Care Home: Clarence Care Home

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What the care home does well People who are accepted for care from the community have a pre-assessment provided for them. This is to ensure that the staff will be able to meet their needs. People are provided with the care support that they need. Staff are trained and new staff will only start work when the required checks have been carried out including a satisfactory Criminal Records Bureau and or Vulnerable Adults check. People who spoke with the inspector said that they were encouraged to do whatever they could and were able to make choices for themself and included in any plans about them. Comments on care included: `I am happy with everything and I have no issues.` Relatives comments included: `I find the staff and manager very helpful they are always friendly. We are always made to feel welcome no matter what time of the day`. People who spoke with us felt that their care needs, privacy and dignity needs were met by the staff from this home. There is a complaint procedure, which is available for people to use and procedures for staff to follow if they suspect anyone is not being properly treated. The Registered Manager is experienced and is suitably qualified to manage the care service. As part of the home`s regular monitoring of people`s views a quality assurance survey is provided as are regular meetings for people to have their say. In this way they are able to rectify and solve any issues as required and people receiving care or their representatives are able to use this method as part of their quality review of the service. What has improved since the last inspection? People are able to see a copy of the last inspection report it is kept in the hallway. Relatives were able to tell us that they have been involved in the care plans. What the care home could do better: Help from other professionals should be sought in the area of assessments for care, for consent and deprivation of liberty issues to ensure that people`s welfare needs continue to be met. There is a medication policy that provides guidance for staff to follow and they should do so.Care plans should contain information about how staff will manage people with challenging behaviour. A further review of activities provided should be considered so that everyone can benefit from some kind of activity. Key inspection report Care homes for older people Name: Address: Clarence Care Home Huthwaite Road Sutton In Ashfield Nottinghamshire NG17 2GS     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: Lesley Allison-White     Date: 2 8 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 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: Clarence Care Home Huthwaite Road Sutton In Ashfield Nottinghamshire NG17 2GS 01623558422 01623558113 clarence@mimosahealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mimosa Healthcare Group Limited Name of registered manager (if applicable) Melanie Harding Type of registration: Number of places registered: care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: No one falling within category DE(E) may be admitted into Clarence Care Home where there are 47 persons of category DE(E) already accommodated within this home. To be able to admit the named person of category DE named in variation application No. V37499 dated 30 November 2006. Date of last inspection Brief description of the care home Clarence Care Home is a purpose built two-storey home situated outside the centre of Sutton in Ashfield. It provides residential care for up to 47 service users with Dementia. All bedrooms are single with en suite facilities and the home has four lounges and dining rooms available. There is an enclosed garden to the rear and plenty of car parking spaces to the side of the building. Fees range between £418.00 and £521.00 as at April 2010 this information was Care Homes for Older People Page 4 of 31 Over 65 47 0 Brief description of the care home obtained from the manager at the time of writing the report. Service users are expected to pay extra for Hairdressing and Chiropody. Copies of the latest Care Quality Commission report are available from the manager at the home when not on display. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is an over view of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is on outcomes for people using the service and their views on the service provided. The last key inspection report for this service was on 27 April 2007. Prior to the visit an analysis of the care home was undertaken from information gathered including information from the Annual Quality Assurance Assessment (AQAA) completed by the provider. Surveys were not sent out as they had been sent out earlier this year for the Annual Service Review. Care Homes for Older People Page 6 of 31 The evidence and judgements that are made are made on behalf of the commission and are written as we although there was one inspector at inspection. The site visit lasted seven hours and the main method of inspection used was case tracking which involved looking at the records of two people in detail and tracking the care they received through the checking of their records and discussing this with them where possible. As this home has many people with communication difficulties judgements about the quality of service is made through observation, case tracking and talking with relatives also. There were thirty people at the care home plus one person who had been admitted to hospital. We spoke with three other people who either received care or were relatives of people who receive care from Clarence Care Home. A discussion with the manager and staff took place during the inspection process. The current Registration certificate and the Employers liability certificate were seen and found to be correct. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Help from other professionals should be sought in the area of assessments for care, for consent and deprivation of liberty issues to ensure that peoples welfare needs continue to be met. There is a medication policy that provides guidance for staff to follow and they should do so. Care Homes for Older People Page 8 of 31 Care plans should contain information about how staff will manage people with challenging behaviour. A further review of activities provided should be considered so that everyone can benefit from some kind of activity. 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 the information they need about the home, have a written contract and their needs are fully assessed. Evidence: There are two sets of doors on entering the building. The internal door to the home is entered by key pad access. During the daytime the administrator or a staff member will open the door from the reception desk area. The managers office is found at the entrance to the building. In the hallway on display is the Statement of Purpose, the Welcome booklet and a copy of the most recent inspection report by the Commission. The Statement of Purpose is available in large print, in braille and on a compact disc for people who would prefer to listen to information about the home. Care Homes for Older People Page 11 of 31 Evidence: Two people were case tracked. We saw copies of a pre-assessment by social services (care management) that included an assessment of needs a further assessment was completed by the Registered Manager. This included looking at communication, vision, hearing, respiratory, sleeping, personal care, Mobility, elimination, skin integrity, nutrition, risk assessment to include safety, social environment, Equipment required and dependency level. The persons emotional and social needs, likes and dislikes was also mentioned. Case tracking confirmed good practise. The Registered Manager visited prospective people either in hospital or in their homes and carried out an initial assessment of their care needs. The relatives of people we spoke with were aware of having a copy of their Service User Guide known as the Welcome booklet and Statement Of Purpose (information about the care home) and told us that they were invited to visit the home before they made a decision to accept a place for their relative at the home. We saw copies of their contracts and terms and conditions of stay on each persons record. We saw that a copy of the fees paid was clearly stated. Surveys were sent out and used in the Annual Service Review. Displayed in the foyer is a copy of the relevant certificates, a copy of the menus over a four week period and a copy of the current inspection report. An activities planner is found in another corridor of the home as are thank you cards and acknowledgements. Customer survey forms are found in the reception area for family, visitors and friends to complete. People told us: The staff were welcoming and put them at their ease. Comments from relatives included: When we visited we thought that it was a pleasant home and the staff were friendly. Intermediate care is not offered by the home. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social needs are set out in their plans of care however further advice should be sought from other health care professionals to ensure the continued and changing needs are being met. A review of the checking systems within the administration of medications is required to ensure the continued safety for people at the home. Evidence: Each person has a care plan. People who were able to said that they were aware of their care plan and had contributed to it. A relative also told us:We are included in the planning of care. Assessments within the care plan includes: Moving and Handling, falls, Nutrition and weight, a brief assessment of the persons cognitive ability, information about their social history, emotional and social needs, likes and dislikes. A brief summary of the persons history and life style before they came into the home is also included. In this way staff are provided with back ground information of the person they will care for. Care Homes for Older People Page 13 of 31 Evidence: We noticed that some risk assessments did not fully identify the needs of the individual. For example a person who walks but is unsteady on their feet, is a diabetic and on sedatives will have an increased risk of falls and skin problems and more attention should be mentioned of the need to monitor and re-assess at regular intervals and to use the skills of the District Nursing team to ensure that the assessments done at the home accurately reflect the persons risk levels. Staff at the home need to ensure that the risk assessments contain sufficient details to cover all aspects of a persons life and need to know what they should look out for so that they can minimise these risks. We saw that when people needed to see other health care professionals such as the doctor, the optician, the chiropodist, a specialist nurse or to attend hospital appointments, arrangements would be made and carried out. This means that people can be confident that they will receive the support they need from people who understand their needs. The Registered Manager explained that she has arranged for the doctors to visit the home on a Monday and on a Friday to ensure that people are well. She has six monthly progress and discussion meetings with the local doctors to ensure that the needs of the people at the home are met. We saw that beds were provided by the District nursing team where a specialised mattress and bed was needed. We saw receipts for a specialised chair that someone had been encouraged to purchase for their room. We were told that a National Health Service bed has now also been provided for their use. We are also aware that people who do not have families have funds and that important financial decisions do not always involve the local authority for the purchase of equipment such as beds, wheelchairs or private arm chairs. It is important for the Registered Manager of the home to seek advice each time peoples money is used in this way to ensure fair practise and proper protection of peoples funds. We spoke with the Registered Manager about this she provided us with contact details of the local authority who have been involved in some of the transactions of peoples funds at the home. We are waiting for further information from them. We spoke with the manager at the home about purchasing decisions and explained that all avenues should be explored before expecting people to fund their own equipment. We looked at the medicines for three people. Photographs of each person was seen at the beginning of the individuals medicine record this is good practise as it will help staff to identify the person who is to receive the medicine prescribed. Care Homes for Older People Page 14 of 31 Evidence: We noticed that allergies were not recorded or information about people who are diabetic. It was also omitted from the front medicine sheet providing important information about the person and also absent from the typed sheet by the supplying pharmacy. One person self administered their insulin. We looked at the device and saw that it should be easy to use. We noticed that there was no mention of the person being diabetic or of other intolerances to medications as identified in the care plan. This could have a poor impact on the individual if staff are not aware of any allergies or needs relating to the persons diabetes. When someone went on leave or were in hospital, staff did not use the correct recording abbreviation of L = holiday but put a dash in the box instead. This could cause confusion although they were not in the building and the risk of error would be reduced. There is a medication policy for staff to follow however there is a need for improvement in this area of care. We spoke with staff who were aware of the need to treat people at the home with respect and to consider dignity when delivering personal care. Each person has their own bedroom with a toilet and face basin in them for their use. Care Homes for Older People Page 15 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. People are encouraged to maintain contact with family and friends and are provided with meals that they enjoy. However there is a need to review current practise and to consider peoples deprivation of liberty at all times. Evidence: We noticed that access to each floor is managed by the use of key pads this included a more private area found downstairs. When people visit other people on the unit access is by a further key pad. In this downstairs unit people who feel the need to wander around or are sometimes noisy are free to walk around in here or to remain in their bedrooms. It is a pleasant area. However, we discussed access with the Registered Manager and the need to re consider peoples needs with regards to their deprivation of liberty as they are not given the key pad code neither is it displayed for them to read it so that they may visit their friends on the unit. Each time a person who lives at Clarence Care Home wants to visit their friends they have to find staff and ask them for access. (This is recorded in their care records). Staff explain that by asking them they will know where this person is in the building and for safety reasons as they are at risk of falling. However, at inspection we saw that this person did not have slippers on their feet or shoes and walked around unaided wearing socks. Within the building are non carpeted floors, this could be slippery for this person when moving around Care Homes for Older People Page 16 of 31 Evidence: freely. Staff explained that they prefer to walk around in this way however, it was not seen in this persons care plan as having been assessed. We saw that at door ways there were safe (unwired) switches and plugs for people to alter as they preferred as part of a distraction to avoid wanting to leave the premises. This is an excellent idea and keeps people satisfied. Photographs of items and places are used to allow staff to engage with people at the home when they show an interest in the objects or photographs. We spoke with people at the home who receive one to one activities with the activities coordinator. During the day time once the coordinator is out with anyone receiving support the care staff are left to provide activities for people at the home. However, as there are people on the ground and first level of the building this can lead to times where there is no planned activity for the majority of people at the home. There are people with severe memory loss that would not benefit from activities in the usual way for example in groups and a more inventive way would need to be used to involve them, including one to one activities. People told us that they made friends at the home. We saw families and friends present on the day of inspection who told us that staff always made them feel welcome. The Annual Service Review used surveys done earlier this year and also confirmed this. We spoke with family members who said they were happy with the appearance of their relative when they visited. People at the home told us that they were given choices that included when to have a bath or shower, when they wanted to get up or go to bed what they wanted to do during the days. People who spoke with us told us that they chose what they wore and what to eat. We saw copies of meetings held with residents, friends, relatives and staff. In the minutes people were informed about the staff changes at the home, and people commented about the upstairs corridor carpet that has now been replaced and has eliminated the unpleasant smells that existed. People present were informed of the forth coming activities to take place and were invited to help with these events. The homes manager explained that there has been a loss of activities such as manicure and massage and gentle movement to music as the previous person that done this had been a gym instructor has left, and the change in people who live at the home has lead to family members saying that it was no longer suitable for their relative, and people at the home chose not to take part in the activity. The manager also explained that the multi sensory room was deem not to be suitable for health and safety reasons. Care Homes for Older People Page 17 of 31 Evidence: Relatives and residents requested that a director be present at the next meeting in April 2010 also. The Registered Manager explained that the meeting had taken place but that the minutes were not yet ready. We observed a lunch time meal. The menu was clearly displayed on a board on the dining room wall. The room was light and pleasant. There was a choice of two meals and sweets. We observed people being moved and handled and noticed that staff spoke with people as they did so and moved people safely from the arm chair to a wheel chair and then into the dining room. Some people were assisted to walk and two or more staff would assist them to do so safely. At lunch time the staff served the meals. Diabetic meals were plated up by the staff also. Meals were sent to the first floor in a heated food trolley and staff were seen assisting people who needed help. People were seen enjoying their meal and talking with each other, some people received assistance from the staff members present. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that their complaints are listened to and said they felt safe. However, to ensure that people remain prtotected the Registered Manager should seek advice with regards to consent issues. Evidence: The manger at the home has kept us informed of incidents that occur at the home and informs us of any identified safeguarding incidents. We saw copies of complaint records at the service and they had been dealt with satisifactorily. We have also received two complaints or concerns about care practises at the home and the local authority have investigated them. We have recently been alerted to a concern with regard to the the correct procedures for the purchase of items at the home for people who may not be able to express them self with financial matters or have no family. The Registered Manager should seek advice on this issue from the local authority, people able to advise on consent issues and advocates to ensure best interest practice prevails. We spoke with people at the home those who were able to express themselves were able to tell us that they had no concerns and would ask relatives or staff to help them if they had. We spoke with relatives who also said that they felt their relative was well cared for and they had no concerns but if they had they would raise any concerns that they may have through the senior staff at the home and knew that they would be taken seriously and acted on. A copy of the complaints procedures is displayed in the Care Homes for Older People Page 19 of 31 Evidence: entrance to the home and is also available in the Service User Guide or Welcome pack information provided by the home. Care Homes for Older People Page 20 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 homely surroundings however it is important that staff to keep the environment odour free. Evidence: On arrival the door was quickly answered. Displayed in the foyer is a copy of the relevant certificates, a copy of the menu for the week and an activities planner. A copy of the current inspection report, the employers liability insurance, acknowledgements and a copy of the latest quality assurance customer survey findings is also found in this area. The managers office is near to the entrance to the building and the administrator is seen working in the reception area of the home and is able to press a button opening the front door to visitors. The Annual Quality Assurance Assessment tells us: The home remains safe, comfortable, clean, pleasant and hygienic. It has been redecorated in many areas of the home. Soft furnishings have been replaced as have some of the carpets. They have been replaced with polysafe flooring and Kardeane laminate. Making the home safer and odour free. We observed two domestic staff employed to maintain the appearance of the home and a well appointed laundry room. The service offers help with labelling clothing to ensure people have their own clothes returned to them. The maintainance staff includes one person who is available people at the home to do small chores such as to: hang pictures, change your light bulbs do any repairs or Care Homes for Older People Page 21 of 31 Evidence: decorating as may become necessary for your comfort. We saw that the home was well maintained. A relatives comments: I am satisfied with the appearance of the home it is kept clean and the parking facilities are nice and easy. Another relative commented: We would like to see the downstairs carpet replaced. We saw two public areas. They were clean this included a bathroom and shower/toilet area and two bedrooms. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided with training to ensure that they are able to meet peoples needs however a review of the staffing levels at night may be considered. Evidence: The culture and diversity of people at this home includes a resident group who are White British and a staff group including people of various cultural and ethnic backgrounds. We looked at a copy of the staff rota. On each shift there is an attempt to have five staff morning and afternoon. Night cover comprises of three or four staff. We spoke with three people at the home who said that when they used the call system staff responded to them. They did not feel that they were kept waiting for long periods of time. They told us: we are satisfied by the care at night and praised the staff for their help and assistance at all times. We looked at the recruitment records of three staff. Appropriate checks had been made to include previous employers references and safeguarding adult protection checks. We spoke with staff members who also verified that the appropriate checks had been done and that they had had an induction when they first started at the home and where possible had been kept supernumerary. Care Homes for Older People Page 23 of 31 Evidence: Training records indicated that most staff have received training in moving and handling, fire safety, vulnerable adults, health and safety, infection control, Food hygiene and had achieved the appointed person first aid with an ongoing training programme. Six senior staff from the home had attended the basic diabetes awareness training days by Nottinghamshire County Council. Other training provided for staff included the National Vocational Qualification in care at level two and above, Dementia care, Pressure area care, handling substances within the home such as cleaning products and Challenging behaviour. The AQAA informs us that there are 13 people who need the help of 2 staff during the day and also at night and 30 people who need help to go to the toilet and 30 people with dementia. During waking hours the staffing levels is better but at night is reduced. The accident book and Regulation 37 notifications show that there have been a high number of falls at the home. The manager said that she would continue to monitor the situation and respond as necessary. The AQAA tells us: Staffing levels meet minimum standards requirement, recruitment practises are satisfactory and meet National Minimum Standards. We were told that one of the people at the home can be aggressive at times. We looked at their care plan and saw that their was no mention of how many staff should attend to this person and that they can be intimidating and some staff we were told was frightened of them. The care plan did not tell staff what to do in this situation just that this person can be aggressive and has mood swings. The action plan was incomplete and could place staff at risk when caring for this person. We spoke with staff about specific peoples care plans, fire safety, infection control measures that they followed when carrying out care, and we spoke about their induction. The staff answered the questions well. They were able to describe their role in safeguarding vulnerable adults at the home and the procedures they would take to ensure this. There have been issues relating to staff. The manager has used the notifications to alert us. She has acted promptly with their employment at the home being discontinued. Care Homes for Older People Page 24 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. People are generally safeguarded by the homes, management, accounting and financial procedures in the home. The health, safety and welfare of people and staff is promoted and protected. Evidence: Visitors are provided with the opportunity to complete survey forms sent by the organisation to them. They are also encouraged to attend the resident and visitor meetings where they can express their views about the home and become involved in activities at the home. We saw that quality assurance systems are used to inform the annual business plans. When people said at the meetings that they were unhappy about the upstairs carpet and the bad odours a review assessment was organised with the continence nurses, extra pads were provided and on monitoring the situation the flooring was changed. In this way the organisation and the management at the home are seen to be responsive to the needs of people receiving care at the home. Care Homes for Older People Page 25 of 31 Evidence: Comments included: The atmosphere of the home is welcoming and I could not wish for anything better. I find the staff and manager very helpful they are always on hand if any situation is encountered. They are always friendly. We are always made to feel welcome no matter what time of the day. Comments from someone living at the home: I am happy with everything and I have no issues. We checked the monies of two people we saw that peoples monies and valuables held in the home is kept secure with appropriate records of transactions maintained. We looked at Regulation 26 visit information about the service and saw that quality review monitoring took place each month by senior managers within the organisation. This allows both relatives, visitors and family to have their say on what could be improved at the home. We saw copies of staff and resident meetings where people were free to express their concerns and a copy of the next meeting where concerns had been addressed. In this way people can feel confident that their needs will be met and their ideas and suggestions listened to. Policies and procedures are readily accessible to staff and information within the policies is updated appropriately. They are kept in the staff room. We were told that the Health and safety records were kept up to date as were the electrical installation certificate, Portable appliance testing certificate, Hoist, passenger and goods lift certificate. Care Homes for Older People Page 26 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 27 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 1 8 13 The registered person 28/07/2010 should seek further help with assessments from other health care professionals to ensure the continued and changing needs are being met. Staff they may not have the skills to identify the hidden risks within a particular condition and therefore not anticipate specific risk factors associated with a specific condition. 2 9 13 Regular audits for the administration of medications is required. This will ensure that peoples health and safety needs are protected at all times. 28/06/2010 3 12 13 The registered person shall ensure that no one is subject to physical restraint unless it is the only means of securing the welfare of 28/07/2010 Care Homes for Older People Page 28 of 31 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 that or any other person and there are exceptional circumstances. Each person should be assessed to consider their mental capacity and their deprivation of liberty to ensure that current practise meets their individual needs and preferences with the assistance of a person qualified to do so. 4 18 12 The registered manager 28/06/2010 shall promote and make proper provision for the health and welfare of people at the home. This is to ensure that everyone living at the home receives fair and proper treatment. For example when peoples funds are spent other agencies have been involved in the decision making process. 5 27 18 Staffing levels should be 28/07/2010 reviewed to ensure that suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of people at the home. Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that both staff and people at the home are kept safe. Working in pairs at night time may prove to be safer and a better use of staff time. 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 26 It is important for staff to keep the home free from unpleasant smells at all times to ensure the dignity and welfare of people who live there. 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. © 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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