Care Home: Church View (Nursing Home) Limited

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What the care home does well Our time at the home found routines relaxed, with people allowed unrestricted access to communal areas, their own bedrooms, people watching the television and staff chatting to residents. One person who lives at the home wrote in a survey, "Its a pleasant and relaxed place to live". Comments from people who live at the home and relatives spoken to, recommended the quality of food provided, with varied meals and choices available if people don`t like the main meal on offer. People are allowed meals in their own room if they choose to. The cooks prepare home baked food and when spoken to said, "I do enjoy using fresh ingredients and baking". Comments from people who live at the home included, "Plenty of choice and the cook is always willing to make something I like". Also, "The food is good". A resident wrote in a survey "I enjoy the meals". Visiting arrangements are informal and family or friends are welcome at any time of the day and are encouraged to maintain contact with people who live at the home. We spoke to a relative visiting who said, "I come every day and its not a problem". One resident spoken to said, "Due to work my family come at different times but they are always made welcome". An `activities co-ordinator` has been employed to ensure people who live at the home are able to follow their chosen interests, provide entertainment and stimulation for people. Speaking to staff, people who live at the home and surveys returned, this has been successful. Comments included, "Staff take me out when I want". And, "They provide some good games in the afternoon for us to take part in". Surveys returned from people who live at the home said, "We have bingo and needlework now". Also, "I enjoy entertainers coming into the home". What has improved since the last inspection? Since the last inspection a new manager has recently taken over and improvements have been made to address the requirements and recommendations made at the last key inspection. Previous visits from a pharmacist inspector had found some serious shortfalls in the way medicines were being handled. On this visit we found good improvements that meant medicines were recorded and given to people correctly. Records of medicines were usually clearly completed so they could now be easily accounted for, and regular audits (checks) were carried out by the managers to help make sure they were handled safely. Care plans are now looked at monthly and evidence in the AQAA and records looked at confirm this. One member of staff spoken to said, "The new manager has informed us to go through all care plans to make sure we have reviewed them". A person who lives at the home we `case tracked` told us the staff every month go through her health and welfare needs to ensure she is receiving the right support and attention. What the care home could do better: We looked at training for staff who work in the kitchen and prepare food. Staff have received training however it was not up to date. `Food and Hygiene` training should be updated to ensure they are aware of new cleaning processes, preparing food and any issues relating to kitchen hygiene. One staff member said, "I do need to update my `Food and Hygiene` certificate". Medication procedures although improved still must be more robust so that people who live at the home are kept safe and are protected by good medication practices in place. Care plans must contain risk assessments which relate to the needs of individual residents, to ensure staff are aware of any prevention, treatment or care the person needs. Recruitment procedures must be thorough and all checks in place before staff start to work at Church View to ensure suitable staff only are employed. One staff member spoken to said, "The new system will make sure we have all the recruitment procedures followed correctly". Parts of the home should be redecorated and some new furniture in place, to ensure people who live here have pleasant comfortable surroundings. Comments from staff and residents confirmed parts of the home need to be refurbished. Comments included, "Some more pictures would brighten the home up", And, "The home needs doing up". Most of the surveys returned from residents when asked `what the home could do better` mentioned the environment, They included, "Some of the rooms need decorating", And, "Make the rooms nicer". Maintenance records of any repairs and renewals should be kept so that the home is maintained well and any repairs are attended to. One member of staff spoken to said, "We now have a maintenance person working and will keep records up to date". A training and development programme should be in place for each individual staff member to ensure staff continue to develop skills, fulfill the aims of the home and meet the changing needs of the people who live here. The manager should register with us the `Care Quality Commission` (CQC) to ensure she is competent and skilled to manage a care home. We spoke to the new manager who said, "The process is ongoing". We looked at health and safety records and found fire safety procedures and records not up to date. Fire safety must be put into place and training provided for staff to ensure people who live and work at the home are protected, aware of the dangers of fire and kept safe. Key inspection report Care homes for older people Name: Address: Church View (Nursing Home) Limited Princess Street Accrington Lancashire BB5 1SP     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: Kevan Royston     Date: 1 0 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 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: Church View (Nursing Home) Limited Princess Street Accrington Lancashire BB5 1SP 01254386658 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Church View (Nursing Home) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing: Code N, to people of either gender, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP (maximum number of places: 22). Dementia - Code DE (maximum number of places 18) The maximum number of people who can be accommodated is: 40. Date of last inspection Brief description of the care home Church View Nursing Home was purpose built in 1990. The home is registered to provide 24 hour nursing and personal care for up to 40 residents, some of whom may have dementia. Accommodation is provided on 2 levels. The first floor comprising only four rooms and a lounge. A stair lift provides access to the first floor. All other Care Homes for Older People Page 4 of 30 Over 65 0 22 18 0 1 9 0 8 2 0 0 9 Brief description of the care home accommodation and facilities are on the ground floor. The floor has been split to provide a dementia care unit, which is separated from the other part of the home by a door with a coded lock. Each unit has its own lounge and dining area. There are gardens and a car park for visitors and staff. The home is situated in a quiet residential area in Accrington close to local amenities. The current fees are available on request from the home manager, they range from, £386.50 to £560.00 Additional charges are payable for hairdressing, newspapers and transport for hospital visits. A copy of the statement of purpose and service user guide is available to prospective service users on request. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced visit was part of the key inspection process and took place on the 10/11/09. We spoke to people who live at the home, staff, the manager, a relative visiting and a group of residents in the lounge. Care, maintenance, previous inspection reports and other records were looked at, as well as a walk around the building. As part of the inspection process we talked to people using the service and asked staff about those people needs. We also looked at their rooms, care plans and daily notes, this is called case tracking. Other people who live at the home were invited to pass their opinions to us if they wish. We received responses from surveys/ questionnaires sent to people who live at Church View nursing home and staff for their views on how the home is run. Comments we did receive were positive and some are included in this report. Care Homes for Older People Page 6 of 30 Every year the person in charge or manager is asked to provide us with written information about the quality of their service they provide and to make an assessment of the quality of their service. This document is called an Annual Quality Assurance Assessment (AQAA). We use this information, in part, to focus our inspection activity. Following a recent random medication inspection, we focused part of our inspection into looking at medication practices, systems, procedures and previous medication issues as part of the inspection process. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: We looked at training for staff who work in the kitchen and prepare food. Staff have Care Homes for Older People Page 8 of 30 received training however it was not up to date. Food and Hygiene training should be updated to ensure they are aware of new cleaning processes, preparing food and any issues relating to kitchen hygiene. One staff member said, I do need to update my Food and Hygiene certificate. Medication procedures although improved still must be more robust so that people who live at the home are kept safe and are protected by good medication practices in place. Care plans must contain risk assessments which relate to the needs of individual residents, to ensure staff are aware of any prevention, treatment or care the person needs. Recruitment procedures must be thorough and all checks in place before staff start to work at Church View to ensure suitable staff only are employed. One staff member spoken to said, The new system will make sure we have all the recruitment procedures followed correctly. Parts of the home should be redecorated and some new furniture in place, to ensure people who live here have pleasant comfortable surroundings. Comments from staff and residents confirmed parts of the home need to be refurbished. Comments included, Some more pictures would brighten the home up, And, The home needs doing up. Most of the surveys returned from residents when asked what the home could do better mentioned the environment, They included, Some of the rooms need decorating, And, Make the rooms nicer. Maintenance records of any repairs and renewals should be kept so that the home is maintained well and any repairs are attended to. One member of staff spoken to said, We now have a maintenance person working and will keep records up to date. A training and development programme should be in place for each individual staff member to ensure staff continue to develop skills, fulfill the aims of the home and meet the changing needs of the people who live here. The manager should register with us the Care Quality Commission (CQC) to ensure she is competent and skilled to manage a care home. We spoke to the new manager who said, The process is ongoing. We looked at health and safety records and found fire safety procedures and records not up to date. Fire safety must be put into place and training provided for staff to ensure people who live and work at the home are protected, aware of the dangers of fire and kept safe. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission and assessment procedures were clear and precise, to ensure care needs of people who live at the home are met and people can make an informed choice before moving in. Evidence: People we case tracked who live at the home had comprehensive personal information obtained by the manager and from social services to develop a care plan. Input from relatives in the assessment process was evident by speaking to staff, and nursing assessments had been carried out by the senior nurse. One person who lives at the home spoke about the admission process and said, They were very good when I first met them. A staff member spoken to said, We have trained nurses to do assessments. A care plan had been developed from the information to ensure social, welfare, physical, nursing and mental health needs are identified and the care and support Care Homes for Older People Page 11 of 30 Evidence: needed can be met. There was evidence of family involvement to gather information so that all needs of people who come to live at Church View are looked at. The manager informs us in the AQAA how the process for assessing people is undertaken prior to them moving in and a plan of care developed as soon as they are admitted to ensure they give the right care and support. The manager tells us in the AQAA to improve the assessment procedure a letter of acceptance is now sent to residents to confirm they can meet their needs. A staff member said, It is working well. The manager tells us in the AQAA the potential resident and family are given a Service User Guide (brochure) when an inquiry is made to ensure they have all the information about the home to make an informed choice. This document has been updated and improved to give more information about the home. One person who lives at the home said, I had a brochure given to me about the home. Standard 6 was not assessed as the home does not provide intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication practices need improving and all risk assessments should be in place to ensure people who live at the home receive the right care and support with good systems to support staff. Evidence: Care records looked at for people living in the home set out a plan of care monitoring health, nursing welfare, social hobbies and interests. Relatives and people who live at the home have a say in care plans and in the way they are supported. Evidence of people living at the home signing care plans was seen. The new manager is currently updating all care records for residents to ensure all information is correctly recorded and easier for staff to follow . One member of staff spoken to said, We are better informed and care planning has improved. We discussed with staff the needs of people we case tracked, we found they had an awareness of peoples needs and were able to discuss the care being given to each person. People who live at the home has a risk assessment in place to ensure their safety. However one resident had been assessed as high risk due to poor mobility, poor diet and requiring a lot of nursing input, but did not have and a skin risk assessment in place. Due to the risk of Care Homes for Older People Page 13 of 30 Evidence: pressure sores a skin risk assessment must be in place to ensure an appropriate plan of intervention and care is recorded and staff are aware of the issues and treatment needed . We looked at records and confirmed nutritional screening of people who live at the home is monitored so that any health issues that may occur are acted upon. This was confirmed by information contained in the AQAA. Care records of people who live at Church View show they have access to health professionals and where possible a doctor (GP) of their choice. As part of the visit a pharmacist inspector checked how medicines were being handled because previous visits had found some shortfalls. We checked medicines records, medicines stock and spoke with three staff. Overall we found continued improvements in medicines handling and any mistakes that were found by the managers were acted upon to help prevent them happening again. Our checks showed that medicines that needed to be given before food were now being given at the right time. The medicines round had been better organised and the records showed people were being given their medicines at the best time for them. We checked a sample of medicines records and stock and found they were usually correct showing medicines had been given and recorded correctly. On our previous visit we found creams and nutritional supplements were not being given and recorded correctly as a result the manager had change the procedures for this. However, we still found they were not always recorded properly and on the day of our visit we found all external medicines and nutritional supplements were now insecurely stored in peoples bedrooms because there were no secure cupboards to store them in. Creams should always be locked away to help prevent any mishandling. Records of medicines given to people were usually signed and up to date. Records of medicines received and disposed of were clearly made although the records of receipt were not properly dated for the latest supply of medicines and the records of disposal only recorded peoples initials instead of their full names. Having clear records of medicines received, given to people and disposed of helps make sure medicines can be fully accounted for. We checked the medicines store room and found it to be tidy and well organised. A suitable fridge was used for storage and a secure controlled drugs medicines that can be misused cupboard was used for storage. A controlled drug register was used for recording and all the entries we checked were correctly witnessed. Secure storage and good record keeping help prevent medicines being misused or mishandled. Care Homes for Older People Page 14 of 30 Evidence: We looked at a sample of care plans and records to check if medicines were properly reflected in them. We found some good information about how when required medicines should be given. We advised the managers to review these plans monthly as some were not fully up to date because new medicines had been prescribed that had not been properly considered. Having clear, up to date information about medicines helps make sure they are given to people correctly. We saw some examples of medicines being regularly checked by the manager and these had helped make some improvements in the general handling and stock control of medicines. Appropriate action had been taken to make improvements when problems were found and new paperwork for checking stock balances had been recently introduced to help improve the general auditing of medicines. We gave some advice about how to develop the recorded audits checks to help make further improvements in the medicines records and care plans. Regular auditing helps make sure medicines are handled safely by suitably skilled staff. During our visit we talked to people who live here in the lounge, individually and watched staff caring for people and helping them in a sensitive, dignified way. One person who lives at the home said to us,The staff are respectful and caring. One resident wrote in a survey, The staff are kind. 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. Social activities and meals are well managed, creative and provide daily variation and interest for people living at the home. Evidence: We had a talk to the cook and a look around the kitchen area which we found clean and tidy. We asked about training and one staff member said, We do need our Food and Hygiene training updated. Training should be up to date so staff are aware of current hygiene issues and food preparation processes. The manager spoken to said, The training is in hand to do. Comments from people who live at the home about the standard of meals provided were good and included, The food is good, Also,Plenty of choice and enough of it. One relative visiting spoken to said,The meals are good and I get offered one. One of the cooks spoken to said, I always use fresh food and bake. One person who lives at the home wrote in a survey, Good food. Records looked at show staff monitor the intake of food and liquid of people living at the home to ensure any concerns are identified and appropriate action taken. Liquidized meals are prepared for some residents and the cook was well aware how to present meals so they look appetizing and are presented well, the cook said, Liquidized meals are always done separately. Care Homes for Older People Page 16 of 30 Evidence: Routines watched during the day looked relaxed, some people were sat in the lounge area, staff were carrying on with their daily routines, we noticed staff chatting to residents when they had time and generally supporting people in a dignified way. The home now employ an activities co- ordinator which has been a success and improved stimulation for the people who live at the home. Comments from surveys returned from people who live here included, The staff take us out when we want And,Always good trips out. One resident spoken to said, At last things are going on in the home. One member of staff spoken to commented,The activities have so much improved since H.... started. The manager informs us in the AQAA of improvements to social activities and entertainment by introducing entertainers once or twice a month, more trips out and a weekly hairdresser. Records show hobbies and interests of people who live at the home are written down so that staff are aware of activities individuals prefer. We spoke to a member of staff who said, I will be speaking to everyone and making sure all care plans have residents hobbies social interests and activities recorded and up to date. A visitors policy is available in the homes Service user guide (Brochure) which says visiting times have no restrictions. All people who live and work at the home spoken to confirmed friends and relatives are welcome any time. One relative spoken to said, I come all day its not a problem. People we spoke to who live here confirmed they were able to bring some personal items into the home which was agreed during the admission. Rooms we were invited into had personal possessions around so that people who live here felt it was home. One person wrote in a survey, I brought my things to make it feel like home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. Evidence: Policies and procedures are in place for dealing with any complaints, concerns and issues people may have to ensure they are dealt with correctly and fully investigated with outcomes recorded. One person who lives at the home spoken to said, I have never complained but I know who to speak to. A member of staff spoken to about complaints said, I covered complaints information at the induction session.The manager tells us in the AQAA they deal with complaints within a set timescale to ensure a full investigation has been carried out. More information and details about the complaints policy is given to potential residents and there families in the brochure of the home. The manager tells us in the AQAA one complaint has been received since the previous inspection and a random inspection by us the Care Quality Commission to look into medication practices, which resulted in requirements being made and improvements in medication procedures. Information the manager gave us in the AQAA tells us of how they have provided safeguarding adults training for almost all staff to ensure they are aware of any signs of abuse taking place and are able to take the appropriate action. Staff spoken to confirm they have attended training both at the home and through the National Vocational Qualification (NVQ). One member of staff spoken to said, Yes I have Care Homes for Older People Page 18 of 30 Evidence: attended safeguarding training through the management. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are kept clean and tidy however some redecoration and general maintenance work needs to be undertaken to provide comfortable pleasant surroundings for people to live in. Evidence: We had a walk around the premises and outside areas, we found it clean, tidy and free from offensive odours. One person who lives at the home wrote in a survey, It always smells nice. One resident spoken to said, They keep it clean. Although the home is reasonably maintained no records are kept of any repairs or ongoing maintenance work. A programme of routine maintenance and records should be kept to ensure the repairs and renewals are attended to. One staff member said, We have not had a maintenance man for a while one has just started. Looking around the premises, information from speaking to people and surveys returned, confirmed some redecoration and new furnishings in parts of the home in particular communal areas, bedrooms, bathrooms and hallways should be undertaken to ensure people live in pleasant surroundings. The paintwork in the main hallway is chipped and scratched and should be repainted. One bedroom had wardrobe door handles hanging off and should be replaced. Curtains in two bedrooms were not properly attached and needed replacing, also a ceiling panel in the ground floor hallway was missing. One member of staff spoken to said, It has been off for a long Care Homes for Older People Page 20 of 30 Evidence: while.Comments from people who live in the home spoken to included, It needs modernising, And,It does look tired in parts. One resident wrote when asked what the home could do better, Make the rooms nicer. A staff member spoken to said, The home needs doing up There are policies in place for laundry processes and for the control of infection ensuring the home is kept clean and hygienic. Information in the AQAA informs us of how staff are trained in infection control, this was confirmed through talking to staff. We checked hot water temperatures and were shown records of regular temperature checks to ensure residents safety. Water was found to be delivered at a safe temperature in line with health and safety guidelines. Care Homes for Older People Page 21 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. Recruitment procedures and checks need to be more robust. Individual staff members receive good access to training, however a training and development programme should be in place to ensure staff continue to develop skills and keep a record of training completed. Evidence: Access to training is good and this was confirmed through information in the AQAA and speaking to staff, comments included, I do have good access to training. Also, The new manager is keen for us to attend training courses. However staff records looked show there is no development and training plan for individual staff. There should be a staff training and development programme for each staff member to ensure staff fulfill the aims of the home, are able to meet the needs of the people living here and continue to develop skills and competencies. The manager tells us in the AQAA how some staff have completed a recognised qualification in care which is the National Vocational Qualification (NVQ) to level 2 or above, some staff are now doing NVQ level 3. One staff member spoken to said, I am doing level 3 NVQ. We looked at two recruitment records of staff and found not all checks had been completed. One staff file had no references, although the manager said they had been obtained but were unable to find them. Also the application form for employment needs to request a full employment history to ensure suitable people only are Care Homes for Older People Page 22 of 30 Evidence: employed. Recruitment procedures must be more robust to ensure proper checks are in place before staff start to work. Staff rotas looked at and observation during the day confirm staffing levels were enough to care for the people who live at the home. One member of staff said, Yes I feel we have enough staff around. A person who lives here spoken to about staff said, The new activities lady spends more time with us. It was clear from watching staff with people during the day and speaking to staff they are clear about their role and work well as a team to ensure the individual and collective needs of people who live at the home are being met . Comments from people who live at the home were positive in the way they were treated by staff they included, They are helpful, And one resident wrote in a survey, Kind staff and very caring. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being managed well however safety systems need to be put in place to ensure people are protected and kept safe. Evidence: The new manager has been in post for only a few weeks, however has over 20 years experience of working and managing care homes. She is a qualified nurse and holds a recognised management and care qualification. Comments from staff and people who live at Church View spoke well of how the home is improving, operates and the attitude of the manager. Comments included, She is very competent and wants to improve and get things done. Also, She is supportive. One person who lives at the home spoken to said,She is a caring person. Although the manager is qualified to run a care home she should be registered with us the Care Quality Commission (CQC) . When spoken to the manager said, I am getting on with the process of registering with CQC. We checked records of health and safety looked at information in the AQAA and Care Homes for Older People Page 24 of 30 Evidence: confirm regular tests are carried out to emergency lighting, gas appliances and electrical equipment, However fire records are not up to date, fire drills have not been recorded or taken place regularly and some staff had not received up to date training. One staff member spoken to said,I need my fire training updated. Fire safety procedures and records must be put into place and training provided for staff to ensure people who live and work at the home are protected and kept safe. We spoke to the manager who is aware of the problem and informed us they have requested a fire inspection to the home which is due next week. Financial records looked at were in good order, systems have improved for people to control their own money where possible and ensure safeguards are in place for their protection. Records of finances for people who live at the home were accurate and up to date. The manager has systems to gather views on how the home is run from people who live at the home and stakeholders include questionnaires, staff and resident meetings to ensure the home continues to develop and run smoothly. Any suggestions to improve the home are discussed with residents and implemented. One staff member spoken to said, The meetings are useful Care Homes for Older People Page 25 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 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 17 A skin risk assessment must be in place for the prevention and treatment of pressure sores to ensure an appropriate plan of intervention and care is recorded for residents who are at risk. This is important for people who are at risk and for staff to be aware and prevent pressure sores developing. 16/01/2010 2 9 13 External medicines such as creams must be securely stored at all times and accurate records kept of when they are used. This is important to help make sure they are safely handled. 31/01/2010 3 29 19 Recruitment procedures must be more robust to ensure checks are in place before people start to work at the home. 19/12/2009 Care Homes for Older People Page 27 of 30 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 Checks for staff must be thorough to ensure suitable people are employed. 4 38 13 -Fire safety procedures and records must be put into place and training provided for staff to ensure people who live and work at the home are protected and kept safe. Fire procedures need to be up to date so people are aware of the procedures and the risk to safety of the people who live and work at the home. 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 31/12/2009 1 15 Training for staff who prepare food and work in the kitchen should be updated to ensure they are aware of new cleaning processes, preparing food and any issues relating to kitchen hygiene. Some areas of the home should be redecorated and provided with new furnishings to ensure people live in pleasant surroundings. A programme of routine maintenance and records should be kept to ensure all repairs are attended to and completed so people who live at the home are kept safe. A training and development programme should be in place for each individual staff member to ensure staff fulfill the aims of the home and meet the changing needs of the 2 19 3 19 4 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 residents. 5 31 The person in charge of the day to day running of the home should be registered with us the Care Quality Commission. 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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