Care Home: Chestnut Lodge

What the care home does well We received some very positive comments about the service offered at the home including: `Constantly ensures my needs are met.` `Looks after everyone.` `Takes care of us. Care is very good.` `Applies care and comfort to us all every day.` `X is very well care for. The home does a very good job.` `I am very happy with the service they provide.` Staff knew what the needs of the people living in the home were and how they wanted to be cared for. People have access to a range of health care professionals to ensure that all their health care needs are met. The home has an open visiting policy so that people can see their visitors as they choose and can continue to maintain relationships that are important to them. There were systems in place to ensure people were safeguarded from abuse. There is little staff turnover at the home which is good for the continuity of care of the people living in the home. People could personalise their own rooms to reflect preferences and tastes. Staff had undertaken training to enable them to care for people safely. What has improved since the last inspection? Peoples` safety had improved as staff were using footrests on wheelchairs. Records of health care appointments were easier to track ensuring staff had easy access to current information. This helped ensure peoples` health care needs were being monitored. Records of the food served to the people living in the home showed that people were receiving a varied and nutritious diet and that cultural needs were being met. There had been some improvements to the environment ensuring it was pleasant and comfortable for the people living in the home. What the care home could do better: Care plans should reflect the current needs of the people living in the home to ensure they receive person centred care on an ongoing basis. Risk management plans must be improved so that people are kept safe on an ongoing basis. The medicine management in the home must be improved to ensure people receive their medication as prescribed. Staff should enable people living in the home to pursue their preferred social activities so that they lead fulfilling lives. The quality of the service being offered to the people living in the home needs to be regularly reviewed. The manager must ensure all safety checks are carried out to ensure people are kept safe. Key inspection report Care homes for older people Name: Address: Chestnut Lodge 135/137 Church Lane Handsworth Wood Birmingham West Midlands B20 2HJ     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: Brenda ONeill     Date: 2 2 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 30 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 30 Information about the care home Name of care home: Address: Chestnut Lodge 135/137 Church Lane Handsworth Wood Birmingham West Midlands B20 2HJ 01215513035 F/P01215513035 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Evelyn McIntosh,Mrs Catherine McHugh Name of registered manager (if applicable) Mrs Evelyn McIntosh Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 15 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 15 Date of last inspection Brief description of the care home Chestnut Lodge is a home providing residential care for up to 15 older people. The premises consist of 2 large houses that are joined, and situated on a busy main road with shops nearby. The home has a well-maintained garden at the rear, with a Care Homes for Older People Page 4 of 30 Over 65 15 0 0 1 0 6 2 0 0 9 Brief description of the care home paved patio area, and furniture for those people living in the home that wish to sit outside in fine weather. There is parking for 2-3 cars at the front of the property. Accommodation is provided on three floors consisting of a mix of single and double rooms. There are ample communal bathing and toilet facilities. The home has two sitting rooms, one at the front of the house and another at the rear overlooking the garden. The atmosphere of the home is very homely. A shaft lift gives access to upstairs rooms. The range of fees charged at the home was not in the service user guide. People should contact the home for this information. Care Homes for Older People Page 5 of 30 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 inspection was carried out over one day by one inspector. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Care Homes for Older People Page 6 of 30 Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with five of the people living in the home, the manager and three staff to get their views on the home. We sent ten Have your Say surveys to people who live in the home and ten to staff members. A total of fourteen were returned, eight from people living in the home and six from staff. These views have been included in the report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Care plans should reflect the current needs of the people living in the home to ensure Care Homes for Older People Page 8 of 30 they receive person centred care on an ongoing basis. Risk management plans must be improved so that people are kept safe on an ongoing basis. The medicine management in the home must be improved to ensure people receive their medication as prescribed. Staff should enable people living in the home to pursue their preferred social activities so that they lead fulfilling lives. The quality of the service being offered to the people living in the home needs to be regularly reviewed. The manager must ensure all safety checks are carried out to ensure people are kept safe. 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 30 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 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was information available to help people decide if the home was suitable for them. Arrangements were in place to ensure the home could meet the needs of the people being admitted but this was not always reflected in the homes recording systems. Evidence: The service user guide for the home had been updated and told people what they could expect from the service. The range of fees charged at the home were not included but there was a statement telling people that fees were dependent on such things as what room they occupied. It did state what was not included in the fees, for example, hairdressing and phone calls. The address for the Commission needed to be updated so that people could contact us should they wish to. The document was available in large print for those with impaired sight. Seven surveys were returned to us before the inspection and they all indicated that Care Homes for Older People Page 11 of 30 Evidence: people had received enough information to help them decide if the home was the right place for them. The people spoken with during the inspection were satisfied with the service they were receiving at the home. The pre admission process was looked at for three people who had been admitted to the home since the last key inspection. Records showed that the home had undertaken an assessment for one persons needs. The assessment document for another person could not be found although the manager stated they had undertaken an assessment. The third person was admitted on an emergency basis and the manager did not have the opportunity to go out and assess the individual. All the files sampled included care plans that had been drawn up by social workers that were involved in the admissions but there were no copies of the social workers assessments. Speaking with the manager it was evident that she had discussed the needs of the people being admitted with families and social workers and she was able to tell us about these. It is important that all the information about peoples needs on admission to the home are available to staff so that they can ensure people are cared for in the way they want. The person admitted on an emergency basis had not had the opportunity to visit prior to admission. They did tell us they had settled well and seemed quite content. The manager told us the other two people had visited the home before admission one with family another on her own. One was not able to confirm this and the other could not remember. Pre admission visits to the home should be recorded to show people have had the opportunity to do this to help them decide if the home if suitable for them. The home does not offer intermediate care. Care Homes for Older People Page 12 of 30 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. The lack of detail in the homes recording systems means that there is a risk that people will not consistently get the care they need in a way they prefer. Management of some of the medicines did not ensure that people received their medication as precribed on an onoing basis. Evidence: We tracked the care for two of the people living in the home. This involved observing their care, sampling their care plans, risk assessments and daily records, speaking to them and the staff where possible. Both of these people had moved into the home since the last key inspection. There was some basic information on the individuals care files about their history and why they had moved into the home. There were a number of different documents on each persons file which included an assessment and daily care plan, daily care plan records and care plans. It was difficult to establish from these which document was the main care plan. The documents included some details of peoples preferred daily routines, for example, rising and retiring times and their preferred activities. These Care Homes for Older People Page 13 of 30 Evidence: were not all up to date as one detailed the individual attending a day centre. The person was no longer attending as the centre had closed. There was some information about individuals preferences, for example, when they liked to have a bath, how many pillows they liked and some of the foods they liked. There was also some detail of peoples abilities, for example, is able to choose own clothes and unable to wash as unable to weight bear. This information gave staff some information about how to care for people the way they wanted and ensure they were able to maintain some independence. However there was very little detail of peoples individual needs in relation to such things as their personal care and culture. One person had specific requirements in relation to skin care and wore a hat most of the time. Although staff could tell us about this the lack of detail in the care plan could lead to this person not having their needs consistently met. From what was seen, what staff told us and the records in the home it was clear people were receiving a lot more care than was detailed in the care plans. As at the last inspection there was quite a stable staff group at the home who knew the people living there well but if any new staff started it would be very difficult for them to know where to find information, what the specific needs of people were or how they were to meet them. This could lead to people not having their needs met. The comments we received about the care people received were very positive and indicated people received the care they needed in a way they liked. These included: Constantly ensures my needs are met. Looks after everyone. Takes care of us. Care is very good. Applies care and comfort to us all every day. X is very well care for. The home does a very good job. I am very happy with the service they provide. There were some risk assessments on files including preventing falls and details of the risks of any alcohol consumption. Some of the people living in the home had some behaviours that could be difficult to manage. One person was seen to have a management plan in place for this and staff were aware of it and able to tell us about Care Homes for Older People Page 14 of 30 Evidence: it. Speaking to staff and looking at records showed us another person had some difficult to manage behaviour at a specific time of day. Staff were able to tell us how they managed this and it had been followed up with medical professionals but there was no documented management plan. There needed to be a plan for staff to follow to ensure consistency and that the person was not put at risk of being managed inappropriately. The people living in the home were satisfied that there health care needs were met. They told us that they could see a doctor if they wanted to. The district nurse was seen to visit the home during the inspection. Daily records and care files showed that people had access to health care professionals such as chiropodists, opticians, doctors, district nurses and so on. The recording of visits from health care professionals had improved which made it much easier to see that any issues were being followed up. This also made information for staff easily accessible. This will help staff ensure the well being of the people living in the home. Daily records did give some information about the personal care needs of the people living in the home being met and their general well being. People spoken with were satisfied with the service they were receiving and generally looked well cared for. People were seen to be dressed appropriately in styles that reflected their age, gender and personal choices. People were receiving their medication via a monitored dosage system. Staff had been trained to use the system. The medication system in the home was being audited quite frequently by the PCT. The report from them in January stated the system was well organised and it ran well. There had been an audit the day before the inspection and the manager stated there had been some issues about paracetamol. We undertook a random audit of some of the medication. The system was generally well managed and medication was being acknowledged when it arrived in the home and signed for when administered. Some discrepancies were found in some of the amounts remaining in boxed medication. These did not tally with what had been booked onto the MAR (medication administration record) and what had been administered. This agreed with what the PCT had found during their audit. It appeared that the balances being brought forward at the end of the cycle were not always correct which led to the discrepancies. However this could not be confirmed for all the discrepancies. It was also noted there was some medication to be administered on an as and when necessary basis. There was no guidance for staff to follow to ensure this was administered appropriately. The manager needed to ensure that the medication system was robust and there was a complete audit trail for all medication to ensure Care Homes for Older People Page 15 of 30 Evidence: people were receiving their medication as prescribed. The people living in the home were treated with respect and their rights to privacy upheld. Staff were very polite and interacted well with the people living in the home. Individuals could spend time in their bedrooms without being disturbed if they wished. Double bedrooms had appropriate screening in place. Assistance with personal care was offered discreetly. Care Homes for Older People Page 16 of 30 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. There were activities available for the people living in the home but it could not be shown that these met the needs of everyone. The people living in the home were satisfied with the meals served to them and cultural diets were being catered for. Evidence: There were no rigid rules or routines in the home. People told us and records showed they chose when to go to bed and get up, what they ate and what they did with their time while in the home. Being able to make choices enhanced peoples individuality and promoted their independence. Peoples preferred activities and hobbies were detailed in the care files and there was some evidence of these being enabled by staff. For example, one person was having the newspaper delivered daily and often spoke of their favourite sport. Records showed and one person told us that did not like the organised activities and this was not an issue with staff. As mentioned previously the details about another persons preferred activities were not up to date. This could be misleading for staff who thought this person still attended the day centre. There was an activity programme on the wall in the dining area which included such things as floor games, bingo, DVDs, sing a longs and church services. Activity records were being kept that showed these activities were taking place but there was no Care Homes for Older People Page 17 of 30 Evidence: indication of whether people enjoyed the activities or not. People spoken with had mixed views about the activities some saying they were o.k. others saying they got bored. It was difficult to determine if the activities were ensuring people led fulfilling lives. There were occasional outside entertainers who visited the home. Occasionally people were taken out to local shops and parks and had recently been out for a pub lunch. One of the surveys returned to us indicated they thought there was a shortage of staff which did not allow for people to be taken to church. The manager told us people who were enabled to go to church wherever possible either via ring and ride or by people picking them up and taking them in their cars. Records showed and our observations confirmed that people were able to keep in touch with people that are important to them. We spoke to one visitor who told us she visits at all times and is always made welcome she said I cant fault them. People spoken with were very satisfied with the food they received at the home. Staff spoken with knew what the likes dislikes and special diets were, for example, one person did not have dairy products and another liked some West Indian food. This ensured people received the food they liked. The records of food being served to the people living in the home had improved and showed they were getting choices and their diet was nutritious. The catering arrangements ensure the nutritional needs of the people living in the home are being met. This in turn helps to ensures their well being. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements were in place to ensure people were listened to and protected from harm. Evidence: People had received a copy of the complaints procedure in the service user guide. This was in large print to make it easier for people with any sight impairment to read. The surveys returned to us indicated people know who to speak to both informally and formally if they are unhappy about anything. One visitor told us if they had any concerns they would raise these with the staff or the manager but she had had no reason to do this. Good relationships were evident between the staff and the people living in the home which would give them the confidence to raise any issues. We were told there had been no complaints lodged at the home since the last inspection and we had not received any about the home. It was recommended that the manager sets up a system for recording minor issues or grumbles that are raised by the people living in the home to further evidence that they are listened to and their comments acted on. The manager told us staff had received training in safeguarding issues. The staff spoken with confirmed this and we were also told they were undergoing further Care Homes for Older People Page 19 of 30 Evidence: training. This training was a distance learning course and covered the the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. The manager was very aware of this legislation and told us she had not had to make any referrals in relation to it. There had been no safeguarding issues raised about the home since the last inspection. Staff spoken with were able to tell us what they should do if they witnessed or suspected any form of abuse. This should ensure people are safeguarded from harm. Care Homes for Older People Page 20 of 30 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. Care was being provided in a homely, comfortable environment that was generally well maintained. Evidence: There had been no changes to the layout of the home since the last inspection. The home is quite small and provides the people living there with a homely environment. There was no doubt that the people living in the home were very comfortable. There had been some further redecoration to the home since the last inspection and the majority of areas were very bright and cheerful making it pleasant for the people living there. The home had ample communal space with two lounges, a dining area and a large entrance hall. All areas were adequately furnished and decorated. It was noted that although the carpet in the entrance hall and one of the lounges is cleaned regularly it was still stained. This should be replaced as soon as funds allow. Some of the communal areas had been redecorated and had new curtains. There was a well maintained garden to the rear of the home. The manager told us they had purchased some new furniture for outside so people could sit in the garden if they wished. As at the last inspection there were bathing and toilet facilities on all floors. Some of Care Homes for Older People Page 21 of 30 Evidence: the facilities allowed for staff to assist the people living in the home where they needed help. The facilities were all very clean but can only be described as basic but all were usable. There were some aids and adaptations in the home to help people move around or summon help. These included, hand rails, assisted bathing facilities, shaft lift, call system and wheelchairs. The practice of using wheelchairs without footrests had stopped ensuring people using them were safe. Some bedrooms were seen. These varied in size, some were singles and others were doubles. Some of the bedrooms had been redecorated and one seen had had new carpet, curtains and furniture. Some of the bedrooms seen were in need of redecoration to ensure they were kept to an acceptable standard for the people living in the home. People were able to take personal possessions into the home and these were seen in some bedrooms. The home was clean and odour free making a pleasant environment for people. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were being cared for by a well recruited, trained, stable staff team that was able to meet their needs. Evidence: Staff turnover at the home is quite low and some of the staff have worked there for a considerable amount of time. This is very good for the continuity of care of the people living in the home. It was evident throughout the day that relationships between the staff and the people living in the home were very good. Without exception all the comments received about the staff team were very positive. These Included: Nothing is too much trouble and staff are always very friendly. The home does a very good job. Keep us safe and happy. The rotas indicated there were always two staff on duty with the managers hours extra to this. The home also had a lot of support from students studying at local colleges. The students helped with all aspects of the care and stimulation of the people living in the home. The home also employed a cook five days a week. On the cooks day off an extra staff member was on duty to do the cooking. There were no cleaning Care Homes for Older People Page 23 of 30 Evidence: staff employed but the manager told us that cleaners came in to do such things as cleaning skirting boards and high cleaning. This ensured care staff were not spending all their time cleaning. The staffing arrangements ensured there were always staff available for the people living in the home. The manager was in the process of appointing one new staff member. The appropriate police checks had been undertaken and she was awaiting one reference for the individual before they commenced their employment. The recruitment procedures in the home ensured only the appropriate people were appointed to work in the home and this ensured people were kept safe. Information on the AQAA indicated that nine of the ten staff employed had an NVQ qualification at either level 2 or 3. Staff spoken with confirmed they had received a considerable amount of training and that this was ongoing. Training topics included manual handling, fire procedures, medication, safeguarding, medicine administration, health and safety and infection control. Staff were very positive about the range of training they are offered and undertake. Comments included: Make sure staff get proper training. The home manager always send the staff on different courses and training. All care staff are trained to do their job. The staff have a sense of humour theyre attentive and work very hard. It was not possible to determine what training all the staff had undertaken as there was no training matrix for the home. It was strongly recommended that the manager developed a training matrix for the whole home that detailed what training staff had undertaken and when. This will enable easy tracking of when staff are due to take any updates. This will ensure all staff have the appropriate skills and knowledge to care for the people living in the home effectively. Care Homes for Older People Page 24 of 30 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 needed to have a development plan in place so that the people living there could be assured the service would be continually improved. Evidence: The manager of the home had been in post for a considerable amount of time and was also one of the owners. She demonstrated throughout the inspection that she has a very good knowledge of the needs of the people living in the home and how they liked to be cared for. The manager had very good relationships with the people living in the home and the staff and we received some very positive comments about her including: There is nothing more the manager could do. I think the home manager has done very well. Care Homes for Older People Page 25 of 30 Evidence: Manager and staff work together to ensure all residents are happy and well cared for. As at the last inspection there was no doubt that overall the home offered a good level of service to the people living there but the recording let them down in some areas, for example, care plans. Unfortunately this could lead to some individuals not having their needs met as they would like particularly if any new staff started working in the home. There had been no progress in developing some quality monitoring systems in the home. We did see some minutes for meetings that been held with the people living in the home. These were run by a visitor from the church. The same topics were discussed at the meetings which were care, food and entertainment however there was little mention of what people had specifically said and no follow up from one meeting to another. It could not be shown that peoples views were being taken into account when trying to progress the service. We were told that there were some staff meetings however the minutes for these were not on site. As at the last inspection the home did not handle any money on behalf of the people living there on an ongoing basis. If anyone needed anything it was purchased by the manager and relatives, Social Care and Health or solicitors then reimbursed the money. The manager was satisfied that all the people living in the home had access to money if they needed it. One exception to this was one person whose personal allowance was sent to the manager by cheque in the name of the home. The manager then cashed this and paid the money to the individual concerned. Health and safety in the home was generally well managed. Staff had received training in safe working practices. The home was well maintained and safe. The information indicated that the servicing of the equipment was up to date. The in house checks on the fire system were sampled. These showed that regular fire drills were undertaken so that staff could keep people safe in the event of a fire. There had been some lapses in the testing of the fire alarm which should be done weekly. The manager needed to ensure this was done to ensure people were safe on an ongoing basis. The fire alarm was serviced on the day of the inspection and was all working effectively. Care Homes for Older People Page 26 of 30 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 30 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 There must be robust management plans in place for any difficult to manage behaviours. This will ensure people are safeguarded. 31/05/2010 2 9 13 There must be robust systems in place for managing medication. This will ensure people receive their medication as prescribed on an ongoing basis. 31/05/2010 3 38 13 The fire alarm must be tested weekly. This will ensure it is working effectively and people are safe. 31/05/2010 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The service user guide should include all the information people would need to help them decide if the home could meet their needs. Records should be available to show that people have had their needs assessed before being admitted to the home. This will ensure staff have the necessary information to ensure they can meet the needs of the people being admitted. Care plans should detail all the current individual needs of the people living in the home and how they want these met. This will ensure people receive person centred care. There should be some consultation with the people living in the home to establish what activities would make their lives more meaningful. It is recommended that the manager sets up a system for recording any minor issues or grumbles that are raised by the people living in the home to further evidence that they are listened to and their comments acted on. All areas of the home should be kept decorated to an acceptable standard for the people living in the home. The flooring in the entrance hall and lounge should be replaced. This will ensure the home is kept to an acceptable standard for the people living there. It is strongly recommended that the home has a training matrix for the staff team. This will show staff have the skills and knowledge to care people effectively. The home should have a development plan in place. This will ensure the service is improved for the benefit of the people living in the home. 2 3 3 7 4 12 5 16 6 7 19 20 8 30 9 33 Care Homes for Older People Page 29 of 30 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. © 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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