Care Home: Churchill House

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What the care home does well There is a very relaxed a homely atmosphere in the home, people were observed to be very settled and comfortable in their surroundings. Comments from people who use the service and their relatives include `Churchill House is really a friendly and warm place to be in. I can`t fault it in anything at all, I`m quite content to call it my home` and `the home is clean and bright and welcoming`. The staff were described as very friendly and caring and people were happy with their care. Comments include `The staff are very helpful and do their best to try and meet my mother`s needs` and `they look after all the residents very well and we are quite happy the way our mum is well cared for and she is always saying how good the staff are and what a lovely homely place Churchill House is`. People living in the home told us it was always very clean and tidy and it was very clean and tidy when we visited. People said that they were offered a good choice of meals and that they enjoyed the quality of the food. People told us that their visitors were always made very welcome and they could stay for meals if they wished. People told us that they really enjoyed the slide shows and discussions of `days gone by` in Hull that were regularly organised. Staff turnover is low which has helped consistency of care. The home has maintained a very high percentage of staff that have gained a National Vocational Qualification (NVQ) in care at level 2 or 3 which is an excellent achievement. What has improved since the last inspection? The management and storage of medication has improved, a new treatment room has been provided. Records of people`s nutritional needs and meal preferences are held in the kitchen for reference. A new complaints procedure has been put in place which is more detailed, userfriendly and gives any complainant more information on how to take issues further if necessary. Recruitment of new staff has improved, all checks are now in place before they start on shift and records are made of the interview meeting. Staff have received more regular formal supervision sessions which cover all aspects of care, training and development.A training plan has been developed and staff have accessed more training relevant to their role, but this could be expanded further. All staff have had safeguarding of adults training. Work is continuing to improve the environment and make it a more pleasant and suitably equipped place for people to live. A lot of redecoration and refurbishment has taken place since the last visit with very positive results. The home has up to date records to support that the fire safety systems have been checked regularly and staff have been involved in safety drills to make sure they know what to do in the event of a fire. All maintenance records in the home are well kept, this better evidences all the safety checks, repairs and decoration work carried out. The home sends to the commission information regarding incidents that affect the wellbeing of people who use the service. Accident records have been completed better, the manager audits these to check prevalence and if appropriate action has been taken to reduce the risk of re-occurrence. What the care home could do better: Assessment records should be completed more consistently so they clearly describe people`s individual needs and how they would prefer to receive their care. The care plans must be more detailed to ensure that that all the information about how people`s needs should be met is available to staff. Care plans need to be updated when people`s needs change. People`s risks of sustaining pressure damage must be assessed properly to ensure they receive the right support and equipment to meet their health needs. People`s social needs must be properly assessed and planned for with particular attention to be paid to individuals with dementia care needs. A structure of activities needs to be in place to provide social stimulation to ensure people are appropriately occupied and fulfilled. Staff must have up to date training in first aid and the training plan could also be expanded to include conditions affecting older people. This will ensure staff have a full range of skills and be confident when supporting people with diverse needs. The way the quality of service is monitored and managed should be improved so that shortfalls we picked up during the visit will be picked up by staff and management. Update the home`s policies and procedures so that staff have the required information they need to support their work in meeting the needs of the service. Key inspection report Care homes for older people Name: Address: Churchill House 745 Holderness High Road Hull East Yorkshire HU8 9AR     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: Jane Lyons     Date: 1 5 0 2 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 33 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 33 Information about the care home Name of care home: Address: Churchill House 745 Holderness High Road Hull East Yorkshire HU8 9AR 01482709230 F/P01482709230 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Wealdplace Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Churchill House is positioned on the eastern outskirts of the city of Hull. It is situated on a main road, which enables easy access to public transport, shops and health facilities. Car parking and an external seating area for residents are situated to the rear of the property. The home is registered to provide care and accommodation for up to twenty-five older people who may also have dementia care needs. The home has recently changed ownership and one of the bedrooms has been utilised into an office. This means although the home is still registered for twenty-five people there are only placements for twenty-four. The home is a mixture of an old building and a new extension and facilities are over two floors serviced by a passenger lift. It has mainly single bedrooms with the exception of one shared room. There are two lounges with space for dining tables and chairs in each. Communal rooms are decorated in a homely style and furniture provided is appropriate for residents needs. The home has two bathrooms and a Care Homes for Older People Page 4 of 33 Over 65 25 25 0 0 2 9 0 1 2 0 0 9 Brief description of the care home shower room. According to information received on the day of the visit the current weekly fees are 359 pounds. The home provides basic toiletries, a daily newspaper, a visiting physiotherapist and reflexologist and also pays for a visiting entertainer. Optional extras include chiropody, hairdressing and personal toiletries. Care Homes for Older People Page 5 of 33 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: The quality rating for this service is 1 star. This means that the people that use the service experience adequate quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 29th January 2009 and a site visit to the home, which lasted approximately eight and a half hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Churchill House. We also had discussions with the manager, the proprietors, some staff members and a health professional. We received surveys from people who live in the home, relatives, staff and a health professional. Comments from discussions during the day and surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, Care Homes for Older People Page 6 of 33 and the homes care plans to see how those needs were met while they were living there. Also examined were, medication practices, risk management, activities, nutrition, complaints, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked to see how people were consulted with in how the home was run and how privacy and dignity was maintained. We also wanted to be sure that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. The provider had returned their annual quality assurance assessment (AQAA) within the required timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Churchill House, the staff team and management for their hospitality during the visit, and also thank the people who had discussions with us. We found some continuing issues with care records and social stimulation although there had been improvements in other areas. We spoke with the providers and were assured that they wanted to work with the Commission to improve the outcomes for people living in the home. The home will receive a warning letter about the continued breaches and must send us an improvement plan. The home may have a further visit to check that the improvement plan has been completed. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? The management and storage of medication has improved, a new treatment room has been provided. Records of peoples nutritional needs and meal preferences are held in the kitchen for reference. A new complaints procedure has been put in place which is more detailed, userfriendly and gives any complainant more information on how to take issues further if necessary. Recruitment of new staff has improved, all checks are now in place before they start on shift and records are made of the interview meeting. Staff have received more regular formal supervision sessions which cover all aspects of care, training and development. Care Homes for Older People Page 8 of 33 A training plan has been developed and staff have accessed more training relevant to their role, but this could be expanded further. All staff have had safeguarding of adults training. Work is continuing to improve the environment and make it a more pleasant and suitably equipped place for people to live. A lot of redecoration and refurbishment has taken place since the last visit with very positive results. The home has up to date records to support that the fire safety systems have been checked regularly and staff have been involved in safety drills to make sure they know what to do in the event of a fire. All maintenance records in the home are well kept, this better evidences all the safety checks, repairs and decoration work carried out. The home sends to the commission information regarding incidents that affect the wellbeing of people who use the service. Accident records have been completed better, the manager audits these to check prevalence and if appropriate action has been taken to reduce the risk of re-occurrence. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 9 of 33 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 10 of 33 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 11 of 33 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. Peoples needs were assessed and recorded prior to admission to the home, although more consistent recording would better demonstrate this process. Evidence: We examined three care files of people living at the home. All the care files examined contained assessments of need completed by the local authority prior to admission. The home has introduced a new assessment record which all files seen contained, the assessments covered aspects of the individuals health and physical and social care needs and associated risks. The assessment format is tickbox in style with some space provided for comments. We noted that staff are recording a lot of assessment information in the actual care plans, staff need to record this information in the assessment section so they have a clearer record of peoples individual needs and how they prefer to receive their care support. This information will then enable staff to write more detailed care plans which better describe how Care Homes for Older People Page 12 of 33 Evidence: peoples needs are to be met by staff. During the visit the deputy manager carried out a pre- admission assessment, during this assessment she had made some notes on a piece of paper which she told us would be filed separately and the information used to assist completion of the main assessment record. The owners confirmed that there is a more formalised pre- admission record available which would be put in place to better demonstrate that detailed pre- admission assessments have been completed. It is clear that the home obtains the required assessment information however more formalised and consistent recording would better demonstrate this process. There was evidence that the home is now formally writing to people following their assessment stating their needs can be met in the home. Staff spoken with were clear about peoples needs and individuals told us their needs were met. The home does not provide intermediate care so standard 6 does not apply. Care Homes for Older People Page 13 of 33 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. Gaps in care planning and risk assessment means that staff may not have the full information required to care for people and important care may be missed. Medication was well managed. People felt their privacy and dignity was promoted. Evidence: We examined three care files to check how peoples needs were identified in care plans. A new care plan format had been put in place since the last inspection, however those care plans seen did not reflect all the information provided in the assessment from the local authority nor did they contain detailed directions for staff to follow to ensure peoples needs were being consistently met. For example a local authority care plan for one person detailed that they had a learning disability and needed support with understanding aspects of daily living and they could not read or write. None of this information was reflected in their care plan. Other plans seen contained single statements referring to an area of need, for example assist with personal care, however records must clearly describe how staff are to provide this support. We saw evidence that the plans were evaluated monthly however there was a lack of Care Homes for Older People Page 14 of 33 Evidence: consistency in the process of evaluation of care plans and recording health professional instructions. The care plans did not always record up to date information about the care required to meet peoples needs. For example, a person had developed pressure damage yet a care plan for this area of need had not been put in place. Another persons records detailed that they had slipped and sustained an injury to their leg, the care plan had not been updated to reflect this nor had the plan been updated to reflect instructions from the community nurse regarding specific care support. Aspects of risk management had improved, there were detailed risk assessments in place to support moving and handling, nutrition and other areas such as falls. However we found that a significant area of risk affecting an individual had not been planned for sufficiently. Care records showed that a pressure relieving mattress had been provided for this person in October 2009 and an evaluation summary in January 2010 detailed that the person had a pressure sore. There was no risk assessment in place to identify this persons risks in relation to sustaining pressure damage. A failure to ensure that risk assessments are put in place and updated when significant needs change places people at risk of insufficient care and affects their health, welfare and safety. There was evidence that people have access to health care professionals. One health professional we saw during the day told us that staff followed their instructions and referred people to the district nursing services the correct way. They found the staff helpful and their patients always appeared well looked after. We received one survey from a health professional who commented, the staff are helpful and follow guidance, residents appear very happy in the home. The company also employs a physiotherapist to spend time in each of their homes, he visits the service fortnightly to support individuals with specific exercises and provide advice and guidance to staff. Improvements were seen with the quality of daily recording and key worker activity, staff were now recording in much more detail how people are supported throughout the day and night. All care plans seen showed evidence that they had been agreed with the person receiving the care or their representative. There was evidence that reviews had taken place with the local authority and family members present. Medication storage has improved since the last visit, there is now a dedicated room and a new medicines fridge has been provided, temperature control of the room and fridge should be monitored regularly to ensure medications are stored safely. Although people can manage their own medication if they want to, none of the current people Care Homes for Older People Page 15 of 33 Evidence: using the service had chosen to do this. There is a system to check that the correct medicines are received from the pharmacy and once in the service they are stored securely. Medication records were well maintained, there were no handwritten entries although the manager confirmed that these would be witnessed by a second staff member to confirm accuracy. None of the people using the service were receiving controlled drugs but storage facilities are in place should this situation change. Information received in the AQQA shows that staff who administer medication have all completed accredited training. Medication policies and procedures still require review, those in place did not reflect current practice and guidance. Observation of staff interaction with people living in the home and conversations with people living in the home evidenced that peoples privacy and dignity was promoted. We saw staff approach people in a respectful manner. People told us they could choose how to spend their time, they said staff knocked on the door before entering their bedroom and ensured that privacy was maintained when they were assisted with personal care. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff provide people with a homely and pleasant environment where they are able to make choices about aspects of their lives and are supported to remain in contact with family and friends. Activity provision is minimal which could mean people, especially those with dementia care needs are not receiving enough stimulation. Evidence: People told us that routines were flexible and visitors were welcomed at any time and offered refreshments. The atmosphere was relaxed and pleasant and there was good interaction noted between staff and individuals with definite signs of wellbeing observed. People indicated that the routines in the home met their individual needs and they enjoyed living at the home. Comments included I can choose where I spend my time and the home is really a friendly and warm place to be in, Im quite content to call it my home. Staff spoken with were clear about how to maintain independence and how to encourage people to make choices, we ask people if they want to do things and respect their decisions and residents are always given choices about meals, what Care Homes for Older People Page 17 of 33 Evidence: they want to wear and what they want to do. There was little evidence that the activity programme had improved since the last inspection, records showed that the home provided a very limited range of social stimulation for people living in the home, especially for people with dementia. There was no daily activity programme in place. We were told by care staff in surveys and in discussions that there were limited activities provided, staff told us that few people wanted to participate in activities and it was hard to motivate them. Some regular external social support was provided this included a physiotherapist and reflexologist visited fortnightly to treat individuals and each month there was a slide show and discussion of Hull in days gone by which people spoken with told us that they enjoyed very much. An entertainer visited every two to three months and seasonal parties were arranged. Some people were quite able to entertain themselves and clearly preferred to stay in their bedrooms. Care plans to support individuals social needs were sampled and these were found to be minimal, for example one care plan detailed likes to socialise with other ladies as well as staff, she enjoys watching television. Daily recording reflected the lack of stimulation. During the visit we observed that the majority of people spent time watching the television, although in the afternoon staff supported two individuals to play a game of Connect Four. We were told in discussions with people who use the service that there were few activities provided and information received in surveys also reflected this. People stated, I would like to do more, we have the odd entertainer but I like playing Bingo and games and they dont do that here and there is not much to do, I like doing jigsaws but there arent any, another person said generally we sit in the lounge and watch the T.V. but it would be nice to do something different. Failure to assess peoples social needs and provide activities and occupations to keep people stimulated will lead to boredom and could impact on their emotional and psychological well being. The visitors to the home said they were made to feel welcome by the staff and the management and that they were always offered refreshments when they visited. One person told us that her daughter often stays for lunch when she visits which was very nice. We observed the lunch being served and spoke with several of the people living in the home about the meals provided. The mealtime was relaxed and individuals were given time to eat their meals. We observed that none of the people currently living in the home required any assistance at mealtimes, staff were on hand if people required support. The meals were well presented and all of those spoken with were very Care Homes for Older People Page 18 of 33 Evidence: complimentary about the food. Comments included the food is very good, the meals are lovely, the cook does a jolly good job and the meals are excellent. Drinks were readily accessible in communal areas. The days menu was displayed in the dining room, staff were observed discussing menu choices with individuals, the cook confirmed that each person was consulted daily about their menu choices. The kitchen was well maintained and was very clean. The home had achieved the best score available, an A rating in the local authority scores on the doors assessment system for safe food management, which was an excellent achievement. Care Homes for Older People Page 19 of 33 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. People who are able, know how to complain and are confident their complaints would be listened to. The home protected people from abuse by staff training and the use of policies and procedures. Evidence: The home has updated the complaints procedures since the last inspection, this is on display in the entrance hall. Staff spoken with and surveys received from them indicated they were aware of what steps to take should people raise concerns with them. No complaints have been made to the home or the CQC in the last twelve months. People spoken with at the home said they would feel comfortable to speak to staff or the manager if they were unhappy with anything at the home, but they did not have any complaints. Comments included I would speak to Anne the manager or my key worker, they would sort it out, I enjoy living here and I have no problems. The home used the multi-agency policy and procedures for safeguarding vulnerable adults from abuse. The proprietors had demonstrated their knowledge of the procedures by making an appropriate referral to the local authority for a particular financial issue they had become aware of. All of the staff spoken with were aware of the policies and procedures and what amounted to an allegation of any abuse. Records Care Homes for Older People Page 20 of 33 Evidence: showed that all of the staff working in the home had recently had training in safeguarding vulnerable adults in November 2009 and one of the proprietors has received more in depth training facilitated by the local authority regarding their referral and investigation role. People who use the service stated they were happy and well cared for and felt safe in the home. Care Homes for Older People Page 21 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well maintained home that is clean, pleasant and considered homely. Evidence: A tour of the building was undertaken. The home was seen to be spotlessly clean and tidy with no mal odours, this is credit to the domestic staff who clearly work very hard to maintain these standards. The home is made up of an old building with a new extension attached, the home has character and homeliness which people appreciate, it provides people with a very comfortable environment which is well maintained. There was clear evidence that the proprietors are committed to improving the environment and have continued with the programme of redecoration and refurbishment throughout the home. Since the last inspection eight peoples bedrooms have been redecorated and refurbished, people told us that they had been consulted about the choice of decor and were very pleased with the results. One person said My favourite colour is green which I chose for the carpet, the new furniture makes the room seem much larger, it all looks lovely. Other work includes the new treatment room, replacement of the boiler, provision of a shower room and refurbishment of the sluice room. Information provided in the AQQA details that improvement works will continue this year with upgrading of the two lounge areas and the kitchen facilities. Care Homes for Older People Page 22 of 33 Evidence: The home employs a maintenance person who is employed for four hours per day. He maintains very clear records associated with the maintenance programme which show all works carried out internally and externally to the home. There was evidence that repairs are carried out very promptly. It was clear from surveys and discussions on the day that people were very happy with the environment. Comments were the home always smells nice, does not smell, I like living here, couldnt find a better home, I like my room and it has a nice view and its always clean and tidy, the staff work hard to keep it looking like this. Specialist equipment is provided where necessary for individuals and to meet requirements to move and handle people safely or reduce the risk of pressure sores. Training is provided in its use. There is a passenger lift for access to the first floor. Policies and procedures for management of infection control need updating. Staff confirmed that they had all the equipment necessary to support good practice in this area. Paper towels had been provided in all communal bathrooms and toilet areas to prevent the spread of infection. Care Homes for Older People Page 23 of 33 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. People have safe and appropriate support as there are enough competent staff on duty. Recruitment procedures offer protection for people. Peoples needs are met and they are cared for by staff who generally get the relevant training and support from their managers. Evidence: The home had sufficient care staff on duty to support the people living in the home. The home currently supported seventeen people. Discussions with staff and examination of staff rotas indicated that there were always three carers plus the deputy manager and manager working during the day and two carers at night. Observation of routines during the visit demonstrated that staff had time to carry out their work in a calm and paced manner and spend time with people. There were sufficient catering, domestic and maintenance staff to support the service. Surveys received from people and discussions with them on the day highlighted that they were very satisfied with the care they received. Comments included the staff are excellent, the staff are very nice, they do a jolly good job, they are all very helpful and kind, staff are very good, very nice, they listen to me and are very respectful. Information provided in the AQQA indicates that staff morale and retention is high which was confirmed in discussions with staff. Comments include the new owners are excellent, there have been lots of changes but they are all positive and we have been Care Homes for Older People Page 24 of 33 Evidence: here a long time and continue to work well as a team. The staff training and personnel files for three of the staff that worked at the home were examined. All of their personnel files showed that they had received the security vetting appropriate to their role. Photographs of staff have been placed in their personnel files and records to support the interview process are now maintained. We discussed CRB checks with the proprietors and the importance of recording decisions taken regarding employment if any staff members are employed with recorded convictions so the home can demonstrate they are taking appropriate action to protect people in the service. Records show that the home has continued to maintain 85 of the care staff having completed a National Vocational Qualification (NVQ) in care at level 2, which is a very positive achievement. Both the deputy and manager have achieved NVQ level 4. The home has recently recruited one new care assistant since the previous inspection records show that the staff member had completed an in-house induction programme which involved an orientation to the homes way of working and shadowing more experienced staff. The manager confirmed that the staff member was due to complete the skills for care induction standards. The home now has a staff training and development programme in place, and there was evidence that service specific training was included. For example dementia care, continence, record keeping, falls and mental capacity legislation. We discussed with the proprietors the need to broaden the range of service specific training for staff to include areas such as: care of the dying, pressure damage, nutrition and conditions common to the elderly, which they confirmed that would try and include in this years programme. Mandatory training such as fire safety, moving/ handling and food hygiene were up to date and courses in first aid and infection control were planned. Care Homes for Older People Page 25 of 33 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. People consider they live in a home which is well run however further improvements are needed to aspects of the administration and recording systems to ensure peoples health and wellbeing is safely met. Up to date, more comprehensive policies and procedures would underpin some of the necessary improvements and provide staff with the information and direction they need. The safety of people who use the service and the staff at the home is generally well promoted and protected. Evidence: The registered manager, Anne Melbourne has many years experience in the care sector and has an NVQ level 4 in care and management. She stated that she was very well supported by the proprietors who visited the home regularly. It is clear that the new ownership has had a positive impact on the service in many ways such as improvements to the facilities and many of the administration systems however it is of concern that three requirements made at the last inspection remain Care Homes for Older People Page 26 of 33 Evidence: outstanding in relation to care records and social stimulation. The home will receive a warning letter about the continued breaches and must send us an improvement plan. Discussions with the proprietors during the visit evidenced that their focus of late had been on the improvement strategy at one of the sister homes in the company however they understood the need to now shift their focus to Churchill House so they can support and direct the staff and management on improving the outcomes for people living in the home. The home had a system of monitoring the quality of care in the home. There was evidence that aspects of the quality assurance and monitoring system needs to be better maintained and used in a more consistent way. Recent surveys had been sent out to people who live in the home and relatives, these need to be evaluated and action plans need to be formulated. Audits have also been carried out on areas such as management of the home, accidents, medications, care practice and care plans, the findings from some of these also need to be reviewed. The way the quality of service is monitored must be improved so that shortfalls are identified and action taken to make the necessary improvements. Outcomes of this process need to be published and made readily available to people living in the home and visitors to the home. The last residents meeting was held in August 2009, records of the meeting showed that people were consulted about menus, activities and the decoration programme. We looked at some of the homes policies and procedures which showed that many of the them were very out of date and did not reflect current legislation and good practice guidance. Provision of up to date policies and procedures is a priority so that staff have the required information they need to support their work in meeting the needs of the service. The interviews with care staff and observation of their personnel files showed that more formal supervision had been provided. There were delays in starting the programme but records showed that staff have now received three sessions within the last six months and the programme is now on track. Records show that last staff meeting was held in April 2009. Staff told us in discussions that that they felt supported by the management. Some peoples personal money is held for safe keeping. Two peoples records were checked which evidenced that the accounts were well maintained and balanced with the money held. The AQQA confirmed that regular safety checks are made of the facilities and equipment to make sure the home is a safe place to live and work. Improvements were seen in the recording of fire safety checks and provision of staff drills. Records showed that all equipment was checked regularly and a current fire risk assessment Care Homes for Older People Page 27 of 33 Evidence: was in place. Accident records were maintained and monthly log was completed to enable the manager to study the prevalence of accidents in the home. The majority of staff need training in first aid, infection control and health/ safety and this is currently being planned for. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 Each resident must have a 20/05/2010 care plan in place that meets their identified needs and gives clear guidance to staff in how to support people. Care plans must be evaluated and updated when needs change. Timescale of 30/04/2009 remains unmet. This will ensure that important care will not be missed. 2 8 13 A thorough risk assessment and risk management system must be in place to help staff identify risk and take steps to minimise it. Timescale of 28/02/2010 remains unmet. This will help staff to support people safely whilst ensuring they help to maintain their independence. 20/04/2010 3 12 16 Each resident must have 20/05/2010 their social needs assessed and planned for. Particular attention to be paid to people with dementia care needs. A structure of activities needs to be in place to provide social stimulation. Page 29 of 33 Care Homes for Older People 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 Timescale of 30/04/2009 remains unmet. This will assist staff in tailoring activities to meet residents needs, prevent boredom and help to prevent a deterioration in residents cognitive abilities. Care Homes for Older People Page 30 of 33 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 30 18 Staff must have up to date skills in first aid. This will ensure the safety of the people who use the service and provide staff with the confidence to support people correctly. 30/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Assessment records should be completed more consistently so they clearly describe peoples individual needs and how they would prefer to receive their care. The training plan should include infection control and health/ safety updates and be expanded to include conditions affecting older people. This will help staff to have a full range of skills and be supporting people with diverse needs. Policies and procedures should be reviewed and up dated in line with changing legislation, good practice advice from the Department of Health, local health authorities and specialist/ professional organisations. This will ensure staff have the right information and direction they need to Page 31 of 33 2 30 3 33 Care Homes for Older People 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 support their work in meeting the needs of the service. 4 33 The homes quality assurance programme needs to be more consistently maintained to improve the monitoring systems and demonstrate that the service is run in the best interests of the people who live there. Care Homes for Older People Page 32 of 33 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 33 of 33 - 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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