Care Home: Chrissian Residential Home Limited

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What the care home does well The Lodge provides a warm, comfortable and homely environment. Visitors are made welcome and people tell us they are satisfied with the standard of care. There is a clear complaints procedure in place and people confirm that they find the staff and managers approachable and helpful. Meals provided are healthy and appetising and the home is suitably staffed to meet the needs of the residents. Comments we received from residents were all positive and included; "I get looked after well", "The carers are good here, very good", "It`s not bad at all. Quite good really", "I like being here" and "It`s a good place". What has improved since the last inspection? The staff records we looked at included all information required and evidenced that recruitment procedures had improved. This will better safeguard residents. Medication is no longer being secondary dispensed, consequently medication is more safely administered and people are better safeguarded from medication errors. The kitchen has been fully refurbished and provides a more suitable environment to meet food and hygiene standards. Residents have more opportunities to take part in planned and spontaneous activities. What the care home could do better: The assessment process needs to be developed to ensure that everyone can be sure of receiving a thorough assessment of their needs before they move in. This will help to identify whether the home is suitable and equipped to meet peoples needs. At this inspection the registered manager agreed to develop the assessment framework used by the home. Care plans should be more detailed so that they clearly specify the assistance that staff need to provide to meet peoples needs. The detail of care plans also needs to be appropriately phrased. This will ensure that peoples needs are met without relying wholly on staff knowledge and the use of inappropriate notes. We would recommend that all staff responsible for undertaking assessments and developing care plans undertake appropriate training to develop their skills in this area. At the current time the home is providing a service to someone with dementia. Although this is not the primary focus of the service we recommend that the training provided to staff is reviewed with relevant professionals to ensure the residents needs continue to be appropriately met. The home must ensure that people are not at risk of scalding by ensuring that there is always a suitable risk assessment in place and hot water temperatures are maintained at safe levels. The home has confirmed that they intend to make significant improvements to the environment in the coming months. These improvements relate to the health and safety of staff and residents, the general maintenance of the environment and the replacement of furnishings, fixtures and fittings. They have also told us that they will meet requirements made by the fire service and the environmental health department. The service needs to ensure that in future they are more proactive about the health, safety and welfare of staff and residents. There is currently no computer on the premises. We recommend that a computer is provided to assist in the day to day running of the home and enable the manager and staff to access up to date and relevant guidance. Key inspection report Care homes for older people Name: Address: Chrissian Residential Home Limited 526-528 Woodbridge Road Ipswich Suffolk IP4 4PN     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: Tina Burns     Date: 1 6 1 2 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 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) 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 30 Information about the care home Name of care home: Address: Chrissian Residential Home Limited 526-528 Woodbridge Road Ipswich Suffolk IP4 4PN 01473718652 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: feizal.molabaccus@ntlworld.com Chrissian Residential Home Limited care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Chrissian House is situated on a main road into Ipswich town centre. The home comprises two buildings joined together at ground and first floor level. One is known as the annex. There is a medium sized garden to the rear of the building, with patio area and a small amount of outdoor furniture and seating. The accommodation was developed in early 2002 to meet the standards at that time. The number of double rooms was reduced, and new rooms were created when the development was completed. The garden has had landscaping, and is attractively maintained. The home caters for those with low and medium needs only. The home has stair lifts to aid those with poor mobility. The home would not accept a resident who was a wheelchair user at the time of admission. 2 4 0 2 2 0 0 9 0 Over 65 22 Care Homes for Older People Page 4 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 was an unannounced key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection process included a tour of the premises and examination of a wide range of documents and records including three residents care plans and three staff files. We also observed activity at the home and spoke with several residents, visitors and care workers throughout the course of the day. Information has also been gathered from the homes Annual Quality Assurance Assessment (AQQA) submitted to the commission in December 2009, and survey forms completed by ten residents, six staff and one relative. The home has a registered manager, Mr Roger Johnson and an operations manager Care Homes for Older People Page 5 of 30 who is a relative of the owners. They were both at the home on the day of our visit and fully contributed to the inspection. The outcomes for people have been assessed using our Key Lines of Regulatory Assessment (KLORA). Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The assessment process needs to be developed to ensure that everyone can be sure of receiving a thorough assessment of their needs before they move in. This will help to identify whether the home is suitable and equipped to meet peoples needs. At this inspection the registered manager agreed to develop the assessment framework used by the home. Care plans should be more detailed so that they clearly specify the assistance that staff need to provide to meet peoples needs. The detail of care plans also needs to be appropriately phrased. This will ensure that peoples needs are met without relying wholly on staff knowledge and the use of inappropriate notes. We would recommend that all staff responsible for undertaking assessments and developing care plans undertake appropriate training to develop their skills in this area. At the current time the home is providing a service to someone with dementia. Although this is not the primary focus of the service we recommend that the training provided to staff is reviewed with relevant professionals to ensure the residents needs continue to be appropriately met. The home must ensure that people are not at risk of scalding by ensuring that there is always a suitable risk assessment in place and hot water temperatures are maintained at safe levels. Care Homes for Older People Page 7 of 30 The home has confirmed that they intend to make significant improvements to the environment in the coming months. These improvements relate to the health and safety of staff and residents, the general maintenance of the environment and the replacement of furnishings, fixtures and fittings. They have also told us that they will meet requirements made by the fire service and the environmental health department. The service needs to ensure that in future they are more proactive about the health, safety and welfare of staff and residents. There is currently no computer on the premises. We recommend that a computer is provided to assist in the day to day running of the home and enable the manager and staff to access up to date and relevant guidance. 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 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 9 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. Prospective residents can expect to be given the information they need to make an informed choice about living in the home, however not everyone can be assured that they will have a suitable assessment to determine that the home is suitable and their individual needs will be met. Evidence: People we spoke with confirmed that the homes pre admission process includes gathering information from professionals such as social workers, hospital staff and discharge teams, the prospective resident themselves and where appropriate their relatives or representatives. As part of the pre admission process people are also invited to visit the home before a decision is made about whether or not the home is suitable. There is a wide range of information displayed in the foyer of the home including a copy of the commissions last report, the homes complaint procedure, the outcome of Care Homes for Older People Page 10 of 30 Evidence: their last quality assurance survey and the homes insurance certificate. The most recent AQAA submitted to us also confirms that each resident is provided with a copy of the homes brochure, service user guide and statement of purpose. During our previous inspection we identified that the home had admitted two people outside of their category of registration. Consequently the providers were asked to produce evidence that they were able to meet the needs of the individuals concerned and confirm that they would not admit anyone out of category in the future. Since the last inspection we were advised that the home may have admitted another person outside of their category of registration. We discussed this matter with the operations manager who told us that they had undertaken the individuals pre admission assessment themselves as the registered manager had been on annual leave at the time. They advised that the diagnosis of the individual had not come to light during their assessment. They felt strongly that they had asked all the right questions and their failure to identify that the individual had dementia lay with the health and social care professionals involved. Although they have provided us with some information to support their view we did find a more thorough look at the medication prescribed would have alerted them to the individuals diagnosis. We were advised that the provider was prepared to submit an application to vary their registration so that the individual concerned could remain resident and they were confident that they could meet their needs. However having considered all information provided to us about the primary focus of the service being provided and the individuals needs, in accordance with the commissions current registration guidance an application is not required in this instance. At this visit we looked at the assessment framework used for prospective residents and discussed the assessment process with the registered manager. We also examined the records of three people including two people admitted since our last inspection. We found that a checklist for potential service users was used to assess whether the home was suitable. It asked questions such as Does the potential client fit in with the category of registration?, Will they require more than one person to assist them?, What are their care needs and are these in line with services carried out? and also Is the potential client clinically diagonsed with Dementia?. The checklist also prompted the assessor to ask for a local authority assessment and information from relevant parties. However, it was not a clear record of assessed needs and this means that for private customers, without local authority assessments, the homes assessment process may not be thorough enough to identify the specific needs of individuals and the suitability of the home. The registered manager agreed to Care Homes for Older People Page 11 of 30 Evidence: develop the homes assessment format so that it covers a wide range of needs and evidences that a thorough assessment is carried out. Six out of ten residents that completed surveys told us that they received enough information to help them decide if the home was the right place for them before they moved in. Seven out of ten residents that completed surveys told us that they always receive the care and support they need and three said they usually get the care and support they need. Comments included; I get looked after well, The carers are good here, very good and The care is very good. Very pleased. 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 procedures in place for administering medication safeguard residents from harm, however they cannot be fully assured that they will always have their health and personal care needs met in away that respects their privacy and dignity. Evidence: The relevant section of the recently submitted AQAA does not refer to care plans although it does tell us that the home works with a wide range of professionals to ensure that peoples health and personal care needs are met. This was confirmed by the people we spoke with during the inspection and in the records we examined. We asked to look at the care plans of three named people and these were provided. Each care plan was in the same format and recorded information under the following headings; mobility, dietary requirements, communication, continence, eyesight, hearing, oral hygiene, haircare, washing, dressing and modesty, bathing and showering, nail care, foot care and social. We found the detail of the information in the care plans varied but in some cases it Care Homes for Older People Page 13 of 30 Evidence: was very limited. For example under the heading Mobility one persons care plan said Independent with some assistance but it did not specify the assistance required. Under the heading hearing the same care plan said Hard of hearing, has a hearing aid but refuses to wear it, it did not then go on to specify how best to support or communicate with the individual. Other examples of lack of detail include Staff to assist under the headings Nail Care and Foot Care but in neither case did it specify how staff should assist. However, everyone we spoke with during our visit told us that they felt that they were being well looked after and confirmed that their needs were met. Comments included; I get looked after well, The carers are good here, very good, The care is very good. Very pleased, They make us as comfortable as possible and Its not bad at all, quite good really. Out of the ten surveys returned to us by people that use the service ten said that they always receive the medical support they need, seven said that they always receive the care and support they need and three said that they usually receive the care and support they need. None of the surveys we received from residents raised any issues or concerns about the care provided and all comments made were positive and complimentary. They included; They do their best to care for you, They do their very best, I like being here and Its a good place. The survey we received from a relative said I am very happy with the standard of care.... During the inspection we observed one member of staff administering lunch time medication. They had a good knowledge of the homes procedures and administered medication to each resident safely and appropriately. They confirmed that the practice of secondary dispensing had ceased since our last inspection. The home used the Boots monitored dosage system and all medication was stored in a suitable locked trolley. The medication administration records (MAR sheets) we examined were appropriately completed, with codes where appropriate and signed by the relevant care staff. We found that instructions to staff about about the care needs of three residents were inappropriately displayed in one of the communal areas. This did not respect their privacy and dignity or maintain their confidentiality. We pointed this out to the management team and they agreed that the information should be included in their care plans rather than on notes that were accessible to residents and visitors as well as staff. They agreed to address the issue as a matter of urgency. More positively, staff we spoke with appeared to know residents well and had a good understanding of their needs. They interacted positively with residents through out the day and were Care Homes for Older People Page 14 of 30 Evidence: polite and respectful at all times. Information provided to us by the local authority tells us that they have concerns about the quality of service provided to some residents, consequently their outcomes and quality monitoring team have undertaken two unannounced visits since our last key inspection. Some of the concerns relate to individuals risk assessments and the lack of detail in care plans. They report that the manager has agreed to go through every care plan to check that it is adequately detailed. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to have a lifestyle that reflects their preferences. They can also expect to enjoy healthy and appetising meals. Evidence: Observations made during our inspection and feedback we received confirmed that residents friends and families are made welcome; people were seen coming and going throughout the duration of the inspection and their was lots of friendly banter between residents, staff and visitors. One relative told us We always get asked whether we want coffee as soon as we get here, and another said I am welcomed at any time of the day or evening. The AQAA tells us that one member of staff has completed a course on the provision of activities through an external College. Consequently the homes programme of activities has developed since the last inspection and now includes additional activities such as reminiscence, knitting, board games, bingo, live entertainment, nature programmes, karaoke, gardening and flower arranging. It also tells us that they have recently recruited a trained beauty therapist and they are looking forward to offering a range of treatments so that they can pamper residents. Care Homes for Older People Page 16 of 30 Evidence: On the day of inspection the activities co-ordinator was on their day off and we did not observe any planned activities taking place. However, there was lots of spontaneous activity taking place with and without the support of staff; some people were enjoying chatting with visitors, others were helping around the home with small household tasks such as laying the tables. Some people were reading newspapers and books, others were watching television or listening to the radio. One of the owners was assisting people with their christmas cards and another visitor had brought in their small dog much to the delight and interest of several residents. The home was festooned with christmas decorations and some of the residents told us that they had enjoyed watching the operations manager putting up the tree and all the trimmings. This had created much festive spirit and enthusiasm about the christmas party that was planned for the following week. Of the ten surveys completed by residents five said that the home always arranged activities that they could take part in, three said usually, one said sometimes and one said dont know. People we spoke with confirmed that they were assisted to follow their preferred daily routines including the time they like to get up and go to bed and when they like to go out. They were also able to personalise their rooms with their own belongings, photographs and ornaments. The home had a four week rolling menu in place. The range of meals looked varied and people were asked to choose their main meal from a choice of two options. On the day of inspection the two main lunch time options were turkey casserole with roast potatoes and vegetables or macaroni cheese. The dessert was creme caramel or yogurt. People we spoke with said that the meals were good and the lunch time meal we sampled looked and tasted appetising. The atmosphere in the main dining room during the lunch time meal was pleasant and friendly. Tables were nice laid with suitable crockery, condiments, glasses and jugs of water or squash. Out of the ten residents surveys returned five people told us that they always liked the meals, four said usually and one said sometimes. Comments we received included; No complaints about food and The meals are good. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to have their complaints taken seriously and acted upon, however they cannot be fully assured that they will be safeguarded by the guidance in place for staff about the management of challenging behaviour. Evidence: There was an appropriate complaints procedure clearly displayed at the home and included in the service user guide. Although one of the copies displayed had not been amended to reflect the fact that the Commission for Social Care Inspection had been replaced by the Care Quality Commission, the manager agreed to update it as a matter of urgency so that the correct contact details were in place. The AQAA tells us that the home welcomes complaints but any issues or concerns are usually dealt with promptly and before they reach the formal complaint stage. It also tells us that they have not received any formal complaints in the last twelve months. People we spoke with during the inspection agreed that the managers and staff were approachable and they could raise any matters of concern. Comments we received were similar and included I am not a person to complain, but touch wood theres nothing to complain about. Six out out ten residents that completed surveys told us that they knew how to make a formal complaint and ten out of ten told us that they knew who to speak to informally if they were not happy. Eight said staff always listen and act on what they Care Homes for Older People Page 18 of 30 Evidence: say, one said staff usually listen to them and act on what they say and one said staff sometimes listen to them and act on what they say. The relative that completed a survey confirmed that they knew how to make a complaint and told us that the service had always responded appropriately if they had raised any concerns. They also told us that their relative has a good rapport with the carers and management and The staff and management are friendly and approachable. Records examined and feedback from staff confirmed that they have undertaken safeguarding adults training and they are confident that they would know what to do if someone has concerns about the home. At the time of our previous key inspection we had concerns about the use of physical restraint. At this visit the manager confirmed that physical restraint is not used but accepted that there was a need to rephrase some care plans so that staff were clear about the techniques to be used to distract or occupy individuals who may occasionally exhibit unsocial behaviour or become agitated or distressed and they undertook to do this. Concerns about the management of one persons behaviour was also raised by the local authority quality monitoring team on an unannounced visit to the home and this was immediately addressed by the manager at the time. We were advised that the operations manager, the registered manager and the assistant manager have undertaken training on the Mental Capacity Act and the Deprivation of Liberty Safeguards and all staff have been issued with relevant literature. In house training on challenging behaviour is planned in 2010. The commission has not received any direct complaints or concerns since the last inspection. However, the local authority have notified us that there has been safeguarding concerns about three people who live at the home and this has led to the authority working with the home with a view to moving people on or improving the care provided to the three individuals concerned. Care Homes for Older People Page 19 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Chrissian provides a warm, comfortable and homely environment but people cannot be fully assured that their health and safety will always be protected. Evidence: The home consists of two semi detached properties that have been converted into one large property. There is a small driveway with very limited parking to the front of the home and a large enclosed garden to the back. The accommodation consists of sixteen single bedrooms and three shared bedrooms. There are limited ensuite facilities but all rooms have wash hand basins as a minimum. There is also three bathrooms and nine WCs. The home has two communal lounge and dining areas, one in each of the original houses. The larger lounge also has a spacious adjoining conservatory that overlooks the back garden. Although residents are able to join one another if they wish people generally use the communal areas that are in the same part of the building as their bedroom. Consequently seven people shared the smaller lounge and dining area and fifteen the larger lounge and dining area. Information provided to us by the local authority raised concerns about the cleanliness of the home. However, at the time of inspection all areas seen were clean and tidy and there were no unpleasant odours. Seven out of the ten residents surveys returned Care Homes for Older People Page 20 of 30 Evidence: said that the home was always clean and three said it was usually clean. Despite the cold winters day the home was warm and comfortable. The decor and furnishings were domestic in style although in places rather worn and dated. However we could see that since our last visit some areas had been painted and some carpets had been replaced. It was also very positive to find that the kitchen had been fully refurbished and the environmental health service had been appropriately consulted about that and the alternative arrangements in place for the duration of the works. The operations manager advised that now that the kitchen was complete it was their intention to continue to make improvements to the environment and they were intending to work through the bedrooms one by one when the weather improves. The AQAA confirms that the next twelve months will see improvements in redecoration throughout the home, as well as the replacement of furnishings, fixtures and fittings and bedroom suites. During our inspection the manager was open with us and told us that since our previous visit they had been inspected by the fire service and the environmental health agency. Shortfalls had been identified by both regulatory authorities and it was evident that while the provider was addressing the issues there were not robust systems in place to effectively monitor matters of health and safety. Hot water temperatures were maintained at safe levels in the bathrooms however the manager confirmed that the hot water temperatures in bedrooms were not controlled. This was also the findings of the health and safety inspection carried out in November 2009. We tested the hot water temperatures at hand basins in five bedrooms and they ranged between 49.3 degrees centigrade and 58.5 degrees centigrade. This was well above the accepted safe level of 43 degrees. The manager confirmed that four of the residents using those sinks did so independently and agreed that they were potentially at risk from scalding. We looked at the risk assessment in place to safeguard people from being scalded by hot water. The risk assessment was not appropriately robust and was out of date; some people it referred to had left or were deceased and other people, more recently admitted were not included. Following the inspection we issued an immediate requirement concerning this matter and within forty eight hours we were provided with an updated and more suitable risk assessment. Further more the operations manager confirmed that thermostatic valves had been ordered for all bedroom sinks and would be fitted in January 2010. Care Homes for Older People Page 21 of 30 Evidence: Observations on the day of our visit and feedback from staff confirmed that the home has satisfactory infection control procedures in place. There were adequate laundry facilities and staff were provided with disposable gloves, aprons and hand wash. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough qualified, competent and experienced staff to meet the needs of people that use the service. Further more, residents are safeguarded by the recruitment procedures in place. Evidence: Discussion with the managers and records examined confirmed that appropriate recruitment checks are carried out before people start working at the home. There was also evidence that staff induction programmes met the skills for care common induction standards and ongoing training was provided in core areas such as moving and handling, protection of vulnerable adults, first aid, food hygiene and health and safety. The homes AQAA also tells us that more than fifty percent of care staff employed at the home have completed NVQ level 2 in care or above. The staff training records we looked at did not include evidence of training in assessment and care planning. This has been identified as an area that needs to improve, consequently we would strongly recommend that appropriate training is provided to those people responsible for undertaking assessments and developing care plans. Out of the six staff that completed surveys five confirmed that thorough recruitment Care Homes for Older People Page 23 of 30 Evidence: checks were undertaken before they started work and six said that their induction had covered everything they needed to know very well. Six out of six staff also told us that they are given training that keeps them up to date and is relevant to their work, helps them understood the needs of residents and gives them the knowledge they need to do the job. We looked at the rota and discussed staffing levels with the management team. The home has a minimum of three care staff on duty during the day and two at night. The senior person or manager on duty is usually supernumerary. There is also a cook and a domestic on the rota every day. Observations made and feedback from staff and residents indicated that the home is suitably staffed to meet residents needs and people were given the assistance they required in a timely manner. Seven out of ten residents that completed surveys told us that they always receive the care and support they need and three said that they usually receive the care and support they need. Five out of six staff that completed surveys told us that there are always enough staff to meet the individual needs of residents and one said that there are usually enough staff. The home is currently accommodating one person with dementia. The managers accepted that although they are not providing a specialist dementia care service it is a progressive condition and the needs of the individual concerned were likely to change. They confirmed that that they would work closely with relevant professionals to ensure that staff are suitably trained to meet the specific needs of the individual concerned. 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 management work to promote a warm atmosphere and a comfortable and homely environment but staff and residents cannot be fully assured that their health, safety and welfare is fully promoted and protected. Evidence: On the day of inspection we met the registered manager Roger Johnson, the owners Mr and Mrs Molabaccus and their son, the operations manager. We also met the recently appointed assistant manager. We were advised that Mr and Mrs Molabaccus had retired from running the home and they were visiting on a purely social basis. Indeed they only stayed for a short while and during that time they were mostly chatting and socialising with residents. We were advised that the registered manager is responsible for the day to day management of care and the supervision and deployment of staff. The operations manager takes responsibility for more administrative matters such as wages, finance and recruitment. We were also advised that the registered manager relies on the Care Homes for Older People Page 25 of 30 Evidence: operations manager to produce computerised documents and handle email correspondence. The home does not have a computer on the premises and we were advised that the computer used for business purposes is at the operation managers home. Feedback we received from staff and residents confirmed that they found the registered manager helpful and approachable. On the day of inspection we found them highly co-operative and they provided all of the information we requested promptly, openly and in a professional manner. Information provided in the AQAA tells us that the home undertakes residents and relatives satisfaction surveys. The results of the survey carried out in July 2009 was displayed on the notice board in the home. Areas covered included matters such as meals, accommodation, care and staff attitude. It said that all comments received were 100 positive, many of which were quoted in the most recently submitted AQAA. The homes most recent AQAA was submitted soon after the given timescale. It was completed electronically by the operations manager. Overall it was adequately completed but it did not fully evidence how all of the key standards are met. It did tell us that there are many improvements planned in the next twelve months. The planned improvements relate to the indoor and outdoor environment, health and safety, activities, meals and staff training. The home does not handle large sums of residents personal monies or manage anyones personal accounts. We were advised that all current residents manage their own finances with support, if necessary, from their relatives or representatives. All bedrooms have lockable facilities for cash and valuables. Five out of six care staff that returned surveys told us that their manager gives them enough support and meets with them regularly to discuss how they are working. Comments we received from staff included; We are well supported by managers. Staff training included health and safety, food hygiene, moving and handling, first aid and fire safety. Manual handling and fire protection equipment was appropriately serviced and maintained and portable electrical appliances had been tested. However, the outcome of inspections undertaken by other regulatory bodies and our findings regarding hot water temperatures evidenced that quality assurance systems had not effectively monitored matters of health and safety at the home (See further evidence in the Environment section of the report). 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 1 19 13 A suitable risk assessment 22/12/2009 must be completed to identify the risks to residents from the hot water outlets in their bedrooms. Where risks are identified control measures must be put in place to eliminate or adequately reduce the risk. This is to ensure that residents are not scalded and are protected from harm. 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 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 30 Staff responsible for undertaking assessments and developing care plans should be provided with further training so that the quality of assessments and care plans improve and residents can be certain that there individual and diverse needs will be met. We would recommend that the training needs of staff are reviewed in consultation with relevant professionals to ensure that they can continue to meet the needs of an individual with dementia. 2 30 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 3 31 That there is a suitable computer on the premises for the use of the registered manager and assistant manager. This would assist them with the day to day running of the home and give them good access to up to date and current guidance. 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. 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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