Care Home: Clare Court Care Centre

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What the care home does well People have the information they need to enable them to decide if they want to live at the home. People have access to a range of health and social care professionals and this ensures that the appropriate advice can be sought to meet their health needs. People can be confident that they receive their medication at the prescribed times so helping to meet their health needs. People are offered a variety of healthy meals that meet any special dietary or cultural requirements. People are supported to keep in touch with their families and friends so that they can maintain relationships that are important to them. The home is sensitive to people`s cultural needs so that they are supported to live their life pursuing what is important to them. The home is well decorated, clean and well maintained so it is homely and comfortable for people to live in. People have big rooms that include an en suite shower room, so they have space and privacy. People benefit from being cared for by a staff team that are supported in their job roles. There is a robust system for checking that people`s money is held at the home in a safe manner. People told us: "I was told this was a brand new home and I liked the idea of modern, of moving into the time that living in." "I think I came to look round before I decided and liked the rooms." "I chose the home because I liked the view from the window." "I am very happy here." "The food is very good, good choice and well cooked." "Lovely food, ask for what you want, can have bacon, sausages and eggs for breakfast every day." Staff told us: "Staffing levels are fine. The manager is very approachable. The owners are always up and about. They know all our names." "I like working here." "We have done most of the training we need." " The manager and owner talk to everyone." What has improved since the last inspection? This was the first inspection of the home since it had been registered. What the care home could do better: Staff should have all the information they need so they know how to support individuals to meet their needs and individual preferences. Information about the home should be available in other formats and languages to make it easier for the people who live there to understand. Staff should have training in diabetes so they know how to meet people`s health needs. Staff should record when medication is received and date when they start using boxed or liquid medication, to help to audit and ensure medication is given as prescribed. Consultation with the people living there should be documented so it is clear that their choices and decisions are considered. People should receive appropriate support at mealtimes so they can enjoy their meals and have a nutritious diet. Key inspection report Care homes for older people Name: Address: Clare Court Care Centre Clinton Street Winson Green Birmingham West Midlands B18 4BJ     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: Sarah Bennett     Date: 1 7 0 3 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 31 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 31 Information about the care home Name of care home: Address: Clare Court Care Centre Clinton Street Winson Green Birmingham West Midlands B18 4BJ 07966537919 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Restful Homes (Birmingham) Ltd Name of registered manager (if applicable) Ms Sarah Elizabeth Slym Type of registration: Number of places registered: care home 79 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 79 The minimum age on admission for Dementia category from 50 years of age The registered person may provide the following category of service only Care Home With Nursing - Code (N) To service users of the following gender Either Whose primary care needs on admission to the home are within the following categories Old age not falling within any other category Code OP maximum number of places 79 Dementia Code DE maximum number of places 79 Date of last inspection 39 0 39 Over 65 39 79 40 Care Homes for Older People Page 4 of 31 Brief description of the care home Clare Court provides care and accommodation for up to seventy nine older people. This includes people requiring general nursing and residential care and people who have additional dementia care needs. The date of registration for this service was 2nd December 2009. The home is located in a residential area less than half a mile from City Hospital. It is close to local shops, the City Centre, and public transport links. Ample off road parking is provided for visitors to the home. At the front of the building there are electronic gates that can only be accessed from inside the building. External CCTV is provided for security purposes. The home is a non-smoking environment. There is a secure garden that is suitable for all people to use. The home is purpose built. Accommodation is provided over three floors, and upper floors are accessed via a passenger lift or stairs. All bedrooms offer single accommodation and have en suite bathroom facilities including wet room style assisted showers. In addition communal assisted baths and showers are available for all people to use. The home offers communal dining and lounge areas. Plans are in place for a shop to be created on the ground floor. There are two hair salons and kitchen and laundry facilities are based on site. Corridors are spacious and allow people to move around freely with any mobility aids required. In the reception area there is information that may be of interest. This includes the statement of purpose and service user guide. All people living at the home are funded by Birmingham City Council. The home does not accept people that are privately funded. Items excluded from the accommodation fee include chiropody, toiletries, hairdressing and newspapers. Care Homes for Older People Page 5 of 31 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 quality rating for this service is two stars. This means that people who use this service experience good quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice, and focuses on areas that need further development. The inspection was carried out over one day by two inspectors. The home did not know we were going to visit. There were thirty eight people living there. We were assisted by an Expert by Experience (in this report known as the expert). This is someone with personal experience of using care services. Experts by Experience observe what happens in the home and talk to people to obtain their views about what Care Homes for Older People Page 6 of 31 it is like to live there. The expert produced a report based on their findings and details of this are included in this report. Prior to the visit taking place, we looked at all of the information we had received, or asked for. This included notifications about events that have occurred in the home. The home have not yet returned the Annual Quality Assurance Assessment (AQAA), but a date has been agreed for the return of this. This tells us about the home and how they think it is meeting the regulations. Four people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to staff. We sampled care, staff and health and safety records. We looked around the areas of the home used by the people case tracked to make sure it was warm, clean, and comfortable for them. Care Homes for Older People Page 7 of 31 What the care home does well: People have the information they need to enable them to decide if they want to live at the home. People have access to a range of health and social care professionals and this ensures that the appropriate advice can be sought to meet their health needs. People can be confident that they receive their medication at the prescribed times so helping to meet their health needs. People are offered a variety of healthy meals that meet any special dietary or cultural requirements. People are supported to keep in touch with their families and friends so that they can maintain relationships that are important to them. The home is sensitive to peoples cultural needs so that they are supported to live their life pursuing what is important to them. The home is well decorated, clean and well maintained so it is homely and comfortable for people to live in. People have big rooms that include an en suite shower room, so they have space and privacy. People benefit from being cared for by a staff team that are supported in their job roles. There is a robust system for checking that peoples money is held at the home in a safe manner. People told us: I was told this was a brand new home and I liked the idea of modern, of moving into the time that living in. I think I came to look round before I decided and liked the rooms. I chose the home because I liked the view from the window. I am very happy here. The food is very good, good choice and well cooked. Lovely food, ask for what you want, can have bacon, sausages and eggs for breakfast every day. Staff told us: Staffing levels are fine. The manager is very approachable. The owners are always up and about. They know all our names. I like working here. We have done most of the training we need. Care Homes for Older People Page 8 of 31 The manager and owner talk to everyone. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. People have most of the information they need to make a choice as to whether or not they want to live there. Peoples needs are assessed before they move in but do not always include sufficient information so that staff know how to meet their needs. Evidence: The manager gave us copies of the statement of purpose and the service users guide. The statement of purpose included all the information that people would need about the home to make a choice as to whether or not they want to live there. The manager said that the service users guide is to be reviewed as more people move into the home, so they have the information they need. It included the relevant information that people would need about the home. Neither document stated whether it could be provided in other formats or languages to make it easier for people to understand. This should be considered, particularly as there are people living there whose first language is not English. The director stated after our visit that the documents are being produced in Punjabi. Care Homes for Older People Page 11 of 31 Evidence: There were 37 people living there and another person moved in during the day of our visit. The people living there have moved from two homes that have been closed by the City Council as a planned process. Social workers and nurses from the Primary Care Trust have worked with the people and the home to ensure that their needs can be met there. The admission process has been staged, so that everyone did not move in at the same time. The manager said this has helped people to settle in. The manager said that most people or their relatives came to look around the home before making a choice as to whether or not they wanted to live there. The manager said that another nine beds are to be used for people moving from another City Council home that is closing in June. They are now looking for referrals for people to move in to the other parts of the home. The middle floor, which will accommodate people who have dementia, is not open yet. An advocate who was visiting the home said that people had a choice as to whether or not they wanted to live there. The expert by experience found that for many people the choice as to whether or not they moved to the home was decided by their family. People said, My sons picked this one out for me and My family sorted it. One resident said their family had dealt with it but felt they chose well. Many people had not wanted to move from their previous home as they had lived there for several years. However, people told the expert, I werent keen as been in last place 11 years but now am here, am happier than where I was. Got lovely room, its cleaner, got everything I want and staff helpful. Another said the idea of moving had been upsetting at the time but now felt settled as I dont know why but I do like it better here. Some people said their choice was influenced by others from the home moving to this home as they wanted to stay with people they knew. People and their relatives told the expert that they had been given information and choice about homes to move to. They said they had a chance to visit the homes they wanted to. A professional from the resettlement team who was visiting said that people were given information about a choice of appropriate homes. The expert said, Residents are still settling in to a new environment and most could not tell me how long they had been at the home. None had wanted to move but had no option due to home closures. However, despite this most seemed to be comfortable and I observed a good rapport between staff and residents. For many the choice of home was mainly decided by others such as family. Some people recalled visiting and having the chance to choose rooms but I was unable to discover if they had been given the opportunity to make comparisons of the choices available. Care Homes for Older People Page 12 of 31 Evidence: We looked at four assessments completed before people moved in. Some of the information on these was not completed. The manager and director said that it had been difficult to obtain some information about peoples needs from the homes they lived in previously.They said that some of these information had been conflicting, which meant that some records were not consistent about how to meet peoples needs. We could not evidence however that the home had sought the missing information. Assessments should be fully completed where possible, as this forms the basis for the persons care plan so that staff know how to support them. Care Homes for Older People Page 13 of 31 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. Staff have most of the information they need, to know how to support individuals to meet their needs and ensure their well being. Evidence: We looked at the records of four of the people living there. These included a care plan. These show staff how to support the individual to meet their needs and achieve their goals. One persons care plan was comprehensive and showed staff how to support them to meet their individual needs. Staff spoken to were aware of how to meet the persons needs. One persons care plans needed to be updated, as they had recently had a change to their insulin medication. Records showed that the right dosage was being given but the care plan had not been updated. However, the evaluation record had but this was not at the front of the care plan, which could cause some confusion for staff. The people living there are from different cultural backgrounds. The home has culturally specific services to ensure that the needs of people from either a European, African, Caribbean or an Asian background can be met in a sensitive and appropriate Care Homes for Older People Page 14 of 31 Evidence: way. One persons care plan did not state how their skin needed to be cared for. However, there was a lot of information in the assessment by the social worker about what creams the person needed to use but this had not been transferred to their care plan. This could result in the person not receiving the support they need. During the feedback the manager and director stated that the care plans did not contain all the information needed because they were still getting to know people and some information they had been given was conflicting. The records we sampled showed the inconsistencies and would be confusing for staff to know what the persons current needs were. The director told us that staff would not have all the conflicting information but the care plans, which stated the persons current needs. The director and a nurse stated that one person was at risk of isolation but the person did not have a care plan as to how staff could support this person to reduce this risk. This could result in their needs not being met. Following our visit the director stated that this had been put in place. People had been weighed when they moved into the home and their Body Mass Index (BMI) had been calculated. This helps staff to know whether or not the person needs to lose or gain weight to ensure their health needs are met. Staff support people to attend health appointments when needed and records of these are kept. The GP visits regularly and peoples medication is being reviewed to ensure it meets their health needs. A nurse told us that they had requested that the GP visit one person to assess them, as they were concerned about the person swallowing their tablets. This shows that action is taken where needed to ensure that peoples health needs are being met. Care staff spoken with said they had not had training in diabetes but knew something about it from their family experience. All staff should have training in this so they know what signs to look for, if a persons diabetes is causing them to be unwell. The manager told us after our visit that this training is being given to care staff. Medication was stored securely in the unit where people lived. Nurses give medication to the people living there. One senior care staff has received training in medication but does not yet give it. The manager said this may be changed in the future when senior care staff who have received training may give medication to people who do not require nursing care. As people have moved in at different times and have medication Care Homes for Older People Page 15 of 31 Evidence: from their previous homes it is not possible for everyone to be on the same cycle of their medication record. This is being worked on and one pharmacy is now being used. Medication records looked at had been signed appropriately indicating that medication had been given as prescribed, so helping to meet peoples health needs. One persons medication was in a box and it was not clear when staff had started giving this medication. It would make it clearer if staff had written this on the box so it is clear that it is being given as prescribed. When people had moved into the home the nurses had not signed the medication records to show that the medication had been received. This would help when auditing to ensure medication is being given to each person as required. People had individual styles of hair and dress and these were appropriate to their age, gender and cultural background. One person had a comprehensive care plan as to how they should be assisted with their personal hygiene that included their cultural needs. Their plan stated that they needed to use a prescribed shampoo twice weekly in the shower but it was only recorded that they had a shower once. One person did not have a care plan for personal hygiene. There was no record of this person having had a bath or shower, although one staff said they had helped them to have a shower a few times. One person said that they only have a shower here but would like to have a bath. We saw in the ground floor bathroom that hoists, wheelchairs and shower chairs were stored so it would be difficult to use the bath. The director said that this bath had been used. The manager said that staff were writing a daily routine for each person so it would be more person centred and would be clear what individuals preferences about their personal hygiene are. Care Homes for Older People Page 16 of 31 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. Arrangements do not always ensure that people experience a meaningful lifestyle and enjoy their meals, which could impact on their well being. Evidence: The manager said that activity workers specifically for this home had not yet been recruited. However, there are two activity workers at one of the organisations other homes next door and they work with the people living at this home. One activity worker was observed sitting with a person playing a memory game, which they seemed to be enjoying. One person told the expert she had been asked if she would like to do things by the coordinator but was happy to sit and just consider life, not interested in games and things like that. The manager said that outside entertainers had not yet started visiting the home. This would be available in the future when they got to know more about what entertainment people would like. They said that they were doing in house activities with people like hand massage, jigsaw puzzles and games. Staff and people living there told the expert that arrangements have been made for two local clergy to hold regular services in the home and other denominations are to be approached. Some people are collected on Sundays by volunteers who take them to their various Care Homes for Older People Page 17 of 31 Evidence: churches. It was noted that some people living there are of other religious backgrounds to Christian. These will need to be considered to ensure individuals religious needs are met. The expert spoke to people who choose to spend time in their bedrooms. One person was doing a word search puzzle. She told the expert she likes to do one every day and that this together with reading her bible every day helps keep me memory going better. She also watches the TV in her room. One person said, I dont know what activities are on offer here, I like to sit on my own and stay in my room apart from meal times. I read mainly and sometimes watch TV or look out at the canal. They had a large box of books, which were delivered by the library service. One person said they were looking forward to staff opening the French doors so they could sit in the garden. They said, I dont like television but I keep myself busy. I look after my plants, tidy my room, read my bible and listen to my tapes. On the top floor of the home there are two lounges. Although the people living there are not segregated as to their cultural background, in one lounge there were mainly people from an Asian background. A DVD that reflected their cultural background was showing on the TV. This had been set on repeat play but there did not seem to be anybody actually watching it. The owner and manager said that there are choices of DVDs in the lounge and staff had offered them but people like to watch the same one. They also said that people had stated that they want it on in the background but may not be watching it. The manager said that they had spent time talking to the people who sit in that particular lounge and they had told him these things. This had not been recorded. It is recommended that these discussions are documented to show that this is how people choose to spend their time. Records sampled included a social interaction assessment. This contained some useful information about the person, their likes and interests and their relationships with others. However, for some people this information had not been transferred into their care plan so that staff would not know how to support them. At the end of the assessment a score was given but there was not a key to indicate what this related to so the purpose of this score was not clear. Records sampled showed and people said that they are supported to keep in contact with their family and friends. Some people had chosen to move to this home so they could be with their friends who they used to live with at the previous home. People were given opportunities to visit their friends in different parts of the home and spend time with them. Care Homes for Older People Page 18 of 31 Evidence: People told the expert they were happy with the choice and variety of food. One person said, Very good choice, more than where I was before and well cooked. Other people said, The food is alright, it is not the same food all the time, we have different things. Lovely food and they ask what you want, can have bacon, sausage and eggs for breakfast every day. On the whole its good. If theres something I dont like I tell them and they put it right. I dont like how they do the fish but I just choose something else. On the top floor lounge we observed that people had a meal that was appropriate to their cultural background. People said it was nice. People had to wait thirty minutes from the time they sat at the table until their meal was served. One person said, It is a long time waiting, no good. One member of staff spoken to later said when they are on duty they take the meal for the people sitting in that lounge out of the trolley and serve it when other meals are served. The operations manager said that they would ensure another trolley was used to improve this. The director said that this was not normal practice for it to take so long for people to be served. The expert said the dining room was pleasantly decorated, with small tables, linen cloths, matching crockery, cutlery and glasses. A notice on the dining room door listed protected meal times when visitors are discouraged in order to provide dignity and respect to the people living there. There were no written menus displayed in the home and a white board in the dining room made no reference to meals or food, which could mean that people do not know what the choice of meals are. The expert ate lunch with the people living on the ground floor. The expert said, There were six main meal options for lunch. These were culturally appropriate and included European, Caribbean and Asian options. Staff started to seat the 20 residents in the dining room at 12 oclock. The first meal was served at 12:35 pm but it was 13:10 before the last diner was served. The food was hot and well presented. Most people did not need assistance but when giving them their meal staff addressed each person by name, confirmed what they were having, checked if everything was okay and made remarks such as enjoy your meal. Three residents needed minimal help to cut food and where more help was needed it was given in a sensitive manner on a one to one basis from a carer sitting alongside. The person who was given her lunch first was not offered any assistance other than having a spoon put in her hand. She made no effort to eat and did not seem to understand what to do. When all the meals were served I pointed this out to the senior carer who then asked the carer who had returned from helping a person who ate in her room to assist. The carer did this but did not check whether the meal was still hot. The manager said that they tried to encourage this person to be independent in eating their meals. However, people Care Homes for Older People Page 19 of 31 Evidence: should still be given an opportunity to have their meals hot, if that is what they like. Care Homes for Older People Page 20 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there can be listened to and they are safeguarded from harm. Evidence: The home has a compliments and complaints procedure that was stated in the service user guide. This states who to report these to and how to do this. It gives details of who to contact, including our contact details. Cards are available that people can write their views down on and put them in a box in the reception area. This helps people who do not want to discuss these verbally to make their views known. The home has not received any complaints and we have not received any complaints about the service provided there. A letter of compliment was received on the day we visited thanking a nurse for the interest and kindness they had given to the relatives of a prospective service user. Staff have received training in safeguarding vulnerable adults from abuse. Staff spoken to demonstrated that they knew how to report abuse and how to safeguard the people living there. There have been no safeguarding referrals made since the home opened. Care Homes for Older People Page 21 of 31 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 homely, comfortable and clean home that meets their individual needs. Evidence: The home is purpose built and is fully accessible to people who have mobility difficulties. The home was clean and well decorated and furnished. People had been given the opportunity to bring with them some pictures from the homes they used to live in so to make the home more homely and appropriate to their cultural background and individual tastes. All bedrooms have an en suite level access shower room that is easy for people to get in and out of. Each person has been risk assessed to see whether it would be safe for them to have their own key to their bedroom. Where they have been assessed as safe these have been provided. People had brought some of their personal possessions with them and bedrooms seen were personalised according to individuals tastes and cultural backgrounds. The middle floor was not yet open. This floor will accommodate people who have dementia. Signage was on the doors to make it easier for people to find their way around. The director said that rooms are of different shapes and sizes and a range of six different colours. This is to help people to find their own bedroom. Care Homes for Older People Page 22 of 31 Evidence: The manager said that all beds have been provided that are specially adapted so that they can move, helping staff to be able to support people to move safely. They also have special mattresses to reduce pressure on peoples skin. The manager said that some people wanted to bring their own three quarter beds but this would make it difficult to move people safely. The director said that they had suggested to people that they try the beds first and if they really want their own bed they can have this but only person has done this. Separate cleaning and laundry staff are employed so that care staff do not have to do these tasks, which would take them away from supporting people. The home was clean and free from offensive odours making it pleasant for people to live in. Staff have received training in infection control. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development help to ensure that the needs of the people living there can be met. Evidence: The manager was not sure how many staff had completed the National Vocational Qualification (NVQ) level 2 or above in care but thought this was about 50 of staff. After we visited the manager informed us that over 50 of staff had completed this training. Other staff were doing this and further staff were to be registered to do this. This ensures that staff have the skills and knowledge to support the people living there. The manager was continuing to recruit staff, as the middle floor of the home was not yet open. On each of the floors that are open there is a unit sister to manage that part of the home on a day to day basis. During the day on each floor there is one nurse and three care staff on each shift and during the night there is one nurse and two care staff on each floor. In addition to nurse and care staff, activity, cleaning, laundry, administration and maintenance staff are employed. Some people living there do not speak English as their first language. Some staff employed speak the first language of people so they can communicate with them. Staff said that they enjoyed working there. Staff said there were enough staff on duty Care Homes for Older People Page 24 of 31 Evidence: to be able to support the people living there. One staff said, Staffing levels are fine. The manager is very approachable. The owners are always up and about. They know all our names. The manager said that there had not yet been any staff meetings but these are planned for the future. Staff said, I have not been to a staff meeting yet but there is one this week or next week. These will help staff to know how to support individuals to meet their needs and keep updated with best practice. Three staff records were looked at. These included the required recruitment checks including evidence that a Criminal Records Bureau (CRB) check had been completed. It was not clear in one record that a robust risk assessment was completed to ensure that the staff member was suitable to work with the people living there. There was no written record that this had been done but the manager, operations manager and director said this had been discussed. They had considered the risk involved and concluded that the person was suitable. This should be written down to evidence their discussions. Staff spoken to said they had an induction when they first started working at the home. They said they have had sufficient training to help them to know how to support the people living there. The manager provided a training record that showed that staff had received training in fire safety, infection control, moving and handling, dementia awareness, safeguarding vulnerable adults, health and safety and food hygiene. A senior care worker provides training to staff using DVDs provided by a training company. This person is going on a train the trainers course to help them to provide training to staff in moving and handling. Care Homes for Older People Page 25 of 31 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. Management arrangements ensure that the health, safety and welfare of the people living there is promoted and protected, so helping to ensure their well being. Evidence: The manager is not yet registered with us but is applying to do so. The manager is a Registered Nurse and has several years of managing homes for older people. Staff said that the manager is approachable and supportive. The manager is supported by an operations manager who is the responsible individual. The manager, operations manager and one of the directors were present throughout the inspection and assisted with this. Reports were available of the operations manager visits to the home. These did not identify which staff or people living there they had spoken with. However, during feedback at the end of the inspection they said this was because they had visited often during the month and the report was a summary of all of these visits. Staff said that the operations manager and directors regularly visit the home. Observations Care Homes for Older People Page 26 of 31 Evidence: showed that the director knew the people living there and interacted well with them. Peoples money can be held securely in the home if people want this. Records sampled showed that the amount of money held for individuals is recorded and kept in a separate envelope for each person. Receipts had been given when people had deposited money in the home. No records indicated that money had yet been spent,. Records of money matched the amount in their envelope. The manager said they are setting up separate transaction records for each person to identify what money they have going in and out to ensure it is managed safely. Staff were observed supporting people to move safely using equipment provided where needed. Staff encouraged people to move as much as they could for them selves so helping them to keep mobile and reducing risks to the person and to staff. Staff have received training in moving and handling. The senior care was to receive more training in this, so they could give further training to staff. Records showed that equipment was regularly serviced by an engineer to ensure it was safe to use. Fire records showed that there have been regular fire drills so that staff and the people living there would know what to do if there was a fire. Staff have received training in fire safety. Fire equipment is regularly tested to make sure it is working. Water temperature records showed that these are checked regularly to ensure that people are not at risk of being scalded. Where the water was too hot so could have put people at risk, the temperature had been adjusted to reduce this. Care Homes for Older People Page 27 of 31 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 31 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 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 1 Consideration should be given to producing the statement of purpose and service users guide in other formats and languages to make them easier for people to understand. Assessments should be fully completed where possible, so that staff know how to support individuals to meet their needs. All care plans should show staff how to support the people living there to meet their needs and ensure their well being. All staff should have training in diabetes so they know how to meet peoples health needs. Nurses should sign on the persons medication administration record when medication is received into the home. This will help to audit that medication is being given as prescribed. Staff should date on boxed medication when they start giving it to people to ensure that medication is given as prescribed. Individual preferences as to how they like to be supported Page 29 of 31 2 3 3 7 4 5 8 9 6 9 7 10 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 with their personal hygiene should be recorded, so that staff know how to support them. 8 12 Discussions with people about what they like to do and the choices they make should be documented. This will help to ensure that peoples choices are taken into consideration. Information from social interaction assessments should be transferred to individuals care plans so that staff know how to support people to meet their social and leisure needs. Mealtime arrangements should ensure that people do not have to wait a long time to be served their meals so ensuring their well being. People should be supported appropriately at mealtimes to ensure they get the nutrition they need and their meals are served at a suitable temperature for them. Individual records should show consultation with the person as to the choice of having their own bed if they have not been assessed as needing a specially adapted bed. Written risk assessments should be in place where needed to ensure recruitment procedures are robust and staff are suitable to work with the people living there. 9 12 10 15 11 15 12 22 13 29 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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