home up to date with staff training and will flag up when training is due to be updated. This system is not fully functional, however most staff training needs have already been added to the system. Four visitors were spoken with during this inspection and all were complimentary of the staff team. All agreed that the staff made them welcome and were friendly and helpful. One stated, The staff are lovely and another said, Nothing is too much trouble. One staff survey returned to the Commission, under what does the home do Care Homes for Older People Page 24 of 31 Evidence: well wrote, Care for the residents and well being of the residents very well. 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. People live in a well managed home and the owners and their staff team strive to provide a stimulating, safe environment that respects and protects peoples rights. Evidence: The Registered Manager, Mrs. Tonya Gerry was available throughout the inspection to assist, as was the deputy manager. Both the manager and deputy hold the Registered Managers Award and an NVQ in Care. Mrs. Gerry confirmed that she undertakes and updates her training accordingly. Mrs. Gerry confirmed she has completed Mental Capacity Act, Deprivation of Liberty and Safeguarding training since the last inspection. Mrs. Gerry is the registered manager but also joint owner of the home and has run the home for a number of years and had a wealth of experience. Mrs. Gerry has an excellent relationship with the people living in the home, the staff team and family and professionals visiting the home. One relative spoken with stated that Mrs. Gerry is very approachable. This helps to ensure that the home is run in the best interest of Care Homes for Older People Page 26 of 31 Evidence: people living in the home. And a staff member wrote on their survey returned to the Commission, I am not afraid to go to the office if I have any problems. The home has competed surveys within the home and visiting family, friends and professionals. All made positive comments and additional forms are always available by the main entrance for people to place in the box provided. Several people spoken with said they had completed a form about the home. The AQAA states, We provide a safe place for service users to keep their valuables and money. The home does not manage the money for any people living in the home and will purchase items if needed and bill the relative when necessary. Sampling of records indicated equipment is serviced regularly and maintained in good order. Health and Safety is a priority in the home and records examined showed fire safety training and fire protection is in place and up to date. The accident records were accurate and files examined showed that information is recorded onto accident forms and also written into peoples daily records with appropriate action taken when needed. Good health and safety practices reduce any unreasonable risk, affecting people living at the home, to an acceptable level. 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 1 9 13 (2) Arrangements must be 25/12/2009 made to record the actual dose administered when a medicine is prescribed with a variable dose This is to make sure that it is possible to feedback to a prescriber the response of a person to a particular dose administered 2 9 13 Arrangements must be made to store all medicines securely and in accordance with current regulations. This is to make sure that medicines are available to administer when required and will act in the way intended by the manufacturer. 25/12/2009 Care Homes for Older People Page 29 of 31 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 29 All newly employed staff should have updated employment checks in place including references, application forms and CRB checks. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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