Care Home: Cleeve Lodge

What the care home does well The home stated in the Annual Quality Assurance Assessment that a new care plan document is currently in use at Cleeve Lodge. This document is evolving and being improved upon with each new admission and the identification of new care needs which require documentation. When possible the resident is involved in the writing of the care plan. Evidence from the visitors` book shows that families, friends, relatives and other visitors are encouraged to visit the home to ensure that regular contact is maintained. Relatives spoken with stated that they are able to visit the home at any time without restrictions. The home has a complaints procedure which is displayed within the entrance of the building with the details of the manager, the provider and the operations manager as well as the Commission to enable people to complain to the organization about any area of the service. The recruitment process at the home is robust to ensure that the right staff are recruited to work at the home. Staff are supported with continuing professional development in order to provide good quality care to the residents. What has improved since the last inspection? The manager told us that new care planning documentation is in place. We saw evidence of this while reviewing care plans. There is a new communication system between relatives and staff. The home has implemented new accident audit forms to ensure that appropriate risk assessment is in place in order to minimise falls. More regular supervision for staff and managers with a `hand on` approach to support staff. Staff are able to access more training and this has raised their morale. What the care home could do better: While touring the building we noted that the home was generally dusty and untidy in various places especially residents` bedrooms. We also noted that two bedrooms had unpleasant odors. We have made requirements to cover these areas in order to uphold residents` dignity and comfort. Furthermore it could be better if the kitchen has a cleaning schedule and is always kept clean to prevent cross contamination. The home must ensure that generic risk assessment includes residents bedrooms and other areas that the residents have access to. The home must ensure that adequate numbers of cleaners are employed at the home to provide a clean and comfortable environment for the residents.It is recommended that the home considers a refurbishment of the `tired` area of the home and worn carpets. The home must develope strategies for interacting with people who prefer to be in their rooms in order to maintain stimulation. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cleeve Lodge Cleeve Lodge Close Downend South Glos BS16 6AQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Grace Agu     Date: 0 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Cleeve Lodge Cleeve Lodge Close Downend South Glos BS16 6AQ 01179702273 01179566027 cleevelodge@shieldscare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Shields Care Limited care home 33 Number of places (if applicable): Under 65 Over 65 33 0 old age, not falling within any other category physical disability Additional conditions: 0 3 The maximum number of service users who can be accommodated is 33. The registered person may provide a service on the following category only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to fall within the following categories: Old age, not falling within any other category - (Code OP) Physical disability - (CodePD) maximum 3 places. Date of last inspection Brief description of the care home Cleeve Lodge opened in 1993 to provide care and accommodation for 30 older people and 3 people with disabilities aged 65 and over. The property is a listed building, dating back to the 18th Century, which has been carefully restored and maintained in keeping with the period of the house. The home is located in the residential area of Downend, South Gloucestershire, close to the border of the City of Bristol. Local shops and other community facilities are close to the home and it is within easy reach of motorway connections. The homes 30 bedrooms (3 of double size) are situated on three floors and are equipped with TVs, emergency call systems and en-suite facilities. Care Homes for Older People Page 4 of 32 Brief description of the care home There are gardens and lawns to the front and side of the property. The philosophy of the home is to promote independence in all aspects of home care life and it aims to offer the ideal environment to improve health and general wellbeing as well as opportunity to make new friends. It stated in its Service Users Guide that it encouraged all staff, residents and visitors to help to offer an environment that is nondiscriminatory, maintains peoples dignity and is respectful at all times. The home has a range of staff with various skills to cover the home 24 hours a day. Training undertaken by staff includes NVQ 2, manual Handling and medicine administration at level 2. Fees range from £417-£585 weekly Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit that was undertaken by two inspectors over nine hours to review medication and other requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. The pharmacy inspector reviewed the homes medication and her report can be found in the body of the report under Standard 9. In addition to the above, the inspection was undertaken in relation to outcome of a strategy meeting in respect of two safeguarding issues. Care Homes for Older People Page 6 of 32 We met with the manager Helen Haughton and the operations Manager Jenny Oaten. To enable us to form judgments about the quality of care provided at the home we toured the building and viewed a number of records. Four service users, three staff members and two relatives were spoken with on the day. What the care home does well: What has improved since the last inspection? What they could do better: While touring the building we noted that the home was generally dusty and untidy in various places especially residents bedrooms. We also noted that two bedrooms had unpleasant odors. We have made requirements to cover these areas in order to uphold residents dignity and comfort. Furthermore it could be better if the kitchen has a cleaning schedule and is always kept clean to prevent cross contamination. The home must ensure that generic risk assessment includes residents bedrooms and other areas that the residents have access to. The home must ensure that adequate numbers of cleaners are employed at the home to provide a clean and comfortable environment for the residents. Care Homes for Older People Page 8 of 32 It is recommended that the home considers a refurbishment of the tired area of the home and worn carpets. The home must develope strategies for interacting with people who prefer to be in their rooms in order to maintain stimulation. 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 set out 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 32 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 32 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. The process of admission is well planned with clear information to enable the prospective resident or their representatives to make decisions about the services provided at the Home. Evidence: The Homes Statement of Purpose and Service Users Guide remains in place and provides information to prospective residents in relation to services provided to enable them to make a decision about the Home. The manager stated that both documents are to be reviewed to ensure that up to date information is given to prospective residents. We expect the updated copies to be forwarded to the Care Quality Commission. Review of three care files of showed that there was Care Management assessments from the Social Services which was given to the home on contact to enable the home Care Homes for Older People Page 11 of 32 Evidence: to determine its ability to meet the prospective residents needs. One resident we spoke with stated that they were assessed before admission to the home; they were offered a trial visit and also given a contract detailing the fees to be paid and what service users can expect from the home. The home also stated in the Annual Quality Assurance Assessment that each new admission into the home is now given a simple page contract which bullet points all the required information. It includes the room to be occupied and the fee payable and is broken down as to who is to pay which element. This is accompanied by a letter stating that the home can meet the needs of the resident. Staff spoken with demonstrated that they had a good understanding of the needs of older people. Care Homes for Older People Page 12 of 32 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. The Home offers care and support to residents throughout their lives and towards the end it also protects residents by reviewing their health needs and satisfactory care planning. Systems in place mean that medicines are well looked after and the health of people in the home is protected Evidence: We reviewed three residents care files in detail. This is to ensure that plans of care addressed the needs of the residents based on the initial assessment. The care plans included information about the physical and the psychological care needs of the individuals and what actions staff should follow to assist the residents in order to meet their needs. The home stated in the AQAA that new care plan documentation is in use at Cleeve lodge. Each care plan is written by the manager and care staff and is individualized for Care Homes for Older People Page 13 of 32 Evidence: the resident. When possible, the resident is involved in the writing of the care plan and signs the relevant pages to confirm agreement of the information. We noted that a day and night record of care is in place for each resident. The AQAA told us that this document is a simple checklist which is signed off by care staff after offering assistance for the residents in the morning or evening. All the records included an assessment of the persons risk from falling. These assessments had been updated on a monthly basis by the care home. Thorough examination of care documentation evidenced that residents are well supported with their health care requirements in order to access services. There were records of when individuals have been visited by dentist, opticians district nurses and general practitioners. The AQAA stated that there are specialist links with the Continence team, Community Psychiatric nurses and Psychologists. Residents told us that care staff also spoke to them in a friendly and warm manner as they assisted them with personal care needs. The pharmacist inspector looked at the handling of medicines in the home. Several people living in the home are able to look after their own medicines and all told us they were pleased with this. We saw that staff had carried out risk assessments to check that people were safe to do so. A medication care plan is in place for each person. This helps staff to give medicines in the way the individual concerned wishes. There is also space to record whether a person can tell staff if they need particular medicines and what signs they may use if they cannot ask for their medicine. A record is also made of whether an individual is vegetarian or vegan and objects to medicines that contain animal products. This shows that staff are looking at peoples individual needs in regard to their medicines. Staff told us that they have recently changed to a new pharmacy and receive their medicines using a monthly blister pack system. Systems have been introduced so that staff can check that the correct medicines are received into the home each month. Clear procedures are available explaining the homes medication system to help staff follow safe practice. We saw staff giving some morning medicines using safe practice. We spoke to two people who told us that they were happy with how staff gave them their medicines. The pharmacy provides monthly printed medicines administration sheets. Handwritten additions made by staff had been signed, dated and checked by a second member of staff. This reduces the risk of mistakes being made and helps ensure medicines are given correctly. We looked at the previous months completed records and saw that Care Homes for Older People Page 14 of 32 Evidence: there were a small number of gaps in the records. This meant that it was not clear whether these medicines had been given. Staff must ensure that a record is made of all medicines given by staff. If a medicine is not given a reason must be recorded. Staff record the receipt of medicines and also record the amount carried over from the previous month to the new administration record. This means that all the medicines can be checked to see if they have been given as prescribed. We checked the medicines for four people living in the home and these indicated that medicines had been given as recorded. Training has been provided for staff involved with giving medicines. In addition the manager told us that she and two senior carers had attended training, provided by their pharmacy, the previous day. Suitable secure storage is available so that medicines can be kept safely. We did not see the current temperature record for the medicine fridge. Staff must ensure that temperatures are recorded daily and that these are in the safe range for medicine storage. Through observation we noted that care staff showed sensitivity and understanding of the complex needs of some of the residents living at the home. The provider invested resources on training of staff on death and dying to ensure that staff are aware of their responsibilities in terms of meeting the needs of a dying resident and at time of death. Staff demonstrated knowledge in relation to keeping information about residents confidential. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables service users to maintain contact with families, friends, advocates and the community. It also provides them with meaningful activities and choice in respect of meals. Evidence: Staff are aware of the residents wishes in regards to the times to assist with their care as far as is practicable and also their wishes for getting up and retiring to bed. The home manager told us that one of the staff members takes a lead in activities for the residents and organizes a monthly planning meeting to enable the residents to choose which activities they would participate in We saw that the residents notice board provided clear information on what regular activities were taking place within the home. Individuals living in the home stated that these activities take place on a regular daily basis. Activities provided include; card making, aromatherapy, board games and drawing, manicures, coffee mornings and a walk to the shops for able residents. Evidence of activities that had taken place in the current month was displayed in the Care Homes for Older People Page 16 of 32 Evidence: entrance lobby. The manager stated that residents who prefer to stay in their rooms are seen by the aromatherapist. While we acknowledge that this is relevant we believe that this should not replace organized activity to engage residents who prefer to remain in their rooms. We noted that the home ensures that the residents enjoy other forms of entertainment. For example the home celebrated May day with a pig roast. The manager stated that relatives and friends were invited and everyone enjoyed the day. Residents are supported to maintain links with the local community and also make social visits. Entries in the visitors book evidence that relatives visit regularly. This was evident on the day of inspection. Some residents told us that they enjoy a friendly, homely and inclusive environment and families and friends are welcome at any time. We observed residents having their meal at lunchtime. The meal was relaxed and residents were given the meals based on the choices they made after consultation on the meals available to them. Residents who were unable to feed themselves were given appropriate support; staff approached the residents in a sensitive manner and treated them with dignity and respect. Residents spoken with on the day said that they enjoyed their meal. The kitchen was found very untidy and there was no cleaning schedule in place. However, the home was inspected by the South Gloucestershire Council Environmental Services in September 2008 and was awarded a five star rating on food safety. We were concerned about the cleanliness of the kitchen in terms of food preparation and ensuring that the residents are not exposed to any form of infection. We also noted that the food store in the basement close to the laundry was very dusty too with cobwebs in different places Our concerns were taken seriously by the chef and both the kitchen and dry food store were cleaned and tidy before the inspection was completed. We have issued a requirement for the home to ensure that the kitchen environment as well as the dry food store are kept in hygienically acceptable standard at all times. We have also made a requirement for the chef to provide a cleaning schedule in the kitchen. There was a kitchen risk assessment. We discussed our concerns with the manager and the chef. The Chef told us that all staff working in the Kitchen have attended Basic Food Hygiene updates. Their Care Homes for Older People Page 17 of 32 Evidence: certificates were displayed in the kitchen area The home would contact an individuals next of kin should they need to be informed of issues, which affect the well being of a person living at the home. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are enabled to complain and are confident that the home is able to protect them from abuse. Evidence: The home has a complaint procedure, which is displayed at the entrance lobby of the building. This document contained information details of the provider, the operations manager and the home manager as well as the Commission for Social Care Inspection (now the Care Quality Commission) to enable the residents to contact the Commission if they were not satisfied with the outcome of their complaint to the organisation. The home stated in the Annual Quality Assurance Assessment (AQAA) that one complaint received within the last four months was investigated and responded to within 28 days and that the complainant was satisfied with the outcome of the investigation. Anonymous complaints forwarded to the home by the Commission were also investigated and action was taken where necessary. Residents spoken with confirmed that they would contact the manager if they had any complaint or concern. The home has a policy and procedure for the Protection of Vulnerable Adults from Abuse. Records show and it was also confirmed by the manager that two staff Care Homes for Older People Page 19 of 32 Evidence: members have recently received training update on the subject to ensure that they are aware of how to report incidences of abuse if they occur. There is a copy of the South Gloucestershire Council policy on the Protection of Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidences of abuse occur. This procedure was acted on for three incidents that happened at the home in relation to two residents care. Two of the incidents resulted in a strategy meeting chaired by South Gloucestershire Council. These incidents were satisfactorily resolved. The home has a robust recruitment procedure to ensure that suitable staff are recruited at the home. Evidence from staff files showed that recently recruited staff had Criminal Records Bureau disclosures and two references before commencement of employment at the home. The home stated in the AQAA that individual financial records are kept for any resident whom the home holds money for. Receipts are obtained for each transaction and are filed with the balance sheet within the office. This was evidenced in the two residents monies seen. Care Homes for Older People Page 20 of 32 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. The residents enjoy a pleasant, safe and homely environment however general cleanliness of the home was below standard and did not provide adequate protection to the residents. Evidence: Cleeve Lodge opened in 1993 to provide care and accommodation for 30 older people and 3 people with disabilities aged 45 and over. The property is a listed building, dating back to the 18th Century, which has been carefully restored and maintained in keeping with the period of the house. The home is located in the residential area of Downend, South Gloucestershire, close to the border of the City of Bristol. Local shops and other community facilities are close to the home and it is within easy reach of motorway connections. The homes 30 bedrooms (3 of double size) are situated on three floors and are equipped with TVs, emergency call systems and en-suite facilities. There are gardens and lawns to the front and side of the property. A tour of the building showed that the environment needs attention in terms of maintenance, carpets in some areas of the building were looking tired, though the homes standard of decoration is satisfactory and creates a comfortable environment for the residents. Care Homes for Older People Page 21 of 32 Evidence: Residents bedrooms viewed looked homely, some were untidy and gave an impression of lack of cleaning over a period of time. All the rooms seen had small items of personal possessions and memorabilia. Residents spoken with stated that they were happy with their bedrooms and felt safe at the home. Staff told us that lack of cleanliness at the home was due to lack of cleaners, this was evidenced on the day of inspection as we noted that there were no cleaners at the home on the day. The manager stated that two night staff have been helping out with cleaning on the days they were not working following the resignation of the main cleaners. Day care staff still tidy the rooms and clean the toilets as observed at the last inspection. We were concerned about what one resident told us that the bin in their room with incontinent products had not been emptied for three days. We also noted that two residents rooms had unpleasant odours. We believe that this undermined the peoples dignity. The manager also stated that when the two newly recruited cleaners start work, care staff will be relieved from cleaning and would concentrate on caring duties. We have issued a requirement for the home to ensure that there are enough cleaners at the home to keep the home in a clean and hygienic condition. The home is reminded that this is a repeated requirement and that failure to meet requirements may lead to enforcement. The homes Maintenance book was in order and appropriate action taken in relation to repairs to be carried out was recorded. There was evidence of regular hot and cold water temperature checks and other routine checks in line with the Health and Safety legislation. The kitchen was untidy with the work-top; the grill and the shelves filled with dried grease. The dry food store was also found untidy and needed attention. The chef was unable to produce a cleaning schedule and we believe that this was contributory to the lack of cleanliness in the kitchen. We discussed this situation in full under Standard 15 This situation puts the health and safety of the residents, staff and visitors at risk and must be addressed to ensure protection of all concerned. A requirement has been made for the kitchen to be deep cleaned and to ensure that the cleanliness is regularly maintained. The laundry area was found fairly clean, the laundry assistant told us that it could be better if there were two laundry assistants to ensure that the work is done properly Care Homes for Older People Page 22 of 32 Evidence: including keeping the laundry tidy and clean. Care Homes for Older People Page 23 of 32 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. The residents enjoy a good warm relationship with competent staff the homes recruitment procedure protects the residents. However it fails to provide sufficient cleaners at the home. Evidence: The homes recruitment policy contained information that offers safeguards to residents. There was evidence to show that two recently recruited staff members had satisfactory recruitment documentation to ensure that people living in the home were protected. Staffing levels were found to be satisfactory. On the day of inspection there were four care assistants from 8am to 1pm and. Four care assistants from 1pm to 5.30pm and two waking night cares from 10 pm 8am The rota also evidenced that three carers were on twilight shift from 5.30 to 10 pm. However we are concerned to note that the home had no cleaners at the home on the day of the visit. As a result of this the environment including residents bedrooms were untidy. We believe that this compromises the dignity of the residents. This concern was discussed in detail under Standard 26. Care Homes for Older People Page 24 of 32 Evidence: Staff spoken with stated that there is good team building at the home and that communication had improved since the last inspection. This had contributed to continuity of care for the residents. Staff training provided at the home include Infection Control, Medication Administration, Mental Capacity Act and Manual handling. The manager stated that on relation to Protection of Vulnerable Adult from abuse training, most staff attended this training in 2007 and that updates have been booked for May and October 2009. Records also show that two staff members attended training on Dementia and four staff have booked to attend in June, three staff have been to attend training on Death and Dying in July and September 2009. Furthermore seven staff members have achieved National Vocational Qualification (NVQ) at level 2 and four staff members have been booked to commence NVQ at level 3. The Registered manager also stated that the home recently obtained the Staff development and training bulletin from South Gloucestershire Council and that two staff were attending training on Care of the Older person, Mental Capacity Act and continence training on the day of the visit. We believe that the homes proactive approach to staff training is very fundamental to providing good quality care to the residents. This is commendable. In relation to induction training for new staff members, it was pleasing to note from the records that the home has adopted the Red Crier Training Package which is the equivalent of the Skills for Care Induction and foundation training programme to ensure that new staff are well equipped with knowledge of their responsibilities in meeting needs before working with service users in an older peoples setting. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes current leadership and management arrangement is satisfactory. Its practices offer full protection to the health and safety of residents. Evidence: On the day of inspection there was a good, friendly interactive atmosphere at the home. Residents looked well cared for and were talking to staff in an informal way. Staff and residents spoken with told us that the home is better managed since the new manager came in December. Ms Helen Haughton is the new manager for Cleeve lodge Residential Care home. Helen has a degree in education and seven years experience in the caring industry. Since joining the organization the manager has attended all the statutory training including risk assessment and health and safety. Helen stated that she has attended Mental Capacity training and is currently undertaking NVQ level 4 in care management Care Homes for Older People Page 26 of 32 Evidence: and the Registered Managers Award. Helen is yet to submit her application for registration to the Care Quality Commission. Staff members and relatives spoken with stated that the manager is good and had supported the home since she took up the position last year. Staff also told us that the manager has provided a clear sense of direction and leadership in the home, which the staff have responded well to that she had managed to pull them together to work as a team. One staff stated The manager is good , given time she will turn things round. She is getting staff and relatives involved. The home is more homely and more settled than before. In relation to health and safety measures, there was an Environmental Health Officers visit in September 08. Central heating checks on March 09. Portable appliance checks were in date. The liability insurance is current. The five yearly Electrical Safety Installation Certificate was issued in July 2006. The fire logbook was found to be up to date and well maintained and there was evidence that staff have attended regular fire drills. Accidents were recorded and risk assessments and care plans reviewed to minimize further occurrence. Statutory Notifications (Regulation 37) in relation to serious incidents at the home were received at the Commission for Social Care Inspection at the time of occurrence. We discussed our concern with the manager in relation to the numbers of accidents at the home in the past 3 months. Although most of the accidents resulted in no injuries the audits showed that three people had frequent falls in January 2009, one resulted in a fracture and another person had a bump on the head which resulted in hospital admission. The manager consulted the services of the Mobility Assessor for advice on action to be taken in order to minimize the falls. The home had a generic risk assessment in relation to various areas of the home however these need to include Staircase, dining area, kitchen, laundry, bathrooms, individual bedrooms and any other areas that residents have access to in order to prevent/minimize accidents The homes Quality Assurance systems were reviewed. The manager stated that the home assesses the quality of its services through questionnaires to residents and their relatives. The home also produces a monthly newsletter to update residents and relatives of upcoming events at the home and any information that would be of interest to them. The manager stated that she holds a clinic monthly to enable Care Homes for Older People Page 27 of 32 Evidence: residents and relatives to raise any concerns that they may have. The home has an open door policy that allows people to come in and see the management when ever they visit the home. The manager undertakes medication, environmental and accident audits regularly. Other tools used include care plan reviews from the Social Services, communication books in the bedrooms for non urgent matters. Good relationship with General Practitioner, District Nurses and other health professionals exist. In respect of service users money, we checked the financial systems for two residents and found that there was a clear written record of all transactions, with receipts available, and that the cash balance agreed with that recorded on the record sheet. Secure facilities are provided in the office for the safekeeping of money and valuables. The home has policies and procedures to include recruitment of staff, complaints, monies and valuables and activities. There was evidence, documentary and verbal, that staff at the home receive regular supervision and there is an appraisal type system in place to identify staff development. We believe that personal development plans are a key element in staff supervision to enable staff to discuss desired training. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 27 18 Ensure that there are 30/06/2008 sufficient numbers of domestic staff in line with the size of the home and the dependency level of the service users living at the home. 2 38 13 Ensure that generic risk assessment includes residents bedrooms and other areas that the residents have access to minimise accidents. 30/06/2008 Care Homes for Older People Page 29 of 32 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 12 16 Develop a strategy for interacting with the people who prefer to stay in their rooms. To ensure they are not isolated. 14/07/2009 2 26 23 Deep clean/replace identified residents rooms. To eliminate unpleasant odour. 14/07/2009 3 26 23 Provide a clean environment 30/06/2009 for the residents. To ensure residents are comfortable. 4 38 13 Ensure generic risk 14/07/2009 assessment includes the bedrooms corridors, lounges and any other areas that residents have access to. To minimize/prevent falls. Recommendations Care Homes for Older People Page 30 of 32 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 20 Consider replacing the worn carpets in the communal areas to provide a better environment for the residents. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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