Care Home: Chestnut Lodge

What the care home does well Prospective residents are assessed prior to admission to ensure the home is able to meet their needs. Service user plans are in place and there was evidence of reviews and input from residents representatives. Healthcare needs are being identified and met. Staff care for residents in a gentle, friendly and professional manner, respecting their privacy and dignity, and there is a very good atmosphere throughout the home. Work is ongoing to include training for staff and discussion with representatives, to ensure that the wishes of residents and their families in respect of health deterioration and end of life care needs can be identified and recorded. The activity provision in the home is good and varied and work is ongoing to provide good environments and activities to meet the individual and collective needs of the residents effectively. The home has an open visiting policy and visiting is encouraged. The food provision at the home is good, offering variety and choice. The home has procedures for the management of complaints and safeguarding adults issues, and these are adhered to. The home provides an excellent standard of accommodation, to include single bedrooms with en suite facilities and good quality communal space, and is clean and fresh throughout. Procedures are in place and being followed for infection control. The home is being appropriately staffed to meet the needs of the residents and this is kept under review, in line with resident dependency. Over 50% of care staff are qualified to NVQ in care level 2 or above, and there is a good induction programme that is completed by staff. In addition, training in topics relevant to the diagnoses and needs of the residents is undertaken, plus more training in dementia care is being planned. The Manager has the skills and experience to manage the home effectively and is approachable, working with the staff to maintain a good standard of care. The home also has an appropriately qualified Head of Nursing, to ensure nursing needs to include specialist needs are identified and can be met. There is a system in place for quality assurance and this is being expanded to ensure an ongoing process of audit and review. Monies held on behalf of residents are being well managed and securely stored. Overall health and safety is being well managed in the home, thus protecting residents, staff and visitors. Comments received included: `The home is always warm and welcoming. The manager is friendly and helpful and frequently available.` `Hygiene is very good. Staff always help keep residents clean and tidy. Menu appears very good and varied to suit everybody. Staff are very polite and friendly.` `Provides a comfortable ambience always evident on visits to the home. The staff and carers are very devoted to dealing with and treating residents with dignity.` `The home provides induction for all new staff. The manager has meetings with staff members to update us with any new information and give us feedback on how well staff are doing and what can be done better to improve work practice. The manager provides us with training that will help us to enhance the work environment and also our personal development needs.` `The home ensures that the clients get the best of care and supervision at all times. We have regular training to help enhance our knowledge towards our job.` What has improved since the last inspection? The home opened in July 2009 and this is the first inspection. What the care home could do better: Although changes in residents needs are reflected in the care plan review document, we recommended this information be incorporated into the care plans, to that all the information in the care plans is current. Resident care assessments had not always been fully completed, and the need to ensure all assessments are complete and up to date was discussed. We identified some shortfalls in the recording and management of medications and these need to be addressed. The manager has since forwarded an action plan for the majority of medication issues identified, to include staff training updates in medication management. The home does have information for advocacy services, however this was not on display. It is acknowledged that all residents are placed by Ealing Social Services, so they do have access to a care manager and resident reviews are carried out. Shortfalls were identified in the content of some of the staff employment records viewed, which could place residents at risk. Although overall health and safety is being well managed, we did identify that night time fire drills were still to be carried out. We also identified shortfalls in the reporting of every incident of unexplained bruising. It is acknowledged that when bruising is identified it is recorded in the residents records. We received some individual comments relating to the food provision, recruitment of permanent staff and some additional ideas for resident outings and activities. These were discussed with the manager who was very receptive and said that some of the areas had already been identified and were being addressed and others would be looked into. Key inspection report Care homes for older people Name: Address: Chestnut Lodge 3 Woodfield Road London London W5 1SL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Clare Henderson-Roe     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Chestnut Lodge 3 Woodfield Road London London W5 1SL 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sheila.king@servitehouses.org.uk Servite Houses Name of registered manager (if applicable) Type of registration: Number of places registered: care home 64 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 64 The registered person may provide the following category / ies of service only Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Dementia over 65 years of age - Code DE(E) Date of last inspection Brief description of the care home Chestnut Lodge is a purpose built care home in Ealing. It consists of 4 units named after famous people, Sinatra, Monroe, Crosby and Armstrong. Each unit has 16 beds and provides accommodation for residents with dementia care needs. 2 units are for nursing care and 2 units are for personal care needs. The home has been built to a high standard, with single rooms that all have en suite facilities to include assisted showers. There is a good amount of communal space available, to include an enclosed garden. The home accommodates residents placed by the Borough of Ealing. The Care Homes for Older People Page 4 of 27 Over 65 64 64 Brief description of the care home following information regarding fees has been provided by Servite Houses: Chestnut Lodge was developed under the Governments Private Finance Initiative and capital costs are met in this way. Ealing Council pays a unitary charge, which covers all the services the council receives from Ealing Care Alliance. It covers the costs of care and the provision of facilities management services to the day care service and accommodation. It is not possible to separate these out to identify how much each residential care and nursing care placement costs. The fee payable to the council by residents who fund themselves in full is £526.00 per week for residential care. The fee payable to the council by residents who fund themselves in full is £651.00 per week for nursing care. Deducted from that will be the free nursing care amount of £125.00 (high) and £83.00 (medium and low) Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection carried out as part of the regulatory process. A total of 10.5 hours was spent on the inspection process, and was carried out by 1 inspector. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Several residents, staff and visitors were spoken with as part of the inspection process. The CQC Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents and their representatives, staff and health and social care professionals have also been used to inform this report. Comments and suggestions received via the surveys were fed back to the Manager in general terms and some comments are included below. It must be noted that it is sometimes difficult to ascertain the views of residents with dementia care needs. Care Homes for Older People Page 6 of 27 What the care home does well: Prospective residents are assessed prior to admission to ensure the home is able to meet their needs. Service user plans are in place and there was evidence of reviews and input from residents representatives. Healthcare needs are being identified and met. Staff care for residents in a gentle, friendly and professional manner, respecting their privacy and dignity, and there is a very good atmosphere throughout the home. Work is ongoing to include training for staff and discussion with representatives, to ensure that the wishes of residents and their families in respect of health deterioration and end of life care needs can be identified and recorded. The activity provision in the home is good and varied and work is ongoing to provide good environments and activities to meet the individual and collective needs of the residents effectively. The home has an open visiting policy and visiting is encouraged. The food provision at the home is good, offering variety and choice. The home has procedures for the management of complaints and safeguarding adults issues, and these are adhered to. The home provides an excellent standard of accommodation, to include single bedrooms with en suite facilities and good quality communal space, and is clean and fresh throughout. Procedures are in place and being followed for infection control. The home is being appropriately staffed to meet the needs of the residents and this is kept under review, in line with resident dependency. Over 50 of care staff are qualified to NVQ in care level 2 or above, and there is a good induction programme that is completed by staff. In addition, training in topics relevant to the diagnoses and needs of the residents is undertaken, plus more training in dementia care is being planned. The Manager has the skills and experience to manage the home effectively and is approachable, working with the staff to maintain a good standard of care. The home also has an appropriately qualified Head of Nursing, to ensure nursing needs to include specialist needs are identified and can be met. There is a system in place for quality assurance and this is being expanded to ensure an ongoing process of audit and review. Monies held on behalf of residents are being well managed and securely stored. Overall health and safety is being well managed in the home, thus protecting residents, staff and visitors. Comments received included: The home is always warm and welcoming. The manager is friendly and helpful and frequently available. Hygiene is very good. Staff always help keep residents clean and tidy. Menu appears very good and varied to suit everybody. Staff are very polite and friendly. Provides a comfortable ambience always evident on visits to the home. The staff and carers are very devoted to dealing with and treating residents with dignity. The home provides induction for all new staff. The manager has meetings with staff members to update us with any new information and give us feedback on how well staff are doing and what can be done better to improve work practice. The manager provides us with training that will help us to enhance the work environment and also our personal development needs. The home ensures that the clients get the best of care and supervision at all times. We have regular training to help enhance our knowledge towards our job. Care Homes for Older People Page 7 of 27 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 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. Prospective residents are assessed prior to admission to ensure the home is able to meet their needs. Evidence: Servite Houses has a pre-admission assessment document and we viewed several that had been completed. These, together with the social services assessments, provided a good picture of each resident and their needs. The majority of residents in the home during the inspection were on respite care placements. All placements are made by Ealing Social Services and there are agreements in place for each resident. Care Homes for Older People Page 10 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user plans are in place and provide staff with a good picture of the resident and how to meet their needs. There was evidence that residents healthcare needs are identified and input from healthcare professionals sought to meet these needs. Shortfalls were noted in some areas of medication management, and this could place residents at risk. Staff care for residents in a gentle and professional manner, communicating effectively and respecting their privacy and dignity. Work is being carried out around the wishes of residents and their families in respect of health deterioration and end of life care, so that their wishes can be recorded and respected. Evidence: We viewed 5 service user plans. Care plans were in place for each identified need and these provided a good picture of the resident and their needs. A monthly review and update had been carried out and any changes in condition had been recorded on the review document. We recommended that the care plans also be updated to reflect any significant changes in a residents condition. Risk assessments for falls were in place, and a record of any falls had been recorded. Where bruising had been identified, either following a fall or where a cause was not known, a record had been completed Care Homes for Older People Page 11 of 27 Evidence: to identify when and where the bruising was discovered. We discussed the importance of ensuring that any unexplained bruising is reported (see Standard 38). The manager said that he would introduce a daily body check for each resident, which could be carried out whilst assisting them with personal care, and a record of the skin condition maintained. There was evidence of input from residents representatives in the service user plans, to include signing the care plan documentation. Assessments for pressure sore risk, nutrition and moving and handling were in place. For one resident, 2 assessments had been part completed and this was addressed at the time of inspection. Where needs had been identified care plans had been formulated. Continence assessments are carried out for each resident and kept in a separate file in conjunction with the ordering of continence care products. On the personal care units there was evidence of input from the District Nurses, and the staff have access to their records. We discussed ensuring that where the District Nurse is involved in a residents care, this be clearly identified in the service user plan so it can be cross-referenced, and the staff said that they would complete this. Residents are weighed monthly and the manager explained that where significant weight issues are identified a referral is made to the dietician. Bedrail risk assessments had been carried out and written consents for their use were in place. There was evidence of input from healthcare professionals to include GP, dentist, district nurses, chiropodist and optician. We viewed medication management and records on each unit. Lists of staff signatures and initials were available. On the nursing units lancing devices for professional use were available for blood glucose monitoring for diabetic residents. Liquid medications had been dated when opened. With one exception, all administration records had been signed. Receipts of medications had also been recorded. Where a hand written entry is made on the medication administration record (MAR) then 2 staff sign to say they have checked the medication entry is correct. We did find one instance where a medication had been signed for but was still in the monitored dosage system (MDS) blister pack, and also for 2 residents for whom we did a stock check on medications there was a discrepancy in the number signed for and the number still in the MDS blister packs. For one medication with a variable dose, the actual number of tablets given had not always been recorded. The importance of ensuring all medication is given in accordance with the prescribers instructions was discussed with the staff on the units concerned and also with the manager. We requested that a full audit of medications be carried out and an action plan drawn up to address any shortfalls identified. There was evidence that monthly medication audits had been taking place, and there needs to be a clear process of feed back to staff so that any shortfalls identified can be addressed without delay. We also discussed the need for staff Care Homes for Older People Page 12 of 27 Evidence: involved with the administration of medications to receive training updates to include the recording and administration of medications with a variable dose. We did check the stock levels of several other medications on each unit, to include those supplied in the MDS and also boxed medication and the stock balances were correct. In some instances the MDS blister packs do not all have the same day of the week as a start date. We recommended this be discussed with the dispensing pharmacist to get the MDS packs starting on the same day of the week for consistency and ease of administration. The blister packs are colour coded for each time of administration, and we noted that some of the packs for the morning were not correctly colour coded, so this was also to be discussed with the dispensing pharmacist. Since the inspection the manager has sent in an action plan to address the shortfalls identified, to include updates in medication training. The regional manager was very aware that the temperature in the clinic rooms where medication is stored is too high and said that she is getting quotes for air conditioning to be installed. The medication fridges for each unit had been removed and placed in the large clinic room on the ground floor, however the temperature in this room was 32 degrees centigrade at the time of inspection. The manager said that he would organise a cooling system for this room as a matter of priority. Staff were seen caring for residents in a gentle, friendly and professional manner, respecting their privacy and dignity. We viewed some items of clothing in the laundry and these had been identified with the residents room number. A more permanent system for clothing identification is being introduced for long stay residents. Residents can have telephones in their rooms if they so wish, either mobile or landline, and there are telephone points in all the bedrooms. We observed good communication between staff and residents. We noted that cultural and religious needs are being addressed, to include meeting dietary requirements, and all residents were dressed to reflect individuality. There was a very good atmosphere throughout the home. There was evidence that the wishes of residents and their families in respect of health deterioration and end of life care are being discussed, and information was available to show this, with representatives in the process of discussing this and making decisions with their loved ones. Some staff are undertaking training in end of life care and this will then be cascaded down throughout the homes. If there is no specific plan in place and someones health deteriorates suddenly then they are sent to hospital. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provision in the home is good and varied, and the activities co-ordinator is very motivated, providing a good variety of activities relevant to the needs and interests of the residents. The home has an open visiting policy, thus encouraging residents to maintain contact with friends and family. Advocacy information is available and needs to be displayed, to respect the residents right to independent representation. The food provision in the home is good, providing variety and choice to meet the needs of each resident. Evidence: The home has a full time activities co-ordinator. There is an activities programme in place and this is advertised throughout the home. The activities co-ordinator has worked hard to transform some of the communal areas within the home, and there is a garden room with plants, wicker seating and reminiscence items to include wartime memorabilia, a record player with classic records playing and other items of interest. In addition there is a sensory room that is very well appointed with sensory equipment to provide a calm atmosphere for residents to sit in, and it was reported that this room does have a positive effect on residents moods. There was also evidence of group and individual activities plus outings. It was clear on speaking with the activities co-ordinator that he has a good understanding of his role and is continually striving to Care Homes for Older People Page 14 of 27 Evidence: introduce more activities relevant to the needs of the residents. There is also a plan to do life story books for each resident, in order to provide staff with a good picture of each residents life history, to include their interests and hobbies. The activities coordinator has provided each unit with comprehensive information about various activities in relation to resident care. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home and offered refreshments. Representatives said that they are kept up to date with any concerns and are confident that they can discuss any matters with the manager. The home has information regarding advocacy services, although this was not on display at the time of inspection. The manager said that this would be progressed in order to provide clear advocacy information for residents and visitors. All residents are placed by Ealing Social Services and so residents all have a care manager, and reviews are carried out. We saw evidence of deprivation of liberty assessments having been carried out and correct procedures had been followed, to ensure resident safety. The manager has also undertaken mental capacity training. We viewed the kitchen. This was clean and tidy and records were up to date. The kitchen had gained a 5 star rating from the Environmental Health Department at a recent inspection, which is the highest grade that can be attained. The home has a 4 week menu and choices are recorded in advance of the meal, with alternatives being available. Cultural and religious dietary needs are catered for. Staff were available to assist residents with their meals and there was a very good and social atmosphere during meals, with residents assisting with the laying and clearing of the tables if they so wished. Special occasions such as birthdays are celebrated with cakes and relatives are invited to take part in parties in the home. The manager explained that they have introduced a grazing menu, which is aimed at those who do not eat well at mealtimes and need to eat little and often so that there is food available to them at all times. Snacks and drinks are available throughout the 24 hour period, and each unit has a kitchenette with a supply of food and drink items. Care Homes for Older People Page 15 of 27 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. The home has procedures in place for complaints and safeguarding adults, and these are followed, thus protecting the residents. Evidence: The home has a clear complaints procedure within the service user guide and the statement of purpose, which includes contact information for Servite Houses and CQC. There is also a document regarding making complaints on display in areas throughout the home, and we recommended that contact information be added to these posters, and that Ealing Social Services contact information also be included in the complaints procedure, as the residents are all placed by Ealing. Representatives spoken with said that they are able to raise any issues and these are addressed promptly. The home has a safeguarding adults procedure and also follows the London Borough of Ealing Safeguarding Adults documentation. Staff spoken with has received safeguarding adults training, were clear to report any concerns and understood whistle blowing procedures. There have been some incidents of unexplained bruising, which had been documented and most had been reported. The importance of reporting any unexplained bruising to Ealing Social Services and CQC was discussed, and a requirement is made under Standard 38. Care Homes for Older People Page 16 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been built to a high standard, providing an excellent environment for residents to live in. Systems are in place for infection control and are followed, thus minimising any risk to residents, staff and visitors. Evidence: The home was purpose built and was opened in July 2009. It has been built to a high standard and the manager confirmed that any repairs or snagging are being carried out promptly. The corridor areas in each unit have been decorated in a different colourway and this individualises each unit and makes it more homely. There are handrails in all corridors and in other areas to assist residents. There is a good amount of communal space and the home has 2 garden areas, one of which is enclosed and provides a safe area for residents to go out in. All the bedrooms have en suite facilities, to include an assisted shower, wash hand basin and toilet. There are assisted toilet, shower and bath facilities on each unit and again these have been completed to a high standard, providing excellent personal care facilities. All the bedrooms are single occupancy and are decorated and furnished to a high standard. Residents are encouraged to personalise their rooms in line with fire safety. Care Homes for Older People Page 17 of 27 Evidence: We viewed the laundry and it was clean and tidy. On the day of inspection one dryer was out of order but the laundry person confirmed that the engineers were attending the home the following day, and that any repairs are carried out without delay. The laundry person had clear procedures in place for the effective laundering of all items. There is also an Otex disinfection system in place, which is effective in dealing with bacteria at low wash temperatures. The home has policies and procedures in place for infection control and these are followed. Protective clothing to include gloves and aprons was available and in use. The home was clean and fresh throughout and it was clear that the staff take pride in their work. Care Homes for Older People Page 18 of 27 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 home is appropriately staffed to meet the needs of the residents and the home in general. Staff receive training to provide them with the knowledge and skills to meet the needs of the residents effectively. Clear recruitment processes are in place, however shortfalls in the employment records could place residents at risk. Evidence: On the day of inspection the home was being appropriately staffed to meet the needs of the residents. The manager explained that on the personal care units there are 3 staff to include a senior carer during the day and 2 staff overnight. On the nursing units there is 1 registered nurse and 3 care staff during the day and 1 registered nurse and 1 carer overnight. These are the minimum staffing levels for the home, and where a need is identified to have additional staff on duty, then this is arranged. The home is in the process of recruiting more staff to include registered nurses and carers. The manager explained that they do use agency staff at the present time, and endeavour to have continuity of agency staff so that they get to know the residents and the working systems in the home. There were appropriate numbers of kitchen, domestic, administration and maintenance staff in place to meet the overall needs of the home. The AQAA evidences that over 50 of the care staff are qualified to NVQ in care level 2 or above, and more staff are to undertake this training. Care Homes for Older People Page 19 of 27 Evidence: We viewed 3 sets of staff employment records. Application forms had been completed, to include reasons for leaving previous employments. In one instance a wrong year seemed to have been written in for the end of an employment, and the manager said he would clarify this. In one instance there was only one reference available and no photographs were seen on the files. Criminal records bureau checks had been completed. Health checks had been carried out and copies of contracts were also available on the files viewed. Interview notes are recorded by the staff carrying out the interviews. Servite Houses have an induction programme that encompasses the Skills for Care common induction standards. Following recruitment of staff for this home, a weeks induction programme was completed by each employee. Servite Houses have a dedicated training and quality assurance manager who was present in the home at the time of inspection. She explained that although staff had undertaken dementia care awareness training, she was very aware of the need for more in depth training in this area and was in the process of arranging this for staff. In addition, training for staff in meaningful activities for those with dementia care needs was planned, and would then be cascaded down to all the staff. There was evidence of training in the management of behaviours associated with dementia having been arranged, and the manager was also very aware of the need for staff to undertake more training relevant to the diagnoses and needs of the residents. We did observe staff being very patient and caring with residents, to include when a resident became distressed. They managed the situation well and the resident did settle. Staff spoken with confirmed that they had received induction training and that further training was ongoing in the home. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the qualifications and experience to manage the home, and does so in an open and approachable manner, thus ensuring good lines of communication. The home has a quality assurance system in place, that is being expanded, to ensure there is an ongoing process of audit and review, from which improvements can be implemented. Residents monies are being well managed and securely stored, thus protecting their interests. Overall health and safety is being well managed in the home, thus protecting residents, staff and visitors. Shortfalls identified should be easy to address. Evidence: The manager has several years experience of managing care homes. He has completed NVQ level 4 in management and in care and has also undertaken periodic training in topics relevant to his role. Staff spoken with said that he is supportive and it was clear from comments received on staff surveys that he provides good leadership for the home. The Head of Care is a first level registered nurse with general nursing and mental health qualifications. Care Homes for Older People Page 21 of 27 Evidence: The training and quality assurance manager explained that she has carried out a full quality assurance audit for the home and will collate the results so that an action plan can be drawn up and addressed. She also explained that Servite Houses have introduced a resident focussed audit, based on the CQC key lines of regulatory assessment, and these will in future be done for all their homes, again with an action plan to address shortfalls identified. The home has a comprehensive auditing process in order to meet the requirements of Ealing who fund the placements at the home. These include daily, weekly and monthly audits of various aspects of the home. There was evidence of audits of service user plans, medications and pressure sores. Staff meetings take place and minutes are recorded. Meetings for residents and relatives are being planned. The home has been open for 4 months, and this area will be looked at in more detail at future inspections. The home holds personal monies on behalf of residents. Each resident has an individual wallet and monies are securely stored. Clear records of all income and expenditure are maintained and receipts were available to view. The administrator audits the personal monies weekly and the manager does an audit every 2-3 weeks. We audited 3 sets of personal monies records and amounts and these all tallied. Personal monies are being well managed at the home. The home opened in July 2009 and the equipment and systems in place are new. We sampled servicing and maintenance records and those viewed were up to date. Risk assessments are in place for equipment and safe working practices. The fire risk assessment was last completed on 15/09/09. Checks of the fire equipment had been carried out. Fire drills had been taking place regularly for day staff, and we discussed ensuring that these are also carried out for the night staff at the required intervals. Regulation 37 notifications are sent to CQC and Ealing Social Services for notifiable incidents, and we discussed ensuring that all incidents of unexplained bruising are reported in future, to ensure CQC and the placing Authority are kept informed. There was evidence that staff had received health and safety training and this is carried out as part of the induction process for all new staff. The manager was clear to ensure that updates in health and safety training topics are carried out at the required intervals. Care Homes for Older People Page 22 of 27 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 23 of 27 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 17 All healthcare assessments must be complete and up to date. To ensure that residents needs are fully assessed and identified 01/01/2010 2 9 13 All medications must be stored at temperatures that are within the recognised safe ranges. So that medication is being stored in accordance with the manufacturers instructions. 05/12/2009 3 9 13 For medications with a 05/12/2009 variable dose, this must be clearly identified on the MAR and staff must record the actual dose given. To ensure residents are receiving their medication as prescribed. Care Homes for Older People Page 24 of 27 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 4 9 13 All medication must be administered as prescribed. To ensure medication needs are being met. 05/12/2009 5 29 19 Staff employment records must contain all the records required under Schedule 2 of the Care Homes Regulations 2001. This is to protect residents. 21/12/2009 6 38 37 All incidents of unexplained bruising must be notified to CQC and the placing Authority. This is to protect residents and ensure information is being shared appropriately. 07/12/2009 7 38 23 Fire drills for night staff must be carried out at the required intervals. To ensure staff are up to date with fire drill procedures and good practice. 01/01/2010 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 7 That in addition to recording any updates in care needs on the care plan review document, these changes also be incorporated into the care plan at the same time, to ensure Care Homes for Older People Page 25 of 27 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 that the care plans are up to date. 2 8 Where a resident is receiving input from the district nurse, this should be cross-referenced in the service user plan so it is clearly identified. It is strongly recommended that advocacy information be displayed throughout the home so that residents right to independent representation is respected. That the complaints procedure and posters available to residents and their representatives include contact details for Ealing Social Services, as they are responsible for the residents placements in the home. 3 14 4 16 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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