Care Home: Chasewood Lodge

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What the care home does well Anyone wishing to move to the home has their needs assessed before they move in to ensure that their needs can be met properly. People 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. People are supported to gain access to advice from health professionals where they need it so their health needs can be met. People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. Accommodation is safe, clean, well maintained and comfortable. The manager is aware of maintenance issues which are addressed promptly. What has improved since the last inspection? All requirements made at the last inspection had been met at the Ransom Inspection in March 2010. Improvements have been made to identify and minimise risks to the health or well being of people living in the home. This includes the risk of developing pressure sores and use of bed rails. Improvements have been made in the management and administration of people`s medicines. What the care home could do better: The home must ensure that all areas of risk are identified, and appropriate plans in place to minimise any risk. This relates specifically to behaviour management. This will ensure the appropriate safeguards and actions to support and protect rights and wellbeing of people. Care plans for the people at the home could be improved to demonstrate a person centred approach to care planning. Person centred care ensures people who use the service are at the centre of their care treatment and support by staff should be carried out whilst ensuring that everything that is done is based on what is important to that person from their own perspective. The management needs to ensure that all documents requested for the purpose of inspection are made available on request and open to inspection. The home must ensure a more robust system is in place in regard to the appointment of staff. Records seen show that references are not always obtained and staff are appointed prior to all safety checks being undertaken. The system for evaluating the quality of the service provided should be developed further and additional consultation with residents, their representatives and other stakeholders should be undertaken to gain their views about the service and ideas for improvements. Key inspection report Care homes for older people Name: Address: Chasewood Lodge Mcdonnell Drive 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 5 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 31 Information about the care home Name of care home: Address: Chasewood Lodge Mcdonnell Drive Exhall Coventry West Midlands CV7 9GE 02476644320 02476645866 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chasewood Care Ltd Name of registered manager (if applicable) Ms Maria Christine Edwards Type of registration: Number of places registered: care home 107 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated 107 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 (DE) 12 Dementia over 65 years of age (DE) 95 Date of last inspection Brief description of the care home Chasewood Lodge Care Home is a registered care home, providing care to people with a diagnosis of dementia, with a facility to take younger adults with early onset dementia. The home is situated in a cul-de-sac and lies next to the M6 with easy access to Nuneaton, Coventry and Bedworth. There are local shops, which are accessible and the nearest town is Bedworth. There is local bus service to the home. The home is registered to provide care for a 107 people. Ninety-five beds are Care Homes for Older People Page 4 of 31 Over 65 95 12 0 7 0 1 2 0 1 0 Brief description of the care home registered for older people with dementia and 12 beds for younger adults with early onset dementia. The old and new buildings are linked. The home provides unitised care in both the new and old buildings; each unit has separate lounge, dining, assisted bathrooms and toilet facilities. Residents are free to walk around the building and use facilities on any of the units. Throughout the home there are also additional quiet communal areas and a hairdressing salon is located on the ground floor. The service has now has a spiritual room and gym facility at the home. Information about the home is available in a document entitled Information book and this contains information and photographs of both Chasewood Lodge and the new home known as Chasewood Manor. There are parking facilities at the front of the building, and further spaces at the entrances to both the new and old buildings. The manager has advised that the current fees for a place in the home is between £420.16 and £435.16 per week for dementia care for people over 65 years. Weekly fees for younger adults with dementia start from £500. Other additional charges include the hairdresser, chiropody, personal toiletries, newspapers and magazines. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. 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: 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: 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 over one day. As the inspection was unannounced the registered owner, manager and staff did not know we were going. A Pharmacy Inspector was also involved in the inspection; she carried out a full inspection of the medication management systems and safety. 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. This includes the evidence gathered at the most recent Random Inspection in March 2010. A Random Inspection is a short, focussed review of Care Homes for Older People Page 6 of 31 the service in which we looked to see if the home had met the requirements made at the Key Inspection in January 2010. Registered care services are required to complete an Annual Quality Assurance Assessment (AQAA). The AQAA provides information about the home and its development. This was sent to us before the Key inspection in January 2010 and was used in this Key Inspection. 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 residents 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 70 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 manager and owner of Chasewood Lodge. 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: The home must ensure that all areas of risk are identified, and appropriate plans in place to minimise any risk. This relates specifically to behaviour management. This will ensure the appropriate safeguards and actions to support and protect rights and wellbeing of people. Care plans for the people at the home could be improved to demonstrate a person centred approach to care planning. Person centred care ensures people who use the service are at the centre of their care treatment and support by staff should be carried out whilst ensuring that everything that is done is based on what is important to that person from their own perspective. The management needs to ensure that all documents requested for the purpose of inspection are made available on request and open to inspection. The home must ensure a more robust system is in place in regard to the appointment of staff. Records seen show that references are not always obtained and staff are appointed prior to all safety checks being undertaken. The system for evaluating the quality of the service provided should be developed further and additional consultation with residents, their representatives and other Care Homes for Older People Page 8 of 31 stakeholders should be undertaken to gain their views about the service and ideas for improvements. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People 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: The AQAA completed by the manager tells us We give all prospective an information booklet and statement of purpose, so that they are able to make their own choice of home. We always do a pre-assessment on service users to make sure we are able to meet their needs. Invite them to come along and try out. 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 their family where possible, and talking to the staff that care for them. Their living accommodation and the facilities available to them were also looked at. Care Homes for Older People Page 11 of 31 Evidence: People who are considering moving in have access to copies of the information booklet and Statement of Purpose. Both documents are informative and are currently being reviewed and updated. The care files of the two recently admitted people to the home were reviewed to identify whether appropriate pre-admission processes take place at Chasewood Lodge. Both files seen contained the standardised documentation used during the preadmission process. All assessments were undertaken by the manager. Information obtained during the pre-admission assessment were detailed. Assessments provided details of their health and personal care needs which include information on physical and mental health history, mobility, nutrition, communication and activities. 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. Records on peoples files show that information was received from health and social care professionals as well as individuals relatives prior to people moving in. Where possible records of peoples own wishes about their prospective move to the home have been recorded. The manager said that potential residents and their relatives are encouraged to visit Chasewood Lodge and have a look around before agreeing to move in. She also said that she discusses with any potential resident or relative the care and systems the home has in place. The home does not offer intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are not always set out in sufficiently detailed care plans to ensure staff have the information they need to meet their needs effectively. Systems are in place to ensure the effective management of medication to maintain the health of people at the home. Evidence: The AQAA completed by the manager tells us Everything is documented in individuals care plans and these have greatly improved over the last twelve months. 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 their family where possible, and talking to the staff that care for them. Eight peoples medication records were looked at by a pharmacy inspector. People at the home were seen to rise at their own pace and receive unhurried support and to eat their breakfast of choice. Everyone was well groomed and dressed in Care Homes for Older People Page 13 of 31 Evidence: appropriate good quality clothing, indicating they are supported to maintain a good self image. One person said staff help me to get washed and dressed, and I can go into the dining room or stay in my room and I am very happy here. Another person said we are well looked after. Three care files were reviewed. Each person had a care plan as well as daily records and monitoring records. Care plans were based on information secured during the preadmission assessment of people and had been supplemented by further assessment on the day of admission. The majority of the information in care files was clearly recorded. The home is currently in the process of reviewing an updating all care files into a new care planning / risk management format. 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, at the last Key inspection we found an absence of detailed information about the use of bed rails. A requirement was made for the home to risk assess this need and to ensure bed rails were being used appropriately and safely. At the random inspection, we found the home to have complied with this requirement and the home has sustained the requirement at this inspection. Additionally, in the care plan that have been more recently reviewed we found that home have improved risk management for people with nutritional needs. We found the home were routinely recording peoples weight and the chef is being provide with more detailed information about peoples nutritional needs. Whilst improvements to care planning and risk management were found. Further work needs to be done to ensure care and risk assessment plans are accessible, and detail all information needed about peoples needs. For example, we observed one person wearing a clinical dressing on their leg. Staff spoken to informed us that they were receiving district nursing support for a sore. When we reviewed their care and risk plan no information was available to inform of this concern, in that, there was no information about the sore, if any dressings were to be applied, and what was expected of staff in terms of monitoring this. The personal care records did not make it clear how staff were to manage any baths or showers while this person had dressings on their skin. Additionally no wound charts were available to show the wound was being regularly dressed. A second shortfall in the care and risk management planning was noted. In our discussion with staff we were told that one person can be reluctant to receive personal care. Information in the care plan supports this. Staff told us that on occasions they will persist in encouraging this person to receive personal care or sometimes will leave Care Homes for Older People Page 14 of 31 Evidence: the individual for a while and return later to offer the care again. There is limited information in the care plan to tell staff about potential triggers to a change in behaviour and how to best manage any reluctance in receiving personal care whilst promoting their independence and respecting their wishes. There were no indications within this care plan what the persons normal patterns of behaviour were, or what symptoms this persons dementia specifically presented. There was also limited information about any difficulties this presented to the person or staff. The care plan states encourage X by gaining her confidence, by assisting with personal care, also involving X in making choices as what X would like to wear.. and staff to keep X calm and comfortable and to make her feel settled and safe. Whilst the plan tells staff to support this person there is no information to advise what staff should do if X becomes reluctant to receiving care. Behavioural charts tell us that there have been three occasions when this person has been became verbally aggressive and physically aggressive, X was swearing and hitting at both staff members. We reviewed the homes policies and procedures on Aggression which state assess the reason for and root cause to determine the factors that led to the aggression. We found no information on this persons record to show that the home has followed this guidance. During the inspection we observed one incident that took place. We observed a resident opening a fire door in their wish to leave the building. Staff responded quickly to the situation, however their responses lacked sensitivity and did not demonstrate a respectful approach to dealing with such situation. This was feedback to the manager who assured us that she would look into the matter. 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. Staff spoken with were knowledgeable about the people in their care but the lack of documented information describing their care needs means that there is a risk of inconsistent care being delivered to people living in the home. Records in three peoples care plans are dated and signed by staff to show when they were last reviewed or amended. There is no evidence that families have been involved in the reviewing of their relatives care plans. There were no written records to tell us if families who were not involved had declined. It was evident throughout the inspection that people receive good care and staff were supportive and friendly towards them. All people at the home spoken to were positive about the care they receive. One person commented that the carers were all very Care Homes for Older People Page 15 of 31 Evidence: good another said staff are ever so nice. The pharmacist inspection lasted two and a half hours. Eight peoples medicines were looked at, together with their Medicine Administration Record (MAR) chart and care plans. Two senior care assistants were spoken with and all feedback was given to the manager at the end of the inspection. The home has dedicated medicine rooms on all units. One of these was too hot. All medicines should be stored below 25C at all times to maintain their stability. The medicines were all kept in dedicated medicine trolleys which were used to transport medicines to the people in the home. They were securely held in the medicine rooms when not in use. The medicines kept inside were well organised reducing the risk of errors as it was easy to find a particular medicine for a person. The home sees all the prescriptions before they are dispensed and uses a copy of these to check the medicines and MAR chart received into the home. Any discrepancies are immediately addressed. An external auditor comes in three times a week to check that the medicines had been administered as prescribed and records reflected practice. This has helped to maintain the medicine management to a good standard. Audits indicated that the majority of medicines had been administered as prescribed and records reflected practice. All controlled drug balances were correct and records reflected practice and they were stored in compliance with current regulations. The two senior care assistants had a good understanding of the medicines they handled enabling them to support the peoples clinical needs. The care plans had improved since the last inspection and the peoples clinical needs were documented. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a nutritious and varied diet and have access to a range of activities. Evidence: The AQAA states daily living activities to encourage staff to grasp each opportunity with each service user. Encourage families, friends and relatives to visit regularly and remain involved. To find out if this was the case, a discussion was held with the manager, staff, people who use the service and visitors to the home regarding recreational activities on offer. Breakfast, lunchtime and evening meal were observed. The overall atmosphere in the home was friendly and relaxed. We spoke to a visitor to the home who told us that they were able to visit at any time and were made welcome. People are encouraged to maintain links with their family friends and the local community. Representatives from the local churches visit weekly / monthly. On the day of the inspection a Church service was planned for people at the home. With the exception of the Church service on the day of the inspection, we found that Care Homes for Older People Page 17 of 31 Evidence: there were no planned activities for the people who live there. People were seen to sit in their bedroom or lounges listening to music and chatting to each other with occasional interaction from staff. Staff spoken to told us that the home does not have any planned activities on a day to day basis, allocated staff are responsible for arranging activities in each of the units. Records in peoples files held little information about activities people were involved in, and lacked information about peoples personal interests, making it difficult for staff to deliver activities that take into account peoples skills and interests. Staff told us that more activities would be planned for the summer months which would include trips out to local parks or the Belgrade in Coventry to see a show. We conducted a short observational exercise in the main lounge, when we observed reactions from a group of people and observed interactions between them and staff. We saw that staff were kind in their approaches to people. We also observed that staff were good at offering choices and supporting people in decision-making. At lunchtime people in the home were seen to enjoy their meal which was served from a hot trolley in the dining room. Good sized portions were given and the meals looked hot and appetising. The cook explained that the home also provides for cultural needs as well as specialist dietary needs. These included alternative meals and food items with reduced sugar or sweetener alternative. Improvements have been noted in the homes approach to meeting peoples cultural needs, for example, one person we spoke to told us that their faith is important to them, when we looked at the care file, information is available to tell staff about this. Information in the care plan also includes dietary needs in relation to this persons religious beliefs and informs us that the chef has been informed to ensure this person has no meat on Fridays. Good practice at meals time was observed for people who require liquidised diets. The cook ensures food portions are liquidised separately to maintain the colour and appearance of the foods where possible Meals times are staggered in each unit to ensure food is provided at suitable temperatures. A member of kitchen staff accompanied the hot trolley around the home to assist care staff. Staff were seen to assist people where necessary. One to one support was offered to people who remained in their beds during meal times. There were positive comments made about the food, such as very nice, you get a lot. 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 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. Staff recruitment is not sufficiently robust to ensure people are supported by staff who are trained to protect them and suitable to work with vulnerable adults. Evidence: The AQAA states We look on complaints as a constructive criticism and try and resolve them within 28 days. We ensure that the appropriate paperwork is completed and sent to The Care Quality Commission unless it is safeguarding which is longer. 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 that is displayed in the home for the benefit of people living there and any visitors. An accessible complaints procedure is also available in the homes information booklets. The complaint folder as review and shows that there has been two complaints made since the last key inspection. Both are being addressed by the manager and records shows the home responds to complaints in a timely manner. There is no information Care Homes for Older People Page 19 of 31 Evidence: to state if the complaints have been resolved and what the outcome of the complaint was. People who were spoken to about concerns or complaints all said that they would speak to staff is they were not happy about something or would address the matter themselves. One visitor told us if there were any serous matters, I would speak with the manager to get it sorted. Protecting people from abuse was discussed with staff and the manager. We saw that a policy was in place for safeguarding vulnerable adults, however there is limited information available to staff about whistle blowing. The manager informs us that this will be looked at and updated. Staff spoken to were aware that they needed to report any concerns to senior staff or the manager. They also knew when concerns needed to be reported to Social Services. There have been no allegations of abuse at the home since the inspection in January 2010. Three staff files were looked to look at the homes recruitment process. The home has recruited one new member of staff since the last inspection. Gaps in the homes recruitment processes were found. The member of staff started to work on the home on the week of the inspection, whilst they had a POVA first check in place, the home had not received references for this person. The home needs to ensure required checks on staff are carried out before they start working with vulnerable adults. Peoples money is held in safekeeping by the home. Three peoples records were checked. Each transaction is being signed by staff as verification of money passed to people or spent on their behalf. As are retained in respect of any purchases made on behalf of people who use the service. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and clean home that allows them to move around freely. Evidence: The AQAA states We have designed the home to specifically meet the needs of service users. We ensure that the home is homely warm and welcoming. We encourage the services users to bring personal items for familiarity. A well maintained outside environment. To find out whether this was the case the living accommodation and the facilities available to people who live at the home were looked at records viewed and spoke with people who live there. There have been no changes to the homes environment since the last inspection. The home provides accommodation over two floors. At the time of this inspection there were 70 people living at this home that can accommodate 107 people. We looked at some of the bedrooms of the people involved in case tracking. They were clean and well 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 21 of 31 Evidence: equipment including specialised air mattresses are available. The kitchen was clean and tidy and in good order. Daily temperature records are being maintained for the fridge and freezer showing appropriate temperatures to maintain good food safety. There also evidence that the cook is checking the temperature of food before it is served. There are risk assessments in place in relation to preparation cooking and cooling of foods. The laundry area has good systems of infection control. Soiled items of bedding and clothing are taken to the laundry in red clinical waste bags which are placed directly into washing machines. The laundry room is equipped with sufficient commercial equipment to manage the soiled laundry for the home and is satisfactory for the control of infection. Systems are in place to reduce the risk of infection. Disposable gloves aprons and hand scrub were available and were used by staff when handling soiled linen and when supporting people with personal care. 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 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 would be better protected by more robust recruitment procedures to ensure staff are suitable to work with vulnerable adults. People cannot be confident that staff have all the skills knowledge and experience to meet their needs. Evidence: When asked what the home does well, the manager responded in the AQAA maintain our current quality of staffing levels and training levels. To check that this is the case, we looked at three staff files, spoke with staff and the manager. Three weeks staffing rotas were seen. Each unit has a senior member of staff during the day shifts and two carer staff to ensure that the needs of each person are met. There are also staff to work in the laundry, kitchens and to maintain the cleanliness of the home. A handyman is available for repairs and to ensure that maintenance checks are completed. As previously stated, three staff files were looked to look at the homes recruitment process. The home has recruited one new member of staff since the last inspection. Care Homes for Older People Page 23 of 31 Evidence: Gaps in the homes recruitment processes were found. The member of staff started to work on the home on the week of the inspection, whilst they had a ISA check in place, the home had not received references for this person. The home needs to ensure required checks on staff are carried out before they start working with vulnerable adults. A review of staff files shows that steps have been taken to increase the frequency of supervision of staff. However the home needs to continue to work towards all care staff receive formal supervision at least six times a year and that this is recorded. This is to ensure people are supported by staff who have the competencies and qualities required to meet their needs. Information supplied by the manager in the AQAA states that 30 members of the 60 permanent care staff are qualified to National Vocational Qualification in Care Level two. This is at the national Minimum Standard for 50 per cent of staff to be qualified. To obtain up to date information on staffing training, we requested the homes training matrix or records of what training staff have received. The home was not able to provide us with information on the day of the inspection and agreed to forward this information within 24 hours. No further information or correspondence was received from the home about this information. As required at the inspection in January 2010, the home must ensure all documents requested for the purpose of the inspection are made available. During the inspection some staff were involved in a three day dementia training program. We spoke to the consultant who was delivering the training and she expressed her satisfaction with the level of understanding and application of knowledge staff have to the training. Staff spoken to told us that they are receiving opportunities to undertake training that meets their needs and reflects the needs of the people they support. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and stakeholders are not consulted about the service and do not have opportunities to influence service delivery. Evidence: The AQAA completed by the manager states the manager and senior team have been in place for along time. Quality assurance system in place an audited by an outside consultant. Since the Key Inspection in January 2010, we have visited the home to check their compliance with requirements made at that inspection. As stated in the Random Inspection report in March 2010 The manager has worked hard to improve the standard of medicine management, care planning, risk management and staff training in the home and this was evidenced by all the requirements being fully met. This was commended. Despite evidence that the home has complied with requirements made at the Care Homes for Older People Page 25 of 31 Evidence: inspection in January 2010, continued shortfalls in the management of the home were found. As identified at previous inspections, the home has not developed any formal systems to monitor practice and compliance with the plans, policies and procedures of the home. No evidence was available to show that the home is in consultation with residents and their representatives about the service to develop the service in the way that meets peoples individual needs. At this visit we found the home were able to sustain the improvements made in the management of medicines and training in the protection of vulnerable adults. However, further shortfalls in care planning and staff recruitment were identified, and not all records requested at the inspection were made available to to us, this relates specifically to training records. There was evidence from a random check of records that equipment is regularly serviced and maintained health and safety checks are carried out. 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. The home has effective systems for maintaining equipment and services to the home to promote the safety of people in the home. A sample of service and maintenance records were examined and found to be up to date for example fire alarm systems are tested weekly and serviced quarterly, Portable Electrical Appliance testing is ongoing on a rolling programme, a gas landlord certificate was seen and was up to date. The owner visits the home on a regular basis to report on the standard of care provided of which reports are made available within the home. Information contained in the reports is limited, reporting on the environment and staffing levels only. More detailed information would provide clearer indications on how the home is monitoring the standard of care at the home and how issues are being managed / addressed. As previously noted, peoples money is held in safekeeping by the home. Three peoples records were checked. Each transaction is being signed by staff as verification of money passed to people or spent on their behalf. We saw that people living at the home were comfortable in the presence of the manager and could speak to her at any time. One of the visitors spoken with said the manager was very approachable and kept them up to date on their relatives life in the home. Care Homes for Older People Page 26 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 27 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 8 13 Strategies for effectively monitoring and dealing with any challenging behaviours and pressure care must be clearly detailed in individual care plans. This is to ensure that there is consistency in care that maintains individuals and staff safety. 30/06/2010 2 29 19 Sufficient information must be secured to determine the fitness of potential employees before they start working at the care home. 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 30/06/2010 Care Homes for Older People Page 28 of 31 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 outcome of a Criminal Record Bureau (CRB) disclosure and checks against the ISA register. This will ensure that the homes staff recruitment practices safeguard people living in the home. 3 32 17 Documents requested for the purpose of inspection must be made available on request and open to inspection. This is so the home can evidence what actions have been taken by the home to comply with the Care Home Regulations 2001. 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 30/06/2010 1 9 It is advised that the temperatures of the medicine rooms are monitored and appropriate action is taken if they rise above 25C to ensure that the medicines stability is not compromised. Records of daily activities for each person should be more detailed and describe the activity and their participation. 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. 2 3 12 14 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 4 27 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. Systems that will effectively monitor and audit working and care practice in the home should be introduced. These procedures must be ongoing and should include obtaining the views of stakeholders regarding the quality of service at the home. 5 28 6 30 7 33 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. 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