Care Home: Colebrook Respite Unit

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What the care home does well Care plans are reviewed and revised at each admission to the unit in order to keep them up to date. All those people staying at the unit looked well groomed, appropriately dressed and well cared for. Observations made and discussion with staff showed us that people are cared for in a respectful manner at the unit. The unit has a medication system that safeguards the health and welfare of those people requiring medication. The unit provides appropriate stimulating activity and occupation for the people staying there. They are able to join the larger group in the day centre or be provided with this elsewhere in the unit. The unit has access to a vehicle to be able to take people out for day trips and outings to the garden centres and to local pubs for lunch. There is no evidence of regimented routines and our observations indicated that people staying at the unit have opportunities to make choices in their daily lives. The kitchen was clean, well organised and well equipped to provide meals for thosse at the unit, th eday centre and other day centres in Solihull. Complaints records looked at showed that concerns are taken seriously and addressed in a diligent manner. This should give people the confidence that their concerns wil be listened to and acted upon. Staff have undertaken training related to safeguarding in order to identify abuse and to protect residents from abuse. The unit is clean, free of offensive odours and well furnished and decorated. There is a pleasant garden with appropriate garden furniture for people to be able to enjoy any good weather. There is appropriate signage on doors to assist people with limited mental capacity to be able to locate, for example, the toilet or bathroom. There are good infection control measures in place. All staff have attended infection control training and are currently receiving instruction regarding infection control outside of hospitals that will further their knowledge and skills. All evidence in records looked at, in observations made in the unit and in discussion with the manager and staff indicated that there were sufficient staff available to meet the needs of the people staying at the unit and to maintain clean and hygenic standards. All new staff undertake induction training that is in line with `Skills for Care`. Staff have also undertaken all mandatory training related to health, safety and welfare issues and training that is relevant to meeting the needs of the people they support. Recruitment procedures and practice are sufficiently robust to safeguard using the service by minimising the risk of the employment of unsuitable people. All care staff have achieved National Vocational Level (NVQ) 2 in Care, all assistant managers have achieved NVQ Level 3 and the manager has achieved the Registered MAnagers Award and NVQ level 4. Thee qualifications show that the peopel who have achieved them have been assessed as competent in their role. The unit has a manager with the appropriate experience and qualifications and has offered stable leadership to the unit in the seven years she has been in post. The manager is supported by competent assistant managers. Any money held on behalf of people staying at the unit is kept in a secure location. Records were made for all transactions and receipts were kept for any spending. These were in good order and safeguarded the residents` financial interests. What has improved since the last inspection? An improved pre-admission assessment and a care plan format had been devised for use in the unit. These are more personal to the individual. The complaints procedure had been updated to include our current details. The unit has been repainted throughout and new carpet has been provided in bedrooms. This adds to the comfort of the surroundings for the people staying at the unit. Surveys have been provided, and returned, asking people for feedback on their stay at the unit. What the care home could do better: Although pre-admisson assessments are now carried out on all new referrals to the unit these are not reviewed on subsequent admissions. This carries the risk of new needs or changes in circumastances not being identified and being omitted from care plans. In the pre-admission assessement continence, cognition, social interests and religious and cultural needs were all included in the section headed, `Social Behaviour`. Consideration should be given to recording specific needs under their own heading. Although each care file included care plans some of the information in these required more explanation to enable care staff to meet and manage the person`s needs effectively. People using the service were wearing disposable plastic aprons, as worn by staff for protection to maintain infection control when attending to peoples` personal care needs. These looked clinical and institutional and the organisation should consider more discreet and appropriate protection for the diners. Key inspection report Care homes for older people Name: Address: Colebrook Respite Unit 291 Bosworth Drive Chelmsley Wood Solihull West Midlands B37 5DP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Beadsworth     Date: 1 4 0 7 2 0 0 9 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Colebrook Respite Unit 291 Bosworth Drive Chelmsley Wood Solihull West Midlands B37 5DP 01217706133 01217706144 colebrookdayunit@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Family Care Trust (Solihull) care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 7 Date of last inspection Brief description of the care home Colebrook Respite Centre is part of the Family Care Trust Organisation. They provide a respite service for people with dementia. Respite is usually offered for up to six weeks a year but can be extended depending on circumstances. Most residents are admitted after a planned admission programme however the unit can, after considering if needs can be met by them, provide emergency placements. All accommodation is at ground floor level and easily accessed by people with limited mobility. Two of the bedrooms have en suite facilities. The centre has an assisted bathing and an assisted shower facility. There are several communal areas that are shared with the day centre, which is also run from the same premises. People spend time in the day centre during the day if they wish and are assisted by day centre staff. Many of the people staying at the Care Homes for Older People Page 4 of 28 7 Over 65 0 Brief description of the care home unit attend the day centre between stays. The company has a minibus, which it uses to and from the day centre and for trips. The cost of a weeks stay at the respite unit has been negotiated for contracted beds with Solihull Care Trust. The manager of the Centre will give the up to date information regarding fees on request. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to Colebrook Respite Unit. As part of the inspection process the registered manager of the unit completed and returned an Annual Quality Assurance Assessment [AQAA], which is a self assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. As all the people staying at the unit for respite care have dementia it was not always possible during the visit or by providing surveys for them to complete, to be confident about their opinion of the unit and therefore we relied on observations, discussion with the manager and with the staff No visitors were sen during the inspection to obtain further comments and views of the unit. Information contained within the AQAA, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Care Homes for Older People Page 6 of 28 Three residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting or observing them, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 11:00am and 05:30pm. Care Homes for Older People Page 7 of 28 What the care home does well: Care plans are reviewed and revised at each admission to the unit in order to keep them up to date. All those people staying at the unit looked well groomed, appropriately dressed and well cared for. Observations made and discussion with staff showed us that people are cared for in a respectful manner at the unit. The unit has a medication system that safeguards the health and welfare of those people requiring medication. The unit provides appropriate stimulating activity and occupation for the people staying there. They are able to join the larger group in the day centre or be provided with this elsewhere in the unit. The unit has access to a vehicle to be able to take people out for day trips and outings to the garden centres and to local pubs for lunch. There is no evidence of regimented routines and our observations indicated that people staying at the unit have opportunities to make choices in their daily lives. The kitchen was clean, well organised and well equipped to provide meals for thosse at the unit, th eday centre and other day centres in Solihull. Complaints records looked at showed that concerns are taken seriously and addressed in a diligent manner. This should give people the confidence that their concerns wil be listened to and acted upon. Staff have undertaken training related to safeguarding in order to identify abuse and to protect residents from abuse. The unit is clean, free of offensive odours and well furnished and decorated. There is a pleasant garden with appropriate garden furniture for people to be able to enjoy any good weather. There is appropriate signage on doors to assist people with limited mental capacity to be able to locate, for example, the toilet or bathroom. There are good infection control measures in place. All staff have attended infection control training and are currently receiving instruction regarding infection control outside of hospitals that will further their knowledge and skills. All evidence in records looked at, in observations made in the unit and in discussion with the manager and staff indicated that there were sufficient staff available to meet the needs of the people staying at the unit and to maintain clean and hygenic standards. All new staff undertake induction training that is in line with Skills for Care. Staff have also undertaken all mandatory training related to health, safety and welfare issues and Care Homes for Older People Page 8 of 28 training that is relevant to meeting the needs of the people they support. Recruitment procedures and practice are sufficiently robust to safeguard using the service by minimising the risk of the employment of unsuitable people. All care staff have achieved National Vocational Level (NVQ) 2 in Care, all assistant managers have achieved NVQ Level 3 and the manager has achieved the Registered MAnagers Award and NVQ level 4. Thee qualifications show that the peopel who have achieved them have been assessed as competent in their role. The unit has a manager with the appropriate experience and qualifications and has offered stable leadership to the unit in the seven years she has been in post. The manager is supported by competent assistant managers. Any money held on behalf of people staying at the unit is kept in a secure location. Records were made for all transactions and receipts were kept for any spending. These were in good order and safeguarded the residents financial interests. What has improved since the last inspection? What they could do better: Although pre-admisson assessments are now carried out on all new referrals to the unit these are not reviewed on subsequent admissions. This carries the risk of new needs or changes in circumastances not being identified and being omitted from care plans. In the pre-admission assessement continence, cognition, social interests and religious and cultural needs were all included in the section headed, Social Behaviour. Consideration should be given to recording specific needs under their own heading. Although each care file included care plans some of the information in these required more explanation to enable care staff to meet and manage the persons needs effectively. People using the service were wearing disposable plastic aprons, as worn by staff for protection to maintain infection control when attending to peoples personal care needs. These looked clinical and institutional and the organisation should consider more discreet and appropriate protection for the diners. Care Homes for Older People Page 9 of 28 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 10 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 28 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. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met by the unit. Evidence: There were only three people staying at the home when we visited and all three were case tracked. As part of this we looked at the care files. Only two had pre-admisson assessments; the third did not have this as the person had had their first stay before the Colebrook was carrying out pre-admission assessments as a regular practice. Neither of the two assessments seen had been updated since the original stay as the unit. The manager told us that they had concentrated on updating the care plan on each visit and this was evidenced in the plans looked at. However not reviewing the assessement before updating the care plan could result in changes not being identified and therefore a care plan for this need not being devised. The original care plans were devised initially from these assessments. Care Homes for Older People Page 12 of 28 Evidence: The new pre-admission assessment format covered all the required areas of need although some were not under their own heading, for example, continence, cognition, social interests and religious and cultural needs, but were included in the Social Behaviour section of the assessment form. The unit should consider if this provides the appropriate emphasis on these needs. Care Homes for Older People Page 13 of 28 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. There are some shortfalls in some care plans details. Residents have access to health care professionals and are cared for in a respectful manner. The medication process safeguards the health and welfare of the people using the service. Evidence: All three care files included a care plan that addressed the needs of the person. These were reviewed and revised at and during each short stay visit to the Colebrook. The manager and staff had devised a new care plan format since the last inspection, which allows a more personalised care plan to be written. Each care plan looked at was sufficient to inform care staff of the needs of the person and in general how to meet them. However in some areas there needed to be further explanation. For instance, reassurance when more confused than normal about someone who has previously shown verbal and physical aggression would not give a member of staff, particularly a temporary or new member of staff, the information they would need to be able to manage the persons confusion or any consequent behaviour; encourage independence in oral hygiene but no details of care were Care Homes for Older People Page 14 of 28 Evidence: given if independence is not achieved; wears glasses but no information as to whether these were for reading or distance vision. However staff spoken with were aware of the care that needed to be provided for the people currently staying at the unit. Although the care plans had not been signed by the resident or by their representative to show their involvement in the care plan, the manager told us that they are involved as often as is practical. She explained that due to the needs of the resident and the type of placement they have at the unit it is very often impractical to involve the resident or their representative. The unit also records a daily report checklist in the morning and the evening where staff record what personal care needs have been provided or any other health care visits for each person. Daily records also record other events or concerns of the day. Records of falls, pressure areas, weight and nutrition and nutritional screening were in place within the files looked at. Completed risk assessments for tissue viability in relation to the development of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) were in place and risk assessments for moving and handling (transferring a person from one place to another) were also in place. These would help to minimise any risk in these areas. Preventative measures such as pressure relieving mattresses and cushions were available for if people at risk of developing pressure sores stayed at the unit. There is also an adjustable bed in one of the bedrooms for when it is required for a resident. The unit is able to summon assistance from a GP or any other health care professional if it is required during the clients stay there, in order to address the residents health and welfare. The people staying at the unit looked well groomed and appropriately dressed. They appeared well cared for. The medication system was inspected. Medication is brought in with person who is to stay at the unit, in original packaging as dispensed by the pharmacist. These are checked in by the person in charge and confirmation that the medication is correct is obtained from the GP. The unit had a good system of storage, administration, disposal and auditing all of which was in good order. Medication Administration Records (which Care Homes for Older People Page 15 of 28 Evidence: staff sign to show when medication has been given or to explain why it has not) were completed appropriately with no unexplained gaps or inappropriate codes used. We carried out an audit of all medications and no errors were found, indicating that the correct medication was given at the correct time. Controlled Drugs were stored and recorded correctly. The medication fridge temperature was recorded daily and was consistently within the correct temperature range to maintain the stability of the contents. The procedure and practice for medication safeguards the health and welfare of the people staying at the unit. Observation and discussion showed that people are cared for with respect and that their dignity and privacy are also respected. Each care plan referred to the need to promote independence and dignity. Care Homes for Older People Page 16 of 28 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. People using the service were occupied and stimulated. Residents had choices and control over their daily lives. Residents enjoyed the nutritious and varied meals provided. Evidence: The Respite Unit is part of the Colebrook Centre which also caters for day care clients with dementia and most of those people using the unit for respite stays also attend the day centre on a regular basis. The day care is not registered with us and therefore was not inspected. People staying at the unit joined them in their activities and pastimes but there were also one to one activities for them. The AQAA told us that activities are personalised and tailored to individuals now instead of group work. The main lounge was used for group activities with a smaller lounge and a large activity room for other activities. The programme ranged from physical exercise to cooking and music therapy. The people staying at the home were in the dining room baking when we visited and the Centre was lively and active. The unit has access to a vehicle and driver and the AQAA tells us that there are trips out to garden centres and local pubs for lunch. There are framed collages of photos hanging in the corridors showing some of the activities and outings people using the Care Homes for Older People Page 17 of 28 Evidence: service have enjoyed. There was no evidence of regimented routines during our visit and we witnessed people being offered choice in the meals, activities and going to the smoking area for a cigarette, indicating that they have a choice over their daily lives. This was further evidenced in discussion with staff. There were no visitors seen during our visit and the manager explained that although they are welcome to visit at any reasonable time, as the respite stay is also for the benefit of any carers, they tend not to visit very often during the residents respite stay. Previous inspection reports tell us that visitors are made welcome. Meals for people staying at the unit and day care clients are served in a comfortable, well furnished and spacious dining room. We joined them for lunch and people enjoyed the chicken casserole and dumplings, mixed veg, broccoli, mashed potatoes, followed by excellent chocolate muffins and custard. There were alternatives for those who did not want or like the main choice. Appropriate tableware was provided. Staff were wearing new and attractive tabards to protect their clothes and for reasons of hygiene but residents were wearing the same disposable aprons used as protective clothing by staff when safeguarding against cross infection. The unit should consider the use of less clinical and indiscreet protection for the diners clothing. The kitchen was visited and found to be well equipped, clean and organised. It also provides meals for other day centres in Solihull. Care Homes for Older People Page 18 of 28 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. The unit has appropriate procedures for managing complaints and appropriate policies, procedures and training to safeguard residents from abuse. Evidence: There have been no formal complaints to us about this service. The unit has a complaints policy, procedure and leaflets to inform people how to make a complaint. These contained our current details. A record of complaints made to the unit and how they are managed is maintained and this was available for inspection. There was only one complaint recorded since the last inspection, which had been appropriately and diligently addressed by the management but which was then found to be a mistake on the part of the complainant. Evidence seen indicates that the unit is open to hearing about concerns and that people using the service can be confident that they will be listened to. The unit has the Local Authoritys and the organisations safeguarding policy for staff to follow. All staff have undertaken safeguarding training, given by in house trainers and for managers training provided by NHS Care Trust, in order to give them the knowledge and skills they need to be able to identify abuse and what to do if they witness or suspect it. Care Homes for Older People Page 19 of 28 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. The unit offers the people staying there comfortable surroundings, which are clean, free of offensive odour, safe and well maintained. Infection control systems are in place. Evidence: There are two entrances/reception areas to the Centre. The premises are single storey and were purpose built to cater for people who need short term accommodation to enable their carers to have respite, and to provide day care services. The unit specialises in offering care for people with varying levels of dementia. We found the communal and private accommodation areas visited to be clean, free of odour and well decorated and furnished. The Centre had been repainted throughout since the previous inspection and new carpet has been provided in bedrooms. Communal areas consist of a large lounge, a smaller lounge, an activity room and a dining room. Seating in the lounges is appropriate and enables there to be social groups. All people using the service are able to access the pleasant gardens that has suitable garden furniture for people to sit outside if they wish. Day centre clients share the communal areas during the day but there are opportunities for the short term residents to use quieter areas if they wish. The large dining room caters for both client groups. Care Homes for Older People Page 20 of 28 Evidence: There is appropriate signage on doors, such as toilets and bathrooms, to advise those with mental impairment/dementia of the rooms use. Bedrooms are attractive and look comfortable and a safety alarm in each of them alert nightstaff if a person is out of bed in order to assist them if necessary and to minimise the risk of injury or falls. Bathrooms are spacious and clean and provide adequate assisted bathing for the people staying at the unit. Infection control measures are in place, including protective clothing (disposable aprons and gloves) for staff to use when assisting with personal care and appropriate hand washing facilities are available in all communal hand washing areas looked at. Staff have undertaken Infection Control training are also undertaking instruction in infection control outside of hospitals to further minimise cross infection. The laundry is equipped and organised to enable the staff to maintain infection control. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient care staff available to meet the needs of the residents but the low numbers of ancillary staff may have an impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. Evidence: During day care hours the staff work in both the unit and the day centre. The rotas showed us that there are two care staff from 07:30am, in the evening and throughout the day on Sundays when the day centre is closed to care for the people staying in the unit. Observations and discussion with staff indicated that there were sufficient staff to meet the needs of the people staying at the unit. In addition to care staff there are domestic and catering staff. A manager and/or an assistant manager is also always on duty during the day. All new staff complete induction training that is in line with Skills for Care to give them the knowledge and and basic skills to carry out their job and all care staff carried on to achieve the National Vocational Qualification (NVQ) Level 2 in Care. The NVQ qualification shows that they have been assessed as competent in their role and the unit exceeds the minimum requirement of 50 of the care staff to have achieved this. Staff have also undertaken mandatory training in health and safety issues such as, Care Homes for Older People Page 22 of 28 Evidence: moving and handling, fire safety, and basic food hygiene, which assists staff to work safel and effectively. Training related to specific needs of the people who use the service, such as dementia, is also undertaken. Three staff files were looked at to assess the recruitment procedure and practice of the unit. Each of these contained the appropriate Protection of Vulnerable Adults (POVA) First checks and the Criminal Records Bureau (CRB) disclosures, two written references and evidence that there had been a formal recruitment process of application form, interview and that a contract had been issued. All evidence showed that the risk of the employment of unsuitable people has been minimised. Care Homes for Older People Page 23 of 28 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 home is managed by a person with the appropriate experience and qualifications. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Health and safety policy, procedure and practice protects residents and staff at the home. Evidence: A person with the appropriate qualification and who has extensive management experience manages the Centre. She has achieved NVQ Level 4 and Registered Managers Award and also has a Diploma in Welfare Studies. She has worked for the organisation for eleven years and has been the registered manager of the Centre for seven years. She is also employed by the organisation as Senior Day Services Manager. This role previously meant that she was working some of her work time from the local Head Office but she is now based at the Centre again to ensure that she is able to fulfil her role. The organisation is hoping to recruit a registered manager in the near future. Care Homes for Older People Page 24 of 28 Evidence: Assistant managers support the manager and they have achieved NVQ Level 3. It was apparent in discussion with them and the manager that they are fully acquainted with the management of the unit and the care needs of the people staying there. The manager told us that the unit is using an organisation called PQASSO for their quality assurance but that they are still in the early stages of this. Questionnaires had been circulated to people at the end of their stay. We looked at six of these, which had been completed using a rating system. They showed that people rated hairdressing, chiropody and meals with a B and every other service provided with an A. The manager should demonstrate what action is being taken regarding the Brated services and what concerns, if any, there are that warrants a B for these areas. Some monies are kept for the people staying at the unit but this is up to a maximum of £20 and is kept in a secure location. As their stay is generally quite short this tends to be sufficient. All transactions are recorded, receipts kept and were in good order, maintaining the financial interests of the people staying at the unit. Supervision sessions with staff take place at the required intervals with the manager supervising assistant managers and the assistant managers supervising the other staff. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. Staff had undertaken training related to health, welfare and safety issues. The AQAA and a random check of records showed that equipment had been regularly serviced and maintained and that in-house checks on the fire system were up to date. No health and safety concerns were noted during the visit. Health and safety policy, procedure and practice makes th eunit a safe place to live and to work. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The use of identifying headings in the pre-admission assessment format for each area of need should be considered. Assessments should be reviewed at or before the point of admission for each visit to the unit. There should be more specific explanation included in care plans that adequately informs staff how to manage a persons care. The use of more appropriate protective clothing for residents at mealtimes should be considered. The organisation should appoint a manager for whom the Colebrook is their only responsibility as promptly as is possible. Auditing of thesurveys sent to users of the service should identify any concerns and any necessary action be implemented. 2 3 3 7 4 5 15 31 6 33 Care Homes for Older People Page 27 of 28 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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