Care Home: Church Walk House

What the care home does well When we spoke with residents they told us that "I like it here" and "I am happy enough here". They told us that the staff are "good" and "very kind". They said that they were satisfied with their accommodation and that the food is good, with choices and alternatives available. Residents praised the garden and said that it was a pleasant view. A relative said that his resident was "quite content" and was "well looked after". A resident said that the manager was very good and when residents were asked if they could talk to someone if they were unhappy about something they were able to name a person they could confide in. We spoke with members of staff. One recently recruited member of staff said that she had received a lot of training, including induction training. Although there had been changes in the person occupying the manager`s post she said that the home continued with "business as usual". Staff said that the service did well in all aspects including personal care, activities, food and the quality of carers. Members of staff commented on good support and help from colleagues. Social and health care professionals commented that the home knows its residents well, it monitors medication well, communicates well with other agencies/professionals and that the members of staff in the home work as a team. What has improved since the last inspection? Since the last inspection the registered manager resigned in September 2009. The deputy manager covered these duties until his resignation in March 2010 and after a handover a manager has been seconded from the company in talks with Church Walk House about a possible merger. Although only in post for a few weeks prior to the inspection the new manager has set about reviewing the service in the home and making changes to improve the quality of care. Described by a member of staff as "massive changes" they were seen as positive and improvements in recording were commented upon during our discussions with members of staff. Although we note that the new ways of working are in their early stages the commitment and effort given by the manager, to this task, is acknowledged. We noted that there is compliance with the statutory requirement notice issued after the random inspection. This has been achieved with the assistance of the other company that is currently supporting the home. We also noted that the statutory requirements identified in the random inspection report have been addressed and compliance achieved. What the care home could do better: During this inspection 12 statutory requirements were identified. The new care plan format developed by the manager must be rolled out to all residents so that care plans are more detailed and informative. These need to be evaluated on a monthly basis so that any changes in condition are quickly identified and addressed. The plan must include end of life information so that final wishes are respected. The activities programme must be kept under review to ensure that its content continues to reflect the interests and understanding of residents. Within the home a plan of refurbishment needs to be drawn up to include all areas in the home. When new staff are recruited a more thorough procedure must be followed to ensure that the safety and welfare of residents is protected. Application forms need to be amended so that they give a full record in respect of work history and checked to ensure that each section has been completed. References must be readable and proof of ID must be recorded. Discussions regarding any trace on the CRB must be recorded. There is currently an ongoing training programme that needs to continue so that members of staff receive both mandatory training and refresher training to update their knowledge and skills. Receipts for items purchased on behalf of residents need to be checked so that items appropriate to the gender of residents are purchased. The home needs to confirm that certain maintenance work is now complete. Key inspection report Care homes for older people Name: Address: Church Walk House Church Walk Childs Hill London NW2 2TJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Schofield     Date: 0 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Church Walk House Church Walk Childs Hill London NW2 2TJ 02077942144 02077942460 wayne@churchwalkhouse.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hendon Old Peoples Housing Society Name of registered manager (if applicable) Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 42 The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Church Walk House is registered to provide personal care and support for 42 older people who may also have dementia. The home is operated by a charitable organisation, the Hendon Old Peoples Society, which manages the home through a management committee. The accommodation is provided in a building that used to be Care Homes for Older People Page 4 of 34 Over 65 0 0 0 0 Brief description of the care home the vicarage. The building is on three floors. In the basement is the kitchen and laundry. On the ground floor are the main lounge, dining room, smaller lounge and a number of bedrooms. On the first floor are the rest of the bedrooms, a quiet lounge and the offices. Six of the bedrooms are double and the rest are single. There are bathrooms and showers on both floors. There is a shaft lift. There is a large, attractive garden at the rear of the home. The staff team consists of a manager, senior staff and a team of carers. There is also a team of ancillary staff including cleaners, cooks and laundry assistants. Information about the service and the fees charged may be obtained, on request, from the manager of the home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took part over 2 days. Two inspectors visited on the first day, the 31st March 2010 and started the inspection at 8.45am. They finished that day at 5pm. The lead inspector returned the next day, on the 1st April, and arrived at 11am. They left at 2pm. During the inspection we carried out a site visit, examined policies and procedures and looked at records belonging to residents and case tracked the care of a sample of residents. We looked at records belonging to members of staff and those associated with the running of the business. We observed the serving of the midday meal. We had discussions with the manager and members of staff. We spoke with residents and we observed care practices. We spoke with a relative who was visiting the home. We would like to thank everyone for their assistance and participation in the inspection. We also checked compliance with the statutory requirements identified during the random inspection in January 2010. A number of these were outstanding from the key Care Homes for Older People Page 6 of 34 inspection in April 2009. As a result of this the Care Quality Commission (CQC) issued a statutory requirement notice, which identified where the care home was in breach of the Care Homes Regulations. Compliance with this notice was also checked during this inspection. Prior to the inspection we requested and received an updated Annual Quality Assurance Assessment (AQAA) from the home and we received 2 completed survey forms from social and health care professionals. Since the previous key inspection the management committee has been considering the future of the service and does not wish to continue as a stand alone service. For this reason it is in talks with another provider of care homes with the view to a possible merger. To support Church Walk House the other provider has seconded one of its managers to cover the duties of the vacant managers post at Church Walk House and is supporting the home by providing assistance from its training, health and safety and human resources departments. It has also provided assistance with carrying out the Regulation 26 inspection visits of the home. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: During this inspection 12 statutory requirements were identified. The new care plan format developed by the manager must be rolled out to all residents so that care plans are more detailed and informative. These need to be evaluated on a monthly basis so that any changes in condition are quickly identified and addressed. The plan must include end of life information so that final wishes are respected. The activities programme must be kept under review to ensure that its content continues to reflect the interests and understanding of residents. Within the home a plan of refurbishment needs to be drawn up to include all areas in Care Homes for Older People Page 8 of 34 the home. When new staff are recruited a more thorough procedure must be followed to ensure that the safety and welfare of residents is protected. Application forms need to be amended so that they give a full record in respect of work history and checked to ensure that each section has been completed. References must be readable and proof of ID must be recorded. Discussions regarding any trace on the CRB must be recorded. There is currently an ongoing training programme that needs to continue so that members of staff receive both mandatory training and refresher training to update their knowledge and skills. Receipts for items purchased on behalf of residents need to be checked so that items appropriate to the gender of residents are purchased. The home needs to confirm that certain maintenance work is now complete. 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 34 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 34 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. Comprehensive and helpful information provided by the home, prior to admission, enables the prospective resident and people acting on their behalf to decide whether this will be an appropriate placement. Evidence: Since the last key inspection the registered manager and subsequently the acting manager have resigned and left the service. At the time of this inspection the duties of the manager were being covered by an experienced care home manager, who works for the other company. Although permanent arrangements have yet to be made in respect of a permanent manager, letters have been sent to the relatives of the residents informing them of the change and introducing the new manager. When permanent arrangements are in place the Statement of Purpose and Service Users Guide will be amended. Previously it was noted that comprehensive details are provided in the Statement of Purpose and that it is a useful document both for prospective residents and for those acting on their behalf. Care Homes for Older People Page 11 of 34 Evidence: There have been no new admissions to the home since the last key inspection in April 2009, although prior to this no concerns had been identified in respect of the pre admission procedure used by the home. The procedure included obtaining information from the funding authority and an assessment carried out by the manager of the home to inform the decision whether the home was able to meet the needs of the prospective resident. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are not assured that their needs are identified and addressed when care plans are not sufficiently detailed or subject to regular review. Supporting residents to attend health care appointments helps residents to maintain a healthy lifestyle. Residents can be confident that the arrangements for administering medication are safe. Discreet and caring support is given to residents by staff so that the privacy and dignity of the resident is respected. Plans for end of life care are needed to reassure residents that their final wishes will be respected. Evidence: After the key inspection in April 2009 the home reviewed its system for care planning and introduced a more easier to use format. We noted that the new format was in place for the files of the residents that we case tracked. The format covered personal, social and health care needs and the documents had been completed recently. However, they needed to be in more detail so that they could be used for reference by members of staff. The new manager identified this shortfall prior to the inspection and has developed a revised format to address this issue. She has started to show senior carers how to use this so that they can in turn cascade this information to carers. Care Homes for Older People Page 13 of 34 Evidence: We noted that there were minutes of recent review meetings, convened by the funding authority, for 2 of the 4 residents that we case tracked. However, monthly evaluations of the care plans were not recorded. We looked at 4 case files and noted that files contained a care plan and a service user plan summary. Where necessary the plan included a pressure ulcer assessment, a falls risk assessment, manual handling risk assessment and medication risk assessment. There were also risk assessments that were tailored to the individual needs of the resident e.g. absconding from the care home. We noted that one of the residents being case tracked had a pattern of refusing assistance with personal care although they were not able to care for themselves. Communication difficulties were affecting this situation. A discussion with the manager took place and a system of more explicit recording has been put in place to keep this situation under review. A programme to support the resident with regular bathing has been set up and we saw part of a new care plan for this resident where the need for assistance with personal hygiene had been identified. It was very detailed and included instructions for staff to follow in the event of assistance being refused. There have been improvements in the standard of recording in the home and we noted that since the new manager has advised members of staff in regard to the quality of the daily and night time recording, the content has become more informative and useful in terms of monitoring the health and welfare of the residents. When we looked at case files we confirmed that there was evidence of access to health care facilities in the community. We saw a record of outpatient appointments, testing of hearing aids, appointments with the chiropodist and dentist, appointments with the optician, blood tests and an assessment by a physiotherapist. It was noted that a residents mobility appears to have improved since their admission to the home. We looked at the arrangements for the storage of medication and were satisfied that it was safe and secure. We looked at the records and they were up to date and complete. The home uses a monitored dosage system. We examined the blister packs and the blisters have been popped in accordance with the time of day and with the day of the week that the packs were examined. We did note however that some of the packs began on different days of the week, which could be confusing for the person administering medication. We saw when examining records that the new manager has begun to repeat the assessment of competence for members of staff who administer medication. We noted that the members of staff responsible for handling and administering medication had received training. Care Homes for Older People Page 14 of 34 Evidence: We spoke with residents and while we did so we observed that residents were being discreetly offered assistance with personal care. Residents confirmed that when assistance is given their dignity and privacy is respected. We saw that when the lunch was served assistance was given to those residents who were unable to feed themselves and that the manner in which assistance was given respected the dignity and self esteem of the resident. The Quality Care Audit report from 2009 recorded that Dignity in Care training had taken place in July 2009. We noted that case files included instructions for the home in the event of the death of a resident. We discussed end of life care and the manager said that end of life care plans will be produced as part of the work required for registering for the Gold Standard Framework. Care Homes for Older People Page 15 of 34 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. A programme of activities for residents is in place although it needs to be reviewed to assure residents that it continues to reflect their interests and understanding. Residents said that they enjoyed the company of their visitors, who were made welcome by the staff when they visited the home. Residents have opportunities to exercise choice in their daily lives. Residents nutritional needs are met through the provision of a diet that is varied and wholesome. Evidence: We were provided with a copy of the weekly activities planner and saw that in house activities included reminiscence, knitting, a sing along, movies and musical mobility. Church services also took place in the home on a regular basis. During the inspection we noted that a hairdresser visited the home on a regular basis and this helped residents maintain a smart and tidy appearance. We spoke with the activities coordinator who also works as a carer for part of their hours. She confirmed that entertainers visited the home and that the last outing for residents took place last September. Residents enjoyed a good rapport with the coordinator and we observed an activity where residents were encouraged to say which part of the world they would like to visit and then to guess about the cost of travel etc. This developed into recalling places visited or holidays taken and resulted in a lively conversation. One of Care Homes for Older People Page 16 of 34 Evidence: the residents we spoke to said that she liked to walk in the garden of the home. When we spoke with the manager she said that as many residents had dementia it was important to engage with residents at every opportunity and said that when staff assist residents throughout the day there were opportunities to encourage residents to talk and to enjoy 1:1 attention. Residents confirmed that when their visitors arrived at Church Walk House they were made welcome and that they could entertain their visitors in the privacy of their room. We spoke with a relative that was visiting the home during the inspection. He said that he was made welcome and comfortable on his visits and that he maintained contact with the home, by telephone, between visits. This enabled him to receive feedback about the resident and said that this made him feel easy about the residents care. At the moment the company that owns the care home is in contact with another provider about a possible merger and the relative confirmed that he has been kept informed of developments and has agreed to an offer of viewing a care home managed by the other company. During the inspection we noted that residents were also being offered the opportunity of visiting the other care home and that details of the arrangements for this visit were on display. Minutes of meetings for residents and relatives confirmed that information was provided to them about possible future changes to the ownership of the care home. No one working for the company is an appointee for any of the residents and if they need support with financial matters this is provided by relatives or people acting on their behalf. In the Annual Quality Assurance Assessment (AQAA) the home recorded that Barnet advocacy had been contacted to act on behalf of residents and that volunteer advocates visit the home on a weekly basis. When we carried out a site visit we noted that some residents had added personal items to their rooms to make them more homely in appearance. There were opportunities for exercising choice in their daily lives including choice of meals and choice in when to get up in the morning and when to go to bed at night. During the inspection we saw the serving of the midday meal. There was a choice of main dish and although most residents had chosen chicken curry from the menu there were also residents having pork goulash or a ham salad. The menu follows a 4 week cycle and reflects seasonal variations. We noted that menus are varied and residents confirmed that alternatives are available. The supper menu includes a hot dish although sandwiches or a cold dish are available. We spoke with the chef who confirmed that the menu includes fresh vegetables and fruit. The meals served looked Care Homes for Older People Page 17 of 34 Evidence: and smelt appetising and portions were generous. When we spoke with the chef we asked about special diets and were informed that 6 diabetic meals, 1 low carbohydrate meal and 7 pureed meals are prepared. We saw that each item in the pureed meal was pureed separately so that the meal looked attractive. Assistance with feeding is provided, as necessary. We noted that in January 2010 catering arrangements in the home were awarded a 5 stars (excellent) Score on the Door by the local authority Environmental Health Department. Care Homes for Older People Page 18 of 34 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. A complaints procedure was in place to protect the interests of the residents. Protection of vulnerable adults training for staff and familiarity with the homes procedure and with the whistle blowing procedure contribute towards the safety of residents. Evidence: A copy of the complaints procedure was on display in the entrance hall. It gave details of the stages involved in the procedure and timescales were identified for each stage of the process. However, the details of the regulatory authority were out of date and when this was brought to the attention of the new manager the correct details were inserted. We looked at the records of complaints that are held in the home. The new manager showed us a book that had been in use since the last key inspection and there was 1 entry. Although the details of the complaint had been recorded there were no details regarding an investigation into the complaint or a record of when the outcome had been shared with the complainant. Relatives of the resident had complained that a member of staff had been rude to the resident and failed to show respect. The member of staff that was the subject of the complaint was suspended shortly after the incident took place. Unfortunately the new manager is unable to talk to the person that dealt with the complaint, as they are no longer working in the care home, so further details were not available. The manager has however set up a new complaints file that is arranged so that Care Homes for Older People Page 19 of 34 Evidence: complaints are filed in date order and there is a summary form at the front of the file, which enables monitoring to take place. The summary form includes a section for the outcome of the complaint and for the date on which feedback is given to the complainant to be recorded. We looked at compliments that had been received by the home and these included he was really well cared for, the staff I met and talked to were so kind and caring, Church Walk House has a great atmosphere and is very welcoming. During the inspection we met and spoke with the trainer that is working with Church Walk House and she confirmed that the current training programme includes safe guarding training. She added that in addition to the sessions that she was holding she has also secured places for members of staff on courses being run by the London Borough of Barnet and the London Borough of Camden. We noted that agency staff working in the home have received protection of vulnerable adults or safeguarding training. The home has a copy of the inter agency guidelines in the event of abuse. Two requirements that formed a statutory requirement notice in relation to safeguarding, which was issued by the CQC after the random inspection of the home in January 2010, have therefore now been met. Since the last key inspection 3 safeguarding referrals have been made to the local authority. One matter was referred to the police, who took over as lead agency in the investigation, and 2 members of staff were suspended. This investigation is now complete and we have been informed that there is insufficient evidence to prosecute any criminal charges against either party. The second referral was dealt with by a strategy meeting and it was not possible to determine the identity of a person who was alleged to have sent texts to a relative of a resident. The third referral was in respect of a resident who left the home and whose absence was discovered after this had occurred. A system of regular, recorded checks regarding the movements of the resident are now in place. The home reported each of these incidents to the local authority and to the CQC and has taken the appropriate follow up action. Care Homes for Older People Page 20 of 34 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. Residents live in a character property that has charm but it is in need of refurbishment. Clean and tidy surroundings provide a safe and hygienic environment for residents. Evidence: During the inspection we carried out a site visit. This property has character and is not purpose built. However, the decor and the decoration in the bedrooms is in need of updating and a programme of renewal and refurbishment is required to enhance their appearance. Where in the past rooms have been occupied on a shared basis and are now occupied on a single basis the old tracking system for curtains hanging from the ceiling needs to be removed. The bedroom doors need replacing as a number of different locks have been fitted and some have then been removed leaving parts of old fitments remaining. Where the barrel of the lock had been removed from one door there was a round hole through the door that compromised its fire safety status. This was attended to immediately. The manager informed us that the layout of the building and how individual rooms and areas are utilised are currently under review. When we looked at the kitchen we noted that it had been re tiled approximately 2 weeks prior to the inspection. There is a beautiful large garden at the rear of the property that is well maintained. Care Homes for Older People Page 21 of 34 Evidence: During the site visit we noted that the home was clean and tidy and free from any offensive odours. We visited the laundry and noted that access to this room did not involve carrying laundry through areas where food is prepared or consumed. There was evidence of infection control or cross infection training on most staff files. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Keeping staffing levels under review would assure residents that there are sufficient carers on duty to meet their needs. Residents benefit from staff that have developed their understanding through NVQ training. Recruitment procedures need to be more thorough to assure residents that their safety and welfare is promoted. Members of staff now have access to a programme of training to develop their knowledge and skills. Evidence: We discussed staffing levels with the new manager. There are 4 carers working under the supervision of a senior carer during the morning and similar staffing levels during the afternoon/early evening shifts. At night the night manager is assisted by a senior carer and 2 carers. In addition there are domestic, catering and laundry staff employed by the home and there is a handy person who deals with the maintenance of the home. The manager reviews the efficiency of staffing levels by monitoring the print outs from the call alarm system to check which residents have used the system and how quickly a member of staff has responded to the call. We observed during the inspection that there are a number of frail residents that require hoisting when staff assist with transfers. On the AQAA the home has stated that 88 of the carers and senior carers have an NVQ level 2 (or higher) qualification. When we looked at the files of permanent Care Homes for Older People Page 23 of 34 Evidence: members of staff there was evidence of level 2 and level 3 qualifications. We were told that it is proposed to offer level 4 training to senior carers. We looked at staffing files for permanent members of staff and the records for members of staff working on an agency basis. Each file or record seen included an enhanced CRB disclosure. However, 1 disclosure had a trace and there was no record of a discussion being held to assess the suitability of the member of staff, who may have been involved in this discussion or on what basis they reached their decision. Application forms for permanent members of staff that we saw lacked space for recording starting and finishing dates for periods of employment and the reason for leaving was not always completed. Files contained 2 references but on 1 file the reference was in German and there was no verified translation. One file did not contain proof of identity. Where necessary the right to work and to reside in the UK had been verified. During the inspection we met a trainer provided by the company that is supporting the owners of Church Walk House. On the day of the inspection manual handling training for carers was taking place. She also confirmed that a programme for safeguarding training was underway and that she was arranging a dementia care awareness update for members of staff. Refresher courses for both health and safety and first aid have been arranged. When we looked at staff files and the records relating to agency staff a list of training courses attended, and attendance certificates where possible, were kept. On the AQAA the home has identified a need for induction training to be more consistent and for a full record to be kept of this. Care Homes for Older People Page 24 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The day to day management of the home provides residents with an environment where their needs are recognised. Quality assurance systems are in place to monitor and develop the service. Residents financial interests are promoted by the home. A programme of supervision for carers assures residents that care practices are monitored and reviewed. Training for staff in safe working practice topics promotes the health and safety of residents, staff and visitors to the home. The testing/servicing of equipment in the home assures residents that it is safe to use. Evidence: The registered manager of the home resigned and left the care home in September 2009. The deputy manager covered the duties of manager after this, on an acting basis, until the beginning of March 2010. He handed over to the new manager, Ms Marie Rose, who assisted with this inspection. She is an experienced care home manager. We looked at her portfolio of achievement and noted that she holds an NVQ level 4 in management and an RMA qualification. She has also obtained an NVQ Assessors Award. There are certificates to demonstrate that she has attended short Care Homes for Older People Page 25 of 34 Evidence: training courses to update and to increase her knowledge, skills and understanding. After the random inspection that took place in January 2010 a Statutory Requirement Notice was issued as the CQC was concerned that the monitoring of the home by the management committee was not robust. We have now seen the report of the February and of the March Regulation 26 visit to the home and are satisfied that the content of the reports reflects a more thorough approach. These are being carried out by another company, on behalf of Church Walk House. The new manager confirmed that she meets with the chairperson of the management committee on a weekly basis and that she completes a monthly report regarding the running of the home that is sent to the management committee. The report includes information about any safeguarding matters, residents requiring pressure care, staffing levels and staff training. We have noted that Regulation 37 reports (of any event in the home affecting the well being of a resident) are being forwarded to the CQC on a consistent basis. A copy of the results of the Quality Care Audit that was carried out in August 2009 was available for inspection. Nine responses had been returned by relatives. Although most comments were positive a comment was made that there were not enough members of staff on duty, there were problems with items laundered and feedback from the manager or senior carers to relatives was poor. Feedback from relatives and residents since the audit was carried out confirm that improvements have been made and it was recorded in the AQAA that the laundry hours have been increased. We looked at the minutes of meetings held with residents and relatives and noted that the chairperson of the management committee has kept people informed of developments affecting the home. The most recent meeting held was in March 2010. We noted that staff meetings have also been held (including meetings for members of staff working on the night shift) to advise members of staff of proposed changes and a representative of the HR department of the other company was in the care home during the inspection, speaking with individual members of staff. The new manager has an open door policy and when we spoke with residents they spoke positively about her. When we spoke with members of staff they commented on the number of recent changes in the post of manager and mentioned business as usual. One member of staff said that in the last few weeks there had been massive changes but rated these as positive. We met the member of staff responsible for handling residents finances. The home handles the personal allowance of 3 of the residents and a separate bank account has been set up for residents monies. We saw that receipts for items of expenditure are kept. We noted that shower gel for female residents was recorded as Lynx products on the automated till receipt. These products are for men and receipts must be carefully checked to ensure that suitable items have been Care Homes for Older People Page 26 of 34 Evidence: purchased for the resident. Records of money held on behalf of residents were satisfactory and up to date with a balance showing. A supervision planner has been drawn up by the new manager and the first supervisions have taken place. The night manager and senior carers share the responsibility of carrying out supervision with the new manager. Regular fortnightly staff meetings have been introduced. We looked at the certificates for servicing/inspecting systems and equipment in use in the care home. We noted that there were valid certificates for the Landlords Gas Safety Record, the fire alarms and emergency lighting, pest control, fire extinguishers, the call alarm system., wheelchair and hoists and the electrical installation. The maintenance person is dealing with some items that failed the portable electrical appliances testing (PAT) and the home is waiting for some replacement parts for the lift although it is still in use. There is a fire procedure for the home and training in fire awareness has been given to the kitchen domestics in March 2010. The book recording recent fire drills was not available as the new manager is still locating records in the home. The record of fire alarm testing recorded weekly testing from February 2010. When we looked at the daily logs for the residents that we case tracked we noted that an accident that had been noted in the log had not been recorded in the accident book although the resident was seen by the GP and by the DN. When we looked at the accident book we discussed the pattern of accidents with the new manager as a number of accidents related to 2 residents. We are satisfied that appropriate follow up action is being taken. We discussed the need for a health and safety officer for the home. The manager has recently attended health and safety training and at the time of the inspection a health and safety officer from the other company was carrying out a health and safety risk assessment of the building. We saw the risk assessment file and noted that the manager has already completed general risk assessments e.g. PAT testing and COSHH for all residents living in the home. Care Homes for Older People Page 27 of 34 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 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 01/07/2010 ensure that the new format for more informative and detailed care plans is applied to each of the residents. This will assure residents that members of staff supporting them have an in depth knowledge of their needs and of the intervention necessary to meet these needs. 2 7 15 The registered person must ensure that the care plans are evaluated on a monthly basis. This will assure residents that any changes in their general well being will be quickly identified and addressed. 01/06/2010 3 11 15 The registered person must ensure that care plans include plans for end of life care. 01/07/2010 Care Homes for Older People Page 29 of 34 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 This will ensure that the final wishes of residents are known and recorded so that the resident can be supported in the way that they would prefer. 4 12 12 The registered person must 01/06/2010 review the programme of activities taking place both inside and outside the home. This will assure all residents that activities are provided for them that are appropriate for their understanding and take into account their interests and hobbies. 5 19 16 The registered person must 01/07/2010 provide the CQC with a plan, timescales attached, for the refurbishment of the residents bedrooms. To ensure that residents are able to enjoy attractive surroundings in which to relax. 6 19 23 The registered person must 01/07/2010 provide the CQC with a plan, timescales attached, for any refurbishment needed in communal areas. Care Homes for Older People Page 30 of 34 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 To ensure that residents are able to enjoy attractive surroundings in which to relax. 7 29 19 The registered person must ensure that there is evidence of proof of identity on each staff file and that references are written in English or have a verified translation. This will assure residents that the recruitment procedure safeguards their welfare. 8 29 13 The registered person must 08/05/2010 be able to demonstrate that when a trace is received in respect of an enhanced CRB disclosure consideration is given to the information and a decision is made on the suitability of the person to provide care. The discussion and subsequent decision must be fully recorded. This will assure residents that no unnecessary risks to their safety and well being are taken. 9 29 19 The registered person must ensure that the application form is thoroughly completed and that there is 08/05/2010 08/05/2010 Care Homes for Older People Page 31 of 34 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 a column for recording starting and finishing dates for periods of employment to provide an audit trail. This will assure residents that the recruitment procedure safeguards their welfare. 10 30 18 The registered person must ensure that the training programme now in place is implemented for all carers so that they receive mandatory training and refresher training at the recommended intervals. This will assure residents of support from carers who have the appropriate and up to date knowledge, skills and understanding of the needs of the residents. 11 35 12 The registered person must ensure that when items are purchased on behalf of a resident the receipt is carefully checked. This will assure residents that items purchased on their behalf are appropriate. 12 38 13 The registered person must notify the CQC when the items failing the PAT testing have been dealt with and 01/05/2010 01/05/2010 01/07/2010 Care Homes for Older People Page 32 of 34 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 when the new parts for the lift have been installed. This will enable the home to demonstrate that all systems and equipment in use in the home are maintained or safe to use. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 That the registered person draws up a list of any review meetings that are overdue and contacts the funding authority for a date on which the meeting can be scheduled to take place. This will assure the residents that their needs are monitored and that any changes can be addressed. That the registered person contacts the pharmacist to enquire whether changes can be made so that all the blister packs start on the same day of the cycle. That the registered person checks each document where a summary of the complaints procedure is included and updates the details of the regulatory authority, if necessary. That the registered person keeps staffing levels under review to ensure that changes in dependency levels of residents are quickly identified and addressed so that staffing levels match the needs of residents. That the registered person reviews arrangements for new members of staff and ensures that an induction training workbook is used, completed and kept on file. That the registered person ensures that during handover it is confirmed that any accidents occurring during the shift have been entered in the accident book and recorded in the daily or night time log. 2 9 3 16 4 27 5 30 6 38 Care Homes for Older People Page 33 of 34 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. 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