Care Home: Claremont Residential Care Home

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What the care home does well Service users have always stated they felt well cared for. This inspection identified that they continue to be satisfied with the care and support they receive. Surveys informed us that they felt members of staff listened to them and acted on what they said. One service users told us that ` everything was very nice` another ` I like it here`. What has improved since the last inspection? The management structure of the home has changed. The registered manager who is also the provider (provider manager) had at the last key inspection recently appointed an acting manager who once registered with us will become the registered manager of the service. A deputy manager has also been appointed and although this is a new appointment there are clear indicators that the new management team have the best interest of service users at the forefront of their thinking and planning. One relative informed us that the `management of the home has improved 100%` and that they ` saw a marked improvement in their relative since they had returned home from the hospital`. Care planning and recording systems have improved immensely and although not all records contained recorded information of the action taken following formal reviews of service users , the outcomes for service users are that they are receiving more personalised care and support to meet their individual needs. Service users now receive their medication in a safe manner. The way the acting manager manages , records and administers medication has significantly improved. We had, at the last inspection serious concerns in the way the home managed and administered medication safely, as a consequence we issued requirements. Because of continued failings we also served a Statutory Notice to make sure they complied with the requirements. At the random inspection this was monitored and we found that they had complied with the numerous requirements we had issued. At this inspection they again demonstrated that better systems were in place to check and record medication entering and leaving the building. Checks were in place for monitoring medication administration and links with the dispensing pharmacist for the home have been developed including auditing procedures carried out by them Meals and mealtimes routines have been developed which means that service users now have the option of serving themselves early mornings a continental breakfast and hot drinks. Hot cooked breakfasts are also offered at a later time. The menu now incorporates a minimum of three options at mealtimes including meat, fish and vegetarian. This means service users have more choice and can have meals when they wish. The quality of some food supplies has also improved and the acting manager has put systems into place for service users to receive more home cooked foods of their choice, homemade cakes each afternoon and homemade soups. Without exception all service users told us that they enjoyed the food served.General practises of staff members and the way they conduct themselves has greatly improved. Staff retention has been good within the last twelve months, this has meant that the acting manager has been able to work with members of staff and develop their practice. Throughout the inspection we found them to be courteous and patient with service users, on hand to meet their requests and flexible in their approach to providing support as the service users required. All service users spoken to indicated that they were satisfied with the services and support provided and felt well cared for. One visitor told us that members of staff were polite and made her and visiting family made welcome. Infection control has significantly improved, the most recent infection control report following an inspection identified that the home was operating at 87% compliance at the time of the inspection. We observed that basic routines had improved and that staff were more aware of their responsibility in respect of minimising the risk of spread of infection. Recruitment and selection procedures have improved, with the provider manager now making sure she does not employ members of staff to work at the home until all required documentation has been received. The acting manager has made sure that members of staff have the opportunity of formal recorded supervision and that staff appraisals are conducted. At the time of the inspection the acting manager was in the process of assessing members of staffs competency, their ability to work and fulfil their roles and responsibilities for their employment position. Some work has commenced on improving the building. When informed that one relative told us the home looked `shabby` and another ` it looks awful` the provider and acting manager agreed. Work has commenced on some aspects of the home. A new shower room has been created and a toilet area upgraded. Some structural work has commenced in a corridor area and garden maintenance services have been employed to make sure service users have a nice, safe garden area to use when they wish. What the care home could do better: Though the manner in which medication is managed, administered and recorded has improved , good systems were not in place for the recording of prescribed creams once administered. Because the service does not have a sustained history of good practice relating to the management of medication we have on this occasion issued a requirement to make sure practice is improved and that all medication administered prescribed or otherwise including creams are recorded. This is to make sure service users are receiving their medication as prescribed. We have again repeated the requirement for the provider manager to put good quality assurance procedures in place. It is essential that the provider manager regularly assessess and monitors the quality of the services provided . Key inspection report Care homes for older people Name: Address: Claremont Residential Care Home Claremont Residential Care Home 254-256 Washway Road Sale Manchester M33 4RZ     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: Sylvia Brown     Date: 1 3 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 30 Information about the care home Name of care home: Address: Claremont Residential Care Home Claremont Residential Care Home 254-256 Washway Road Sale Manchester M33 4RZ 01619737130 01619738484 info@claremontresidentialhome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Claremont Rest Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Over 65 24 Care Homes for Older People Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service would experience adequate quality outcomes. The report was written on behalf of the Care Quality Commission therefore throughout the report the terms we and us are used. The inspection report is based on information and evidence gathered by the Care Quality Commission (CQC) since the last key inspection, which was completed on the 28th October 2009. As a consequence of a complaint raied with us we conducted a random inspection of the service in December 2009. Both inspections were unannounced which means the registered manager and staff did not know we were going. We found at the random inspection that we could not substantiate the complaints brought to our attention. We also identified as part of the inspection that some areas of Care Homes for Older People Page 5 of 30 practice within the home had improved. This Key inspection was conducted over one day and was unannounced, which means the registered manager and staff were not told that we would be visiting. We gathered information from a number of people. During the course of the site visit we were able to observe the routines of staff members as they supported service users and we sat and consulted with service users and some visitors to find out their opinions of the service. We sent out surveys to service users, relatives and members of staff. This gave them an opportunity to talk with us about their opinions on the services provided at Claremont. Comments received are included within the report. There had been one new admission to the home since we last completed a key inspection, as a consequence we looked in depth at their records and the care support they were receiving. We also gathered an overview of two service users who had lived at the home for some time and who we have previously monitored in depth. In February 2010 the registered provider manager completed a self assessment form which is called an Annual Quality Assessment Audit (AQAA) . This should tell us what the home had been doing since the last key inspection to meet and maintain the National Minimum Standards. It should also include information about their thoughts on what they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. Though the document had sufficient information overall, the registered provider manager did not complete all the sections in sufficient detail and at times information did not relate to the specific questions asked. We gathered information through general contact with the home and through their reporting procedures, which are called Notifications. The report of this inspection is a public document and should be made available for reading at the home. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? The management structure of the home has changed. The registered manager who is also the provider (provider manager) had at the last key inspection recently appointed an acting manager who once registered with us will become the registered manager of the service. A deputy manager has also been appointed and although this is a new appointment there are clear indicators that the new management team have the best interest of service users at the forefront of their thinking and planning. One relative informed us that the management of the home has improved 100 and that they saw a marked improvement in their relative since they had returned home from the hospital. Care planning and recording systems have improved immensely and although not all records contained recorded information of the action taken following formal reviews of service users , the outcomes for service users are that they are receiving more personalised care and support to meet their individual needs. Service users now receive their medication in a safe manner. The way the acting manager manages , records and administers medication has significantly improved. We had, at the last inspection serious concerns in the way the home managed and administered medication safely, as a consequence we issued requirements. Because of continued failings we also served a Statutory Notice to make sure they complied with the requirements. At the random inspection this was monitored and we found that they had complied with the numerous requirements we had issued. At this inspection they again demonstrated that better systems were in place to check and record medication entering and leaving the building. Checks were in place for monitoring medication administration and links with the dispensing pharmacist for the home have been developed including auditing procedures carried out by them Meals and mealtimes routines have been developed which means that service users now have the option of serving themselves early mornings a continental breakfast and hot drinks. Hot cooked breakfasts are also offered at a later time. The menu now incorporates a minimum of three options at mealtimes including meat, fish and vegetarian. This means service users have more choice and can have meals when they wish. The quality of some food supplies has also improved and the acting manager has put systems into place for service users to receive more home cooked foods of their choice, homemade cakes each afternoon and homemade soups. Without exception all service users told us that they enjoyed the food served. Care Homes for Older People Page 7 of 30 General practises of staff members and the way they conduct themselves has greatly improved. Staff retention has been good within the last twelve months, this has meant that the acting manager has been able to work with members of staff and develop their practice. Throughout the inspection we found them to be courteous and patient with service users, on hand to meet their requests and flexible in their approach to providing support as the service users required. All service users spoken to indicated that they were satisfied with the services and support provided and felt well cared for. One visitor told us that members of staff were polite and made her and visiting family made welcome. Infection control has significantly improved, the most recent infection control report following an inspection identified that the home was operating at 87 compliance at the time of the inspection. We observed that basic routines had improved and that staff were more aware of their responsibility in respect of minimising the risk of spread of infection. Recruitment and selection procedures have improved, with the provider manager now making sure she does not employ members of staff to work at the home until all required documentation has been received. The acting manager has made sure that members of staff have the opportunity of formal recorded supervision and that staff appraisals are conducted. At the time of the inspection the acting manager was in the process of assessing members of staffs competency, their ability to work and fulfil their roles and responsibilities for their employment position. Some work has commenced on improving the building. When informed that one relative told us the home looked shabby and another it looks awful the provider and acting manager agreed. Work has commenced on some aspects of the home. A new shower room has been created and a toilet area upgraded. Some structural work has commenced in a corridor area and garden maintenance services have been employed to make sure service users have a nice, safe garden area to use when they wish. 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 8 of 30 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have their needs assessed before moving into the home. This means the registered manager can make sure the home can meet the needs of the service user before they are accommodated. Prospective service users do not always receive sufficient information about the home or have an agreed contract in place. This mean they may not always know what services are to be provided or the cost of the service. Evidence: We case tracked one service user who had been admitted to the home since the last inspection. We were informed by a family member that they had been able to visit the home in the evening when managers were not in attendance. They stated they were made to feel welcome by a member of staff and were shown several vacant bedrooms and general living areas within the home. Care Homes for Older People Page 11 of 30 Evidence: They confirmed that someone from the home had been to visit their relative in hospital to assess their care needs. They told us that though there was some difficulty in the service user settling into the home, they were satisfied with the support provided. Pre admission records were completed by the home and the acting manager had completed an assessment of the service users needs. The acting manager told us that the recording of any pre admission visits have yet to be developed as have letters to prospective service users and where appropriate their relative to confirm that after assessment the home is able to meet their needs. Though the service user had been been accommodated for more than six weeks, no contract temporary or otherwise had been completed. Records did not detail if a key worker had been assigned to the service user or of any process taken to admit the service user and support them to settle into the home, meet other service users or be informed of the homes routines. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can expect to have their general and health care needs met. Evidence: The AQAA identified that systems for monitoring the needs of service users has improved and that individual care plans are in place for all service users. We looked at a number of care files one of which was in depth. Service users needs had been recorded by the acting manager , who had also completed risk assessments. The acting manager explained that she was aware that improvements could be made to the homes recording in care plans. She stated once the new management structure is fully effective, training and support will be provided for senior members of staff and the management on how recording systems are to be developed. The records we looked at identified that service users needs were assessed, recorded and relatively up to date. A substantial amount of statutory reviews have been carried out by the Local Authority for those service users who receive funding. It was evident from most reviews that the support service users receive has improved. Most service Care Homes for Older People Page 13 of 30 Evidence: users have received health care support and treatments from visiting professionals such as opticians, audiologists and chiropodists. Furthermore service users health care needs were looked after by district nurses , nutritionists, specialists nurses and Doctors. All professional visits were recorded as were advice and treatments. When we consulted with service users about the care and support they received they told us I could not ask for more, I am looked after very well and the doctor comes if I need one and they give me my medication when I need it. The manner in which service users dignity and respect is promoted has improved. We observed that members of staff were more courteous and polite with service users. We overheard a conversation between one service user and a member of staff which identified that the service users wishes and feelings were promoted and that flexible routines for providing support were in place. When we spoke with the service user later, we were told the staff are lovely. Although we have identified that most staff we observed treated service users in a respectful and dignified manner some staff still appear to disregard service users feelings and make comments about them within hearing. One service user who was becoming agitated and requested changes to the bread she received and a second drink. This was disregarded until requested by the inspector. The member of staff to whom the request was made appeared to be unhappy at the request and served the items abruptly. The member of staff stated within hearing of the service user that the the bread served was what she wanted yesterday. At this the service user became distressed and stated she did not want to cause trouble. District nurse support is provided in private as is all treatments provided to service users. The locking of service users doors is still not routine and many doors remained unlocked when we tested them.In addition two door locks were broken. Care files did indicate if service users wanted a key to their rooms and if they should remain locked or unlocked. We were told that one service user who does have comprehension has on occasions gone into others bedrooms to look around and has been known to take refreshments without permission. Best practice is to provide service users with keys to their room and a lockable cabinet on the day of their admission and furthermore to make sure service users have privacy and their rooms secure unless otherwise stated bedroom doors should be locked. The acting manager was able to demonstrate that where service users health Care Homes for Older People Page 14 of 30 Evidence: conditions were deteriorating that she took action to make sure their best interests were served. Arrangements were in place for one service users care and care package to be reviewed and discussed with a number of medical professionals involved with the service user to make sure that she was suitably placed at Claremont. Since commencing employment the acting manager has arranged for a number of service users to have medication reviews. This has led to some service users receiving unrequired medication and for some drastically reduced the amount of medication the receive. Medication administration records were looked at. We found that though systems for recording were greatly improved there remained a number of signature omissions to confirm that medication had been administered as prescribed particularly relating to the administration of prescribed creams. The acting manager personally undertakes to audit all medication coming into and out of the home. She has completed initial competence monitoring of members of staff with responsibility for medication administration and has requested additional audits to be carried out by the dispensing pharmacist for the home. The way medication is managed has improved, we saw that medication storage was better secured and kept safe. Systems for returning medication had improved which meant that large amounts of stock were no longer on the premises. One service user has been assessed as being able to administer and manage their own medication, however one service user told us they wanted to administer their own eye drops but had not been able to. When we spoke with a relative about this they confirmed that the service user was able to in their opinion continue to do this. We have advised the acting manager to give due consideration on ways to promote service users who are able, to be supported to administer all or part of their prescribed medication themselves, albeit with some support. At the time of the inspection there were no service users on controlled drugs. We have advised the registered and acting manager that the manner in which district nurse supplies are managed particularly in service users rooms should be improved. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can expect to be treated as an individual. The home does not always support service users to follow their chosen interests and hobbies. There is minimal meaningful daytime occupation for service users. Evidence: Periodically service users are able to gather together as a group with the manager ,to talk through issues at the home, make suggestions for change and be involved in the development and running of the home. It was clear that service users were asked their views and that they were given some information about the changes within the home which were to be made. Service users surveys stated that they were kept informed and felt in the main listened to. The home has a two weekly activities programme which identified various activities taking place at the home. The registered provider manager provides service users with outside musical entertainment and private physiotherapy fortnightly. Each Monday the activities programme identified hairdressing took place. We observed this and found that whilst the hairdressing service did support service users to look and feel nice Care Homes for Older People Page 16 of 30 Evidence: there was little done to make it an enjoyable experience. We observed four service users asleep or dozing with rollers in their hair, whilst others were waiting their turn for the service. There was no allocated member of staff to oversee the service users or provide them with some stimulation. There was no music, radio or television playing, no form of conversation, no magazines to read and no drinks were served as part of the service. Because there appeared to be no allocated care worker to oversee hairdressing services we observed that the hairdresser transferred service users when required. The activities programme stated that each morning newspapers, magazines , coffee and biscuits were served. We observed only those service user who had ordered newspapers and magazines received them. There were no communal papers delivered to the home and no member of staff designated to support service users to read them or have them read to them. Morning tea and coffee are routinely serviced as part of the overall service and is not seen as an activity. When we spoke with visitors and relatives all stated that in their opinion the provision of activities was lacking. They stated more could be done for them(service users) and it seem very boring just sitting there. Both the provider manager and acting manager stated that they were aware that significant changes are required in the way activities are provided at the home and gave assurances that within the next three months action would be taken to make sure each service user receives support to socialise as they individually desire, that meaningful daytime activities will be provided for those that wish to join in and that external trips to local venues will be increased. We were informed that the home was currently advertising for someone to visit the home to provide activities. Since we last inspection improvements have been and continue to be made in relation to food, mealtimes and meals served. Without exception service users commented positively on the food served. The home relies less on pre packed or prepared food and has introduced more home baked goods. The cook informed us that fresh cakes and buns are made daily and soups served are homemade. We have monitored the food quality and found that it has also improved. Better quality bread is now served for service users enjoyment. The cook informed us that fresh bread and milk is not delivered daily and that bread is still frozen. We have suggested to the provider manager and acting manager that consideration should be given to having a variety of bread delivered daily to further improve service users choice and quality of food they receive. One service user was adamant that they wanted a specific type of bread which was currently not served at the home. Whilst it is recognised that some of the Care Homes for Older People Page 17 of 30 Evidence: service users requests and dissatisfactions with the service may be associated with their mental health and new admission to the home, it may reduce their anxiety and bring them pleasure to receive the bread they are requesting. To make sure service users independence is promoted and that all service users can have breakfast when they choose, a continental breakfast station is set up early morning to support service users to serve themselves and eat when they wish. Fresh fruit is also provided at this time and hot and cold drinks and juices. Hot breakfast items are available from 8:30am. At the time of the inspection a change to the times of meals was being trialled. The main meal of the day was being served at 4pm with a lighter meal served mid day. The acting manager stated she was aware that this was not suitable for all service users and that consideration was being given to how all service users could receive the meals of their choice when they wished. The menu has greatly improved since we last conducted a key inspection. Service users are offered a full menu with three food options for their main and lunchtime meal. This includes meat, fish and vegetarian options. During the course of the inspection the cook informed us that the same tea time meal was requested by all service users, the acting manager identified that the next days lunchtime meal was the same for all service users and was not being prepared how she required. The acting manager stated she was in the process of evaluating kitchen staff, their competency, flexibility and attitude towards service users and that it is envisioned that an additional cook will be joining the kitchen team in a effort to bring about new practises which are maintained to the required standard. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are produced from abuse by members of staff who are trained in the protection of vulnerable adults and who know they action to take should a suspicion of or allegation of abuse be made. Evidence: During the course of the inspection we had the opportunity of sitting with and consulting with service users and visitors to the home. When we asked them about the services provided they told us that they had seen a vast improvement since the acting manager took up her position. One service user said shes (the acting manager) lovely, she sorts everything out...she will tell staff if they are doing anything wrong. A visitor stated that whilst she is aware that many areas of the home could do with improving she was satisfied with the direct care and attention her relative received. Another said that my relative has improved greatly since returning from hospital. there is no cause for complaint. The homes complaints record had no complaints recorded since we last inspected. The provider manager told us that they had not received any formal complaints. From conversations with two service users regarding mealtimes we are aware that they have informed the acting manager of their dissatisfactions and although alternative arrangements have been put into place they were not recorded. A discussion was held with the provider and acting manager to clarify their Care Homes for Older People Page 19 of 30 Evidence: understanding of complaints formal or otherwise. It became apparent that the provider manager has yet to develop the recording of general day to day complaints received from service users and what they do about it. The provider manager and acting manager informed us that the Local Authority had been to the home to investigate a complaint . We found this was not recorded in the complaints log, however we were given detailed information of the actions taken by the provider and acting manager in response to that complaint. We have since the last key inspection, conducted a random inspection in response to a complaint. At that time we found that whilst there remained areas for improved practice, many areas aspects of the service had significantly improved since the previous inspection. Service user surveys confirmed that they knew how to make complaints and had confidence that their complaints would be taken seriously. When asked if they felt safe within the home service users told us they did. They told us they had someone they could talk to if they had any concerns which included members of staff or the acting manager. Training records identified that protection of vulnerable adults continues and that the acting manager has planned training in place for herself . This will make sure she knows of her role and responsibilities and the procedures to be followed as a manager should an allegation of abuse be made. We spoke with one member of staff about protection issues. They knew of their responsibility for protecting service users and how to report any suspicions of abuse. Staffing surveys returned identified that members of had received some training in the protection of vulnerable adults. There have been no allegations of abuse made at the service since we last inspected. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users continue to live in a home which offers them comfort and safety but still requires upgrading. Evidence: Most parts of the home were looked at during the site visit. All areas used by service users were nicely decorated and generally service users had pleasant and bright places to sit. Lounges continue to be light and airy with ample artificial and natural lighting. Service users were happy with their surroundings and continue to comment positively about their preferred seating areas and personal spaces. We have consulted with the provider and acting manager about improving communal areas through the provision of seat cushions for service users comfort when napping in lounge chairs, foot stools, ornaments and appropriate sized pictures all of which should make the home more homely and inviting Though there were no odours many of the carpets within the home showed signs of staining and some appeared dirty particular the lift area,inside the lift, corridors and some rooms. When we looked in some bedrooms we found them personalised to varying degrees by service users. It was clearly evident that service users are encourage to have their rooms as they desire which includes bringing in items from their own home if they Care Homes for Older People Page 21 of 30 Evidence: wish. Some bedrooms showed signs of ageing and redecoration would be beneficial as it would in some communal areas of the home. Some bedroom doors did not have appropriate locking devices, though the provider manager told us plans would be put into place to rectify the matter as soon as possible. We again met with one service user in their room and found that they continued to be satisfied with they way they were supported and of how their room was kept nice. Service users were seen moving around the home as they wished, going from lounge to lounge and to and from their bedroom areas. Bathroom area need some personalisation and arrangements need to be made to store products used by care staff away from view. A new showering facility has been put on the first floor and the upgrading of a toilet area on the ground floor was almost complete at the time of the inspection. Significant work has been undertaken to improve infection control within the home. A previous infection control audit identified that there were serious failings, however the most recent inspection identified that the home was 87 compliant with standards. The inspector concluded the care home has provided evidence of improvement and has attempted to action most of the action plans identified in the previous inspection report towards addressing the areas of partial or non compliance The report does indicate that some additional work is required for full compliance. The provider and acting manager gave assurances this would be completed within the timescales set. Externally the home looks uncared for and shabby. The provider manager explained that new signs are in place to replace the old ones and that garden maintenance services have been secured. In addition to this we have advised the registered provider to give due consideration to repair and or repaint old peeling paint work to the outside of the home so that service users may feel they live in a home which fits well into the local area and which they can be proud of. There is a rear garden which we found to be of a good size and pleasant place to be. We have been informed of and had it confirmed that a gardening service is contracted to make changes to the area to make sure it is safe for use. The provider manager stated once this is completed service users will have free access to the garden on fine weather days. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have appropriate support as there are enough competent staff on duty at all times. They can have confidence in the management of the home to recruited staff members correctly. Evidence: There has been one new member of staff recruited to a deputy managers position since we last inspected. On the day of the inspection the deputy manager was on duty and in day to day control of the home. We were informed that she had been at the home for approximately one week and was experienced to manage the home when the provider and acting manager were absent. We looked at the recruitment file for the deputy manager and found that improved systems were in place regarding recruitment and selection. The provider manager had made sure a full application form had been completed, relevant references and statutory checks had been received, interviews carried out before offers of employment were issued. The deputy manager has NVQ training at level 3 and has the qualifications, training and experience to hold a senior position. The provider manager has not made sure that the deputy manager had been fully inducted before she was given day to day responsibilities for managing the home. There was no job description or person specification for the position , the probationary Care Homes for Older People Page 23 of 30 Evidence: period was unclear and the deputy manager had not been issued with a contract of employment. The provider manager could not confirm that the deputy manager had received a staff handbook, had sight of policies and procedures or received the code of conduct issued by the General Social Care Council. Notwithstanding that, the deputy demonstrated a good understanding of her role and responsibilities for us, appeared efficient at providing us with information and took action appropriately to contact the provider and acting manager of our presence at the home. We again looked at the acting manager file and found that the provider manager had not took action to make sure she received a job description and person specification,a thorough induction or formalised support and supervision. The provider manager stated that she continues to provide members of staff with training and that the acting manager has systems in place to follow up if the training was completed as planned. The acting manager stated she continues with formal supervision of all levels of staff and is currently conducting staff appraisals which identified their competency and areas of development. Throughout the inspection the staff team appeared to be more professional in their conduct and presented themselves well. Most presented themselves more smartly and were courteous and polite when speaking with service users. Moving and handling techniques observed were carried out correctly and when spoken to, members of staff appeared more aware of their roles and responsibilities when caring for service users. We were given copies of the rota of hours worked. The acting manager stated that as a consequence of receiving a complaint about the lack of management at weekends, the new rota shortly to be introduced will identify that care and ancillary staff duty times have been altered to suit the needs of service users and the demands of the home. Furthermore the acting and deputy manager will be on duty some weekends as will the provider manager. The AQAA identified that all of the care staff team have completed or are working towards completing NVQ training at level 2 or above. Currently 13 of the 19 staff members have completed NVQ training , this exceeds the required level to have 50 of the workforce trained to NVQ level 2 or above. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can have confidence that the home is being led and run in their best interests Evidence: Since we last conducted a key inspection the homes management structure has developed considerably. Currently there is a provider manager who is registered with us but who does not have the appropriate qualification or leadership style to manager the home affectively. There is an acting manager who is primarily running the home currently and taking the lead for developing all aspects of the service. She is in the process of submitting and application to become the registered manager and will take on that responsibility fully once she has successfully completed the registration process with us. The provider manager has also recruited a deputy manager to support the running of the home. Both the acting and deputy manager have the appropriate qualifications , skills and experience to affectively manage the home. The acting manager has worked hard at Care Homes for Older People Page 25 of 30 Evidence: introducing many new systems including the monitoring and development of care practises of staff members. She has and continues to change routines within the home to suit the needs of service users and has started to improve recording and administration systems. The acting manager is part of and included on the staffing rota. We advise that should she be registered with us as a manager she works supernumerary to the staffing rota. This should mean she has sufficient time and opportunity to make sure new and improved routines are maintained to the required standard and that the development of the service continues for the befit of service users. Though there are still areas for development within the home, there has been a clear change in how the home and staff team operate. Service users best interests have become the focal point of most practises and of the overall running of the service. Since the acting manager has commenced employment she has held three service user meetings in order to seek their views and many aspects of the service. She has confirmed that service user meetings will take place more routinely now a full management structure has been implemented at the home. The provider manager has not completed an annual quality assurance which complies with the required standards or produced a public report on the service. Service users have arrangements in place for managing their own finances. The home does not manage service users finances unless it has been assessed that it is in the service users best interest for them to do so. Staffing records confirmed that staff receive formal supervision which is carried out by the acting manager. Team meetings are arranged periodically to give members of staff the opportunity to receive information, share their thoughts on the home and receive up to date information. We looked at a sample of servicing records for equipment and facilities and can confirm that we found they corresponded with the information given to us within the AQAA. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 9 13 All prescribed medication should be signed for at the time of administration This is to confirm that the prescribed medication has been administered as directed and taken by the service user. 12/05/2010 2 33 24 The registered provider must have appropriate systems in place for gathering, recording and evaluating accurate information about the quality and safety, treatment and support the service provides and its outcomes. This is to make sure that service users benefit from safe quality treatment and support 15/12/2010 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Prospective service users or others acting on their behalf should receive information about the home and services before any decisions are made about accommodation. This is to make sure service users can make informed choices and decisions about their future. Prospective service users or others acting on their behalf, who pay the provider for the services to be received should know how much they are expected to pay, when and how to pay and know what services will be provided for the fee paid. Service users should be treated with dignity and respect at all times. Service users should find the lifestyle experienced in the home matches their expectations, preferences and satisfies their social, cultural and recreational interests. All complaints received at the home verbal or otherwise should be recorded in detail. Service users should have direct access to safe and secure garden areas which contain comfortable and appropriate seating for use when required. Service users should be able to lock their rooms securely if they desire. All newly employed members of staff should receive the appropriate and relevant information appertaining to their employment,support , supervision and induction. 2 2 3 4 10 12 5 6 16 19 7 8 24 30 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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