Care Home: Chasewood

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What the care home does well Throughout the visit staff were observed to offer help where needed and in such a way that maintained independence dignity and safety. Staff are knowledgeable about people`s needs. Anyone wishing to move to the home has their needs assessed before they move in to ensure that their needs can be met properly. Visitors are welcomed at the home and a flexible visiting policy is in place to make it easier for people to stay in touch with friends and relatives. People are supported to gain access to advice from health professionals where they need it, so their health needs can be met. The home has a complaints policy in place. Staff are aware of how people with limited communication make their needs known. There were no unpleasant odours identified during the inspection and areas of the home seen were clean. What has improved since the last inspection? Requirements set at the last inspection have been met. This was determined at a random inspection of the home carried out on the 20th October 2010 by two inspectors. Care plans and risk assessment have been reviewed to provide more up to date information on the needs of the people who live there. Some work has been carried out at the home to improve the environment in which people live. What the care home could do better: People could be provided with more opportunities to get out and about in the local community. This is particularly important for supporting people`s good mental health. Care plans must continue to improve to ensure they reflect people`s needs, detail the support people require to meet their needs, and demonstrate how identified areas of risk are being managed. The home should continue to implement plans to install a system for evaluating the quality of the service. Consultation with residents their representatives and other stakeholders should be undertaken to gain their views about the service and ideas for improvements. The management of people`s finances must improve to ensure robust systems are in place and any errors dealt with immediately. This will minimise the risk of financial abuse. The home must improve the system in place with regard to the appointment of staff to ensure staff are suitable to work with vulnerable adults. Key inspection report Care homes for older people Name: Address: Chasewood 39 School Lane Exhall Coventry West Midlands CV7 9GE     The quality rating for this care home is:   one star adequate 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: Julie McGarry     Date: 2 0 0 4 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 33 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Chasewood 39 School Lane Exhall Coventry West Midlands CV7 9GE 02476738211 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chasewood Care Ltd Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 22 The registered manager must work at least 3 days a week supernumary to the care rota in order to complete management tasks. 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: Dementia - over 65 years of age - (DE(E)) 22 Date of last inspection Brief description of the care home Chasewood is a converted, detached property, providing accommodation on two floors. The home is set back from the road and to the front of the home there is parking space for about six cars. The home is registered to provide care for 22 people with a dementia. The ground floor of the home provides accommodation for fourteen people. Care Homes for Older People Page 4 of 33 Over 65 22 0 Brief description of the care home There is a large open-plan communal area at the centre of the ground floor, and leading off from this area are three wings providing bedrooms, a kitchen, laundry and the manager s office. There is a further lounge with a conservatory leading into the garden. Ten single bedrooms are provided for people at ground floor level, and two shared rooms. There is a passenger lift to the first floor, as well as the stairs, where accommodation is provided for eight people. Facilities provided on this floor are a lounge, dining room with a kitchenette, and six bedrooms, two of which are shared rooms. There are two separate lavatories at this level, a bathroom and a shower room. On the ground floor French windows lead onto the rear garden, and the home has a small patio area to the rear of the property. Information about the home is available in an information booklet provided in the entrance of the home. Information about fees are detailed in the Service User Guide for the home. Additional charges include the hairdresser, chiropody, personal toiletries, newspapers and magazines. Care Homes for Older People Page 5 of 33 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: one star adequate 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 quality rating for this service is one star; this means that people using the service receive adequate outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at key aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. We carried out this unannounced key inspection on one day. As the inspection was unannounced the registered owner and staff did not know we were going. Before the inspection we looked at all the information we have about this service such as information about concerns; complaints or allegations; incidents; previous inspections and reports. Care Homes for Older People Page 6 of 33 Registered care services are required to complete an Annual Quality Assurance Assessment (AQAA). The AQAA provides information about the home and its development. This form was completed by the deputy manager of Chasewood Lodge (sister home) and returned to us within the required timescales. Ten people at the home completed questionnaires with staff support as part of the inspection process and three staff completed and returned questionnaires. At this key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Some time was spent sitting with people in the lounge watching to see how residents were supported and looked after. These observations were used alongside other information collected to find out about the care they get from staff. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. There were 17 people in residence on the day of our inspection. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Throughout this report the Care Quality Commission will be referred to as us or we. At the end of the visit we discussed our preliminary findings with the owner and manager of Chasewood Lodge. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: People could be provided with more opportunities to get out and about in the local community. This is particularly important for supporting peoples good mental health. Care plans must continue to improve to ensure they reflect peoples needs, detail the support people require to meet their needs, and demonstrate how identified areas of risk are being managed. The home should continue to implement plans to install a system for evaluating the quality of the service. Consultation with residents their representatives and other stakeholders should be undertaken to gain their views about the service and ideas for improvements. The management of peoples finances must improve to ensure robust systems are in place and any errors dealt with immediately. This will minimise the risk of financial abuse. The home must improve the system in place with regard to the appointment of staff to Care Homes for Older People Page 8 of 33 ensure staff are suitable to work with vulnerable adults. 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 33 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 33 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 who are considering moving into the home benefit from having their care needs assessed before admission so that they can be sure the home can meet their needs. People and their families are provided with information and visit the service prior to admission to enable them to make an informed choice. Evidence: In the AQAA the deputy manager stated All services users have a full pre-assessment before coming to have a look around the home to ensure that the home is able to meet all of their needs and are given a comprehensive booklet. All care plans are implemented on admission and are regularly reviewed and updated with any changes needed each month. All families are involved as much as possible. Service users come in on a trail period to meet staff, look around the environment, and chat to some other service users. To find out whether this was the case three people were case tracked during this Care Homes for Older People Page 11 of 33 Evidence: inspection. This involved looking at their care files, talking to them, and talking to the staff that care for them. Their living accommodation and the facilities available to them were also looked at. The care files of the two most recently admitted people to the home were reviewed to identify whether appropriate pre-admission processes take place at Chasewood. Sufficient information is obtained about people before the home confirm that they are able to meet their needs. Assessments provide details of peoples health and personal care needs which include information on physical and mental health history, mobility, nutrition, and communication. The availability of this information helps to ensure that the specific care needs of each person can be identified and used to help complete a plan of care. Relatives and people who may wish to use this service are encouraged to visit have a look around and stay for the day before they decide if they would like to move in. The homes statement of purpose and service user guide was looked at as part of the inspection. Both documents clearly identify the levels of service that could be offered to specific user groups. They are detailed, informative and reflective of the actual service being provided. This ensures that people have enough information to make an informed choice about whether they would like to live at Chasewood. Five Individual Placement Agreements from the Local Authority were seen for people who there, the home does not routinely provide people with contracts of their stay there. Care Homes for Older People Page 12 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has a plan of care but a lack of consistent detailed recording may result in inconsistent care being provided. People have access to health care services that meet their assessed needs. Staff have a good understanding of how to offer care and support to each person. Improved medicine management better protects the people who use the service. Evidence: The AQAA completed by the deputy manager tells us Ensure all care plans are comprehensive so that care can be given. All service users health and access to health services are met. To ensure that all policies and procedures are adhered to this includes administration and disposal of medication. That all service users privacy and dignity is respected at all times. To find out whether this was the case, three people were case tracked during this inspection. This involved looking at their care files, talking to them, and the staff that care for them. Three peoples medication records were looked at. Care Homes for Older People Page 13 of 33 Evidence: People at the home were seen to rise at their own pace. Everyone was dressed in appropriate, good quality clothing indicating they are supported to maintain a good self image. It is evident that since the last inspection the home has made improvements in peoples care plans. Three peoples care plans were looked at. The care files covered all the main areas of care including medical history, personal care, pressure care, nutrition, continence and mobility. The care plans are evaluated on a monthly basis or more often if needed and changes are made to the care plans if there is a change in the need of the person. Care plans were individually dated and signed so there was a clear audit trail of when the care needs had been identified. This is helpful to know particularly when care needs change so that it is possible to see if a persons health has improved or deteriorated. There was no documentary evidence to demonstrate that people or their representatives have been involved in planning care. There is evidence to show that improvements have been made to identify and minimise risks to the health or well being of people living in the home. For example, good recordings were seen for the moving and handling support. Records on one persons plan tells staff about the need for use of a stand aid hoist and a wheelchair for all moving and handling. Staff spoken to were able to discuss this persons mobility needs and why specific equipment is needed. We observed staff using the hoist to assist this personal at lunch time, staff offered an explanation and continual reassurance to the individual when using the hoist, this is good practice. Another example of good recording practices were seen for one person who is at risk of choking. Due to concerns, a speech and language therapist and dietitian have been involved in assessing this persons nutritional needs. Their assessment concludes that this individual should have a soft diet and to be observed at all meals. The homes risk plan for this person shows they require support and supervision to have a well balanced diet and sufficient fluid intake. Records state is at risk of choking and needs staff to encourage him to swallow... needs a soft diet....Ensure X is weighed on monthly basis. Staff spoken to were knowledgeable about risk of choking for this individual, and were seen to monitor the individual at meals times. Monthly weight charts are being maintained to monitor any weight changes. Overall care plans have improved, however further work is needed to ensure individuals who have been assessed as high risk have detailed information in their plans about their needs. For example, one persons care plan states staff to offer x a Care Homes for Older People Page 14 of 33 Evidence: well balanced diet and staff to prepare food as x is a diabetic....Staff to weigh x on a monthly basis and report and document changes. Whilst a care plan is in place for diabetes management, it lacks the detail needed to ensure all staff provide a diet suitable to this persons needs. Daily records document one doctors advice on managing this persons diet he is to have no sugary food whatsoever... one spoonful of canderell in drinks. However this information has not been included in the care plan or risk assessment. Further more, a test in October 2009, found Xs blood sugar levels to be dangerously high, however there is no information to tell us how the home is managing his blood sugar levels to minimise the risk of this reoccurring. A discussion with chef shows that he was aware of this persons diabetes but, has informed us that he has given this person foods with sugar. Additionally one person at the home requires the use of a hospital bed with bed rails and bumpers. Records show that no assessment of need or risk of is in place to explain the need for bed rails and to measure an risks . The home took immediate action to put a risk plan in place once the this omission was identified. Another person has been identified as being at risk of falling out of bed, their care plan reads Staff need to put a mattress on the floor. This will minimise accident. We found that staff were not aware of this need or the risk, and we found no mattress was being used. The manager of Chasewood Lodge and the owner gave us assurances that this would be addressed immediately. Entries in peoples health records show that they are being supported to attend health care appointments to monitor and treat diagnosed health needs. Peoples records show that they are being supported to attend routine health appointments such as annual health checks, dental check ups, chiropody support and eye tests. We saw that care plans are not written from the point of view of the person using the service. A more person centred approach to care planning would help remind staff about the way the person would wish to be treated and how they would like their care to be delivered. Senior care staff inform us that all care plans are currently being reviewed and where appropriate updated to reflect peoples needs. People spoken to told us that they are supported in a respectful manner and their personal care needs are met. Staff are knowledgeable about the people who use this service. They have a good understanding of their roles and responsibilities. Three peoples medicines were looked at together with their Medicine Administration Record (MAR) chart, care plans and daily records. One senior care worker was spoken with and all feedback was given to the owner. Care Homes for Older People Page 15 of 33 Evidence: The service uses a monitored dosage blister packed system. Medicines are stored in a locked medication trolley. The home had installed and implemented a good system to check the prescriptions prior to dispensing and to check the medicines received into the home. In the audit of medicines, one discrepancy was noted when found one person has less tablets that should have been in the box. Staff could not account for the discrepancy. Audits indicated that all medicines had been administered as prescribed and records reflected practice. No gaps in records were seen. The arrangements for storing controlled drugs comply with legislation. The medicine contents of the controlled drug cupboard corresponded with the numbers recorded in the controlled drugs register. The carer spoken with had a reasonable understanding of the medicines she handled and understood the clinical needs of the people they looked after. During the inspection it was noted that all people living at this service are treated with respect and dignity. Personal care was carried out in privacy and all those seen were appropriately dressed in clean clothes and looked comfortable and neat. Each person was able to spend time where they choose, and during our observations of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind caring and generally attentive towards them. Care Homes for Older People Page 16 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not benefit from the opportunity to participate in stimulating activities that reflect their own personal interests and preferences. Open visiting arrangements encourage regular contact with relatives and friends. Residents benefit from a varied tasty and nutritious choice of food. Evidence: The AQAA states Carry out daily social activities throughout the day, staff prompt and encourage all service users to participate in, to join in, and interact and socialise with each other. Relatives and families are encouraged to visit at any time. To ensure all aspects of daily living is flexible, available and varied but takes into account the service users capacities, expectations and preferences. To give service users choice and personal autonomy. To ensure that we offer a varied wholesome and nutritious diet as suited by each individual. To assess whether this was the case we observed the interactions between people and staff, talked to the people who receive a service, looked at the programme of activities, and discussed peoples nutritional needs with care staff. We looked at a range of documents, and we looked carefully at the care provided to three people Care Homes for Older People Page 17 of 33 Evidence: from the point of their admission to the present time. There is no planned program of activities at the home, and no designated activities coordinator. It is the responsibility of care staff to offer different activities on a day to day basis based on peoples interests. On the day of the inspection we observed no activities taking place through the day. People spent their time watching television, sitting in the lounge or looking at newspapers. One person we spoke to told us Im bored. Peoples care files maintain brief records of peoples participation in activities, and do not include peoples views on the activity and whether they enjoyed this. More detail would help staff ensure that the activities offered reflect peoples preferences. Records of activities at the home included going to the local park, going shopping to Tescos for coffee and cake. From the records we noted that these trips do not occur on regular basis, and from discussion with staff, occur when there is more staff on duty. Senior staff told us that the home are trying to raise money through Christmas raffles and a planned fete to raise money to enable people to go on more trips. Staff told us that they feel more trip and activities would benefit the people living here. One member of staff told us that peoples religious needs are considered and supported when possible. We were told that the home has and in house service once a month, and staff invite church choral groups to sing occasionally. Daily records seen show that this happens. The home has an open visiting policy which means residents can receive visitors when they want. There have been no changes to the running or the kitchen since the last inspection. Menus are held in the kitchen for a four week period. The chef said that food orders and the menus are done at the sister home Chasewood Lodge. Therefore people in the home are excluded involvement in planning menus. However, menus showed that the people who live there have a choice of meals through the day. The menu was varied and meals appeared nutritious. The chef informs us that people are offered the choice of a cooked breakfast each morning or cereals, tea, toasts etc. Kitchen staff have records to inform them of people diets, however the chef was not aware of this at the time of the inspection. We observed the midday meal service during our visit. Lunch was served at 12.30pm. Care Homes for Older People Page 18 of 33 Evidence: People were offered a choice of beef stew or pork casserole followed by jam sponge. Staff told us that some people need to be supervised or monitored at meal times, staff were available to offer discreet, timely and sensitive assistance to residents who needed help eating their meal. We visited the kitchen and spoke with the chef, who was able to describe the individual dietary requirements of people living in the home; for example those people who required a soft texture diet. Whilst the chef was aware that one person who has diabetes, he was not aware that this involved restrictions to sugary foods, and told us that he had baked a cake for this person which had jam and icing sugar. Additionally he told us that he had given this individual jam tarts on a previous occasions. When staff were informed of our concerns that the chef was not following the professional advice for this persons dietary needs, we were told that immediate action would be taken to ensure the chef is fully aware of all peoples dietary needs. Care Homes for Older People Page 19 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can be confident their complaints will be taken seriously and staff will respond appropriately. People are not protected by robust recruitment processes. Evidence: The AQAA states To deal with any complaint as quickly as possible. Within the 28 days deadline. To complete the appropriate paperwork and if needed to forward it to CQC. To look on complaints as constructive criticism and not as a negative. That the complaint procedure is accessible and includes stages and timescales for the process. To ensure that all service users rights are protected and that they are able to access these rights. To ensure that all service users are safeguarded of any abuse in line with policies. To find out if this is the case we requested the concerns, complaints and compliments folder, looked at staff records, and talked to staff about complaints and safeguarding the people who live there. The home has a complaints policy this is displayed in the home for the benefit of the people who use the service or visitors. Staff spoken were clear about who they would speak to should a resident or relative other raise a concern. Surveys completed by people who live at the home tell us that not all people know how to make a complaint and it is evident that some people may not be able to make a complaint without Care Homes for Older People Page 20 of 33 Evidence: support. Staff told us how they would monitor for indications that individuals need help or were unhappy. The home has received one complaint since the last inspection. Records of this complaint were seen to show that it is being addressed in line within the homes complaints policy and in conjunction with the local authority. There has been one referral to the local authority in relation to the safeguarding of vulnerable adults. This concern was investigated by the local authority and not upheld. It was found to be a health and safety matter and all areas of concern have been resolved. The home has a good system in place with regard to the appointment of staff, however this is not consistently followed. Records seen show that references are not always obtained and staff have been appointed prior to all safety checks being undertaken. The home could not demonstrate that staff appointed on a PoVA first are being supervised until a CRB clearance is received. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse, this needs to be updated to include local joint agency guidelines. Staff spoken showed some evidence of their understanding of the polices and procedures, and are aware that any incidents or allegations of abuse need to be reported to the person in charge. Three staff files were seen, all contained evidence that staff have received training in the Protection of Vulnerable Adults. Discrepancies were found in the management of peoples finances. Receipts were not always available to show how money has been spent. Staff could not give an explanation for the discrepancies. Care Homes for Older People Page 21 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further work at the home is required to ensure people live in a well maintained environment. People benefit from personalised bedrooms but do not benefit from all parts of the home being maintained to acceptable standards. Evidence: THE AQAA tells us The home is clean tidy and well decorated warm and inviting. To encourage service users families and relatives to bring any personal items that will enhance and help settle the service user into the home. That the home is well suited for its purpose and is accessible well maintained to meet service users requirements in line with all relevant guidelines. The home is kept well maintained clean has no offensive odours and infection controls carried out in accordance with all legislation. The home has made some improvements to the environment since the last inspection, this includes new carpets, curtains and painting in the communal areas and some bedrooms. We looked at some of the bedrooms of the people involved in case tracking. They were clean and simply furnished. The rooms were personalised with their own belongings. Equipment is available to assist residents and staff in the delivery of personal care which includes assisted baths profiling beds accessible showers and moving and handling equipment including hoists. A range of pressure relieving Care Homes for Older People Page 22 of 33 Evidence: equipment including specialised air mattresses are available. Systems are in place to reduce the risk of infection. Disposable gloves and aprons and were available and were used by staff when handling soiled linen and when supporting people with personal care. We noted that hand wash was not available in any bathrooms or sinks areas where staff wash their hands. Action was taken by the home to make hand wash available during the inspection. The home has a laundry room care staff carry out laundry tasks. Residents clothing looked well laundered and ironed, however not all clothes were labeled advising staff who each item of clothing belonged to. Records are kept of the fridge and freezer temperatures showing appropriate temperatures to maintain good food safety. At the last inspection the home were required to ensure that fire doors at the home must not be wedged open. We carried out a random inspection October 2009 and found that the home has complied with this requirement. We found evidence at this inspection that the home has continued to comply with this requirement. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels in the home meet the needs of the people who live there. Recruitment practices at the home need to be more robust to help safeguard the people who live there. Evidence: The AQAA states To ensure all have staff have NVQ in place and to ensure that all recruitment of any new staff is based on equal opportunities whilst ensuring protection of our service users. To maintain staff training and development. To check that this is the case we looked at three staff files spoke with staff and the deputy manager of Chasewood Lodge. Senior care staff told us that the usual staffing complement planned in order to meet the needs of the 17 people currently living in the home includes three care staff during the day and two waking night staff. This was seen from three weeks duty rotas. It was evident from the appearance of residents and information recorded that the numbers of staff on duty were sufficient to meet their physical personal care needs. Evidence was available that new care staff undertake an induction programme and Care Homes for Older People Page 24 of 33 Evidence: have access to mandatory training in fire safety, abuse awareness, and moving and handling however this is not always clearly recorded in the training matrix. The home does not have a system or tool to decide the number of staff required to meet the identified needs of residents in the home this is monitored informally by the manager from Chasewood Lodge. Training records show that five out of the fifteen care staff currently employed in the home have achieved a National Vocational Qualification (NVQ) in Care at level 2 or above which at is below the National Minimum Standard for 50 of staff to be qualified. The personnel files of three recently recruited staff were examined and not all contained evidence that satisfactory checks such as Criminal Record Bureau (CRB) and references are obtained before staff commence employment in the home. From records and discussion with staff we found evidence to show that staff starting work with a PoVA first are not being supervised until CRB checks are received. Robust recruitment procedures and pre-employment checks need to be in place to protect the vulnerable people living in the home. We noted an improved frequency in the supervision of staff since the last inspection, however not all staff are receiving supervision at least six times per year as previously recommended. Regular supervision is necessary to ensure people are supported by staff who have the competencies and qualities required to meet their needs. Staff spoken to were clear about their lines of accountability and were able to tell us who they would speak to if they had any queries. Staff are aware that management support is available from the manager at the sister home Chasewood Lodge. Staff were seen to interact well with people living in the home throughout the day; residents were at ease making requests and asking for assistance. Care Homes for Older People Page 25 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not being managed in the best interests of those who live there. Evidence: The AQAA states Provide appropriate training to all our care staff to enable them to deliver the best quality of care to the service users in our care. Communicate effectively complete all relevant in line with all of the standard. We have a positive and inclusive atmosphere all views are in place of service users to measure all successes in aims objectives within the purpose of the home. All accounting procedures are adopted to ensure an efficient management of finances. The Annual Quality Assurance Assessment (AQAA) was completed by the deputy manager of Chasewood Lodge. This was completed to an adequate standard. There has not been a registered manager at the home in excess of two years. This has a direct impact upon the way the service is managed. The manager of Chasewood Lodge and the owner inform us that the home is hoping to appoint a new manager in the coming weeks as they are actively interviewing. Care Homes for Older People Page 26 of 33 Evidence: Staff spoken to were clear about their lines of accountability and were able to tell us who they would speak to if they had any queries. Staff are aware that management support is available from the deputy manager and the manager at the sister home Chasewood Lodge. When discussing supervision with staff it was noted that annual appraisals have not taken place in the past, but the home has recently started to ensure that formal supervision system is in place. Regulation 26 visits are being carried as required by the home owner. A record of each visit is kept including details of area of the homes looked at during the visit. This complies with the law that says providers must make a monthly unannounced visit to the service. At the visit they need to check on the quality of service provided at the home. The provider needs to keep a copy of the report so that it can be inspected at the next key inspection. Staff spoken to were complimentary of the home one stated Maria has provide support is fantastic, staff working together more, and like a little family now. Staff are stable. An improvement plan was developed and returned to us to address the requirements we made at our last inspection in June 2009. The service has complied with the requirements we made. Evidence from this inspection and our random inspection in October 2009 shows that the service has sustained the improvements in managing peoples medication safely and recording of peoples needs. The provider is currently reviewing working practices at the home with the support of an external consultant by assessing the outcomes experienced by the people living in the home measured against National Minimum Standards. Information provided by the manager in the pre-inspection questionnaire indicates that relevant Health and Safety checks and maintenance are being carried out at the home. A number of Health and Safety records were checked including the fire safety log. These records showed that health and safety matters are well managed. A gas landlord certificate was seen and was up to date. Care Homes for Older People Page 27 of 33 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 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans must state actions to be taken to minimise risk for those individuals who have been assessed as being at risk. This includes diabetes management. This will ensure that all staff are fully aware of the risks and actions to take to minimise the risk. 13/05/2011 2 8 13 A full assessment and risk assessments must be available for those people who require bed rails or crash mats for safety. This is to demonstrate that bed rails are used appropriately to maintain safety and not to restrain. 13/05/2010 3 29 19 Sufficient information must be secured to determine the fitness of potential employees before they start working at the care home. 18/06/2010 Care Homes for Older People Page 29 of 33 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 To include: two written references, including where applicable, a reference relating to the persons last period of employment which involved work with vulnerable adults. A full employment history together with a satisfactory written explanation of any gaps in employment. The outcome of a Criminal Record Bureau (CRB) disclosure and checks against the Protection of Vulnerable Adults register (PoVA). This will ensure that the homes staff recruitment practices safeguard people living in the home. 4 34 17 Accurate records of all monies kept for people at the home must be maintained. This is to ensure that the risk of financial abuse is minimised. 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 28/05/2010 1 1 People should be provided with contracts by the home Care Homes for Older People Page 30 of 33 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 detailing the terms and conditions of their stay at the home and what they can expect to receive for their money. This is necessary so that everyone is clear about what they have to pay for and so that their rights may be upheld. 2 7 Where appropriate the person and or their relative should be involved in the planning of care and reviews to demonstrate their agreement. Where this is not possible a record should be kept to indicate this. Made at the last inspection. 3 12 Residents should be consulted about a programme of activities that takes into account individual and group needs. Records of social and therapeutic activities should include the residents views on the activity and whether they enjoyed this or were satisfied with the outcome. This will ensure mental and physical stimulation which meets their individual needs. Made at the last inspection. 4 14 Wherever possible service users must be offered choice and the opportunity to exercise some control over their lives. This should be demonstrated in a person centred care plan and reviewed regularly to reflect changing needs and abilities. Made at the last inspection. 5 18 The homes policy and procedures on responding to suspicion or allegation of abuse should be reviewed to include local joint agency guidelines. 50 of staff should be qualified to NVQ level two to ensure people are supported by staff who have the competencies and qualities required to meet their needs. All staff should complete the required training to provide safe care and services to the people at the home. The training schedule should be kept updated and show the dates when refresher training should be undertaken by. This will ensure that staff get their skills and knowledge updated regularly. An up to date training matrix should be maintained so people can be confident that training needs and any updates will be responded to appropriately. Page 31 of 33 6 27 7 27 8 30 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 9 33 The management should ensure the Annual Quality Assurance Assessment is legible or completed in a format that can be accessed by the commission. Made at the last inspection 10 35 Receipts should be retained in respect of any purchases made on behalf of people who use the service. This will protect the financial interests of people living at the home. All staff should have supervision at least six time a year to help in staff development and ensure staff have the appropriate knowledge and skills to carry out their jobs. 11 36 Care Homes for Older People Page 32 of 33 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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