Care Home: College View Care Home

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What the care home does well The home is clean, warm and welcoming. It has a friendly and homely feel and people told us they were very comfortable, which was observed during the visit. A survey received from a relative detailed `the home is small and friendly`. The home records in detail how people would like their needs to be met and their preferred routines. Observation indicated that people`s individual needs were attended to as per their care plan and that staff promoted people`s privacy and dignity. The health care needs of the people living in the home are well met. One relative wrote `Care at College View is very good, the staff are very caring and I am very satisfied`. There is a good staff training system in place, which enables staff to develop their skills and knowledge. In surveys, all staff members confirmed this, `training is very good, we are always updating and looking at new work practices`. The medication systems in the home are well managed. People who use the service generally liked the food provided and said they had plenty to eat and drink. The staff are well supported, they are provided with individual time to talk to the manager about how well they are doing, or if they need more training or support with their work. This better ensures that they can provide a good standard of care for the people who use the service. What has improved since the last inspection? Facilities at the home have been significantly upgraded and improved which includes the provision of a small extension. More single rooms with en- suite facilities have been provided and some of the communal rooms enlarged. Electrical, heating and laundry systems in the home have been upgraded. People who use the service are now provided with a more pleasant, comfortable and better maintained environment. The home has introduced specific care documentation and staff have received more training on end of life care. Staff have been provided with separate facilities on the second floor, further storage space in this area has also been created. The management now ensures that all individuals receive a copy of the home`s statements of terms and conditions. The home`s kitchen facilities and food management has been awarded a five star rating from the Environmental Health Team which is a positive achievement. What the care home could do better: The management of the home need to make sure that there are enough staff working in the care home to care for the people that live there. Where new staff are working in the home, without a full C.R.B. disclosure, systems must be in place to ensure they are appropriately supervised to ensure people who use the service are fully protected. Some people don`t feel that they have enough social things to do. The home needs to improve the choices people have about activities and provide more regular sessions to make sure people are stimulated and fulfilled. They must make sure that they address maintenance problems in the home quickly such as the key pad lock on the front door so that visitors have ease of access. Although there is evidence that the home consults with people more regularly, it is important that the suggestions they have canvassed and the management have agreed to implement, are carried out in a timely fashion. The quality monitoring systems in the home should be better maintained to ensure the service develops. The garden should to be properly maintained so it looks attractive for people living at the home and suitable garden furniture provided for people to use. Key inspection report Care homes for older people Name: Address: College View Care Home 71 Bargate Grimsby North East Lincs DN34 5BD     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: Jane Lyons     Date: 0 8 0 9 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 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) 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 31 Information about the care home Name of care home: Address: College View Care Home 71 Bargate Grimsby North East Lincs DN34 5BD 01472879337 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: collegeview@talktalk.net Mrs Katrina Peerbux care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home College View is a long established home situated in a pleasant central location of Grimsby, it is close to the local amenities of Scartho Village and local public transport. The building is Victorian in style maintaining much of the character and original features. The home is registered to take 12 persons with residential care needs, these beds are also registered for people with needs associated with dementia. The home consists of two storeys serviced by stairs and a passenger lift. The homes facilities were upgraded in 2008 and there are now ten single rooms, seven of which have en- suite facilities and one shared room with en- suite facilities. There are four single bedrooms on the ground floor. Assisted bathing and toilet facilities are provided on each floor. There are two lounges and one dining room, all of which are located on the ground floor. There is a small secluded garden at the rear of the property. Car parking space is provided at the front of the property. The home has a pleasant, homely inclusive atmosphere. Care Homes for Older People Page 4 of 31 Over 65 6 12 0 0 Brief description of the care home The home is owned Mrs K Peerbux. The manager is Mrs Michaela Turner. Weekly fees are: 367 pounds - 410 pounds. Additional charges are made for the following: toiletries, newspapersmagazines, hairdressing and chiropody. Information about the home and its services can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 8th September 2009. This inspection report is based on information received by the Care Quality Commission (CQC) from the last twelve months including information gathered during a site visit to the home which took approximately eight and a half hours. During the visit we observed peoples experiences of living at College View so that we could understand what it is like for people who live at this service. We spoke with the owner, relatives, visiting community nurses and staff members on duty on the day of the site visit, we also met most of the people who live there. Care Homes for Older People Page 6 of 31 We looked at the environment and checked maintenance records to make sure the home is safe and well maintained for the people who live there. We checked documents that relate to peoples care and safety. These included needs assessments, daily records, care plans, risk assessments and staff recruitment and training records. Before the visit the manager had completed an Annual Quality Assurance Assessment report (AQQA). This report provides information about how the service operates. We have used some of this information within the report. People who use the service were given surveys eight were returned. Relatives were given surveys and four were returned. Staff that work at the service were given surveys and three were returned. Placing social workers and health care professionals were given surveys and none were returned. Comments and views from everyone have been included in relevant parts of the report. We would like to thank the people who were staying at College View, the staff team and the management for their hospitality during the visit and also thank the people who spoke with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use the service are not being put at significant risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. 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: Care Homes for Older People Page 8 of 31 The management of the home need to make sure that there are enough staff working in the care home to care for the people that live there. Where new staff are working in the home, without a full C.R.B. disclosure, systems must be in place to ensure they are appropriately supervised to ensure people who use the service are fully protected. Some people dont feel that they have enough social things to do. The home needs to improve the choices people have about activities and provide more regular sessions to make sure people are stimulated and fulfilled. They must make sure that they address maintenance problems in the home quickly such as the key pad lock on the front door so that visitors have ease of access. Although there is evidence that the home consults with people more regularly, it is important that the suggestions they have canvassed and the management have agreed to implement, are carried out in a timely fashion. The quality monitoring systems in the home should be better maintained to ensure the service develops. The garden should to be properly maintained so it looks attractive for people living at the home and suitable garden furniture provided for people to use. 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 receive the information they need to make an informed choice about the home, they have their needs assessed prior to admission so they can be confident that the home can provide the care they need. Evidence: The owner confirmed that the Statement of Purpose and Service User Guide were in the process of being updated to detail the improvements to the facilities and recent management changes. They are also in the process of developing a website for the service. We looked at a sample of files, which belong to people who are staying at the home, and we saw that these contained a range of assessments undertaken by the home. The assessments cover all aspects of health and personal care needs. In addition to this, information is also requested from the family and health and social care professionals where possible so that the home has as much information about the Care Homes for Older People Page 11 of 31 Evidence: prospective individual prior to their admission. Wherever clients are referred through the Local Authority the home has obtained copies of relevant assessment reports and care plans. The assessment process also takes account of peoples cultural and social needs. This information is recorded and made available to carers so they have a good understanding and know how people wish to be addressed and their preferred lifestyle. A recommendation was made at the last visit to provide people who are publicly funded with a copy of the homes statement of terms and conditions, we saw evidence in peoples files that this was now in place. Staff spoken with confirmed that they were always informed of new peoples care needs and that the management communicated a clear sense of direction about the importance of using an approach that was person centred and reflected the individual needs of people living in the home. The home provides care for a number of persons with needs associated with dementia and there was good evidence from the visit that these individuals are well supported and happy at the home. One relative wrote in their survey Care at College View is very good, they are caring and do their best to help my mother enjoy the later years of her life. There was evidence to demonstrate that the care staff had accessed some service specific training courses over the last twelve months and that more courses are being arranged, this will help ensure that they have the skills to enable them to deliver up to date care methods and have a good understanding of the varied conditions common to the elderly. The home does not provide intermediate care support. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people who use the service are well met in a way that respects their privacy and dignity. The medication systems at the home are well managed ensuring the promotion of good health. Evidence: The home continues to produce and keep clear and well - written care plans for individuals which set out the health, personal and social care needs identified for each person. Detailed individualised plans have been developed from the assessments, there was good evidence that the plans have been updated when changes in need have occurred. There are risk assessments in place for mobility, tissue viability, nutrition, falls and general issues. Records show that the risk assessments are reviewed regularly and where high risk areas have been identified, care plans are in place to support appropriate care and equipment provision. The quality of the evaluation records was Care Homes for Older People Page 13 of 31 Evidence: good with evidence of formal review meetings taking place. We saw evidence that the quality of the daily recordings was improving to better describe how people have spent their day and what they have enjoyed doing, although there is still some way to go. Care plans did detail clearly the support required from staff to meet individuals needs associated with their dementia, these plans were very person centred. There was evidence that people have access to health professionals and any contact and outcomes from discussions and visits were clearly documented. During the visit we spoke to two health professionals who regularly visit the home, they told us The staff and management here are very good, they always inform us of any changes and request support at an early stage. The standards of care are very good and We are very happy with this home, our patients are well cared for and happy here, the management have dealt with some complex issues well. We saw evidence that people are weighed on a regular basis. Pressure care and continence care is reviewed on a regular basis and any equipment needed is provided, there is evidence that advice is sought from others where necessary. People spoken to confirmed where possible that they receive the medical support they need. We saw that the standards of personal care support are very good, individuals are helped to wear neat and clean clothes so they can present themselves how they want. There were some mixed opinions about the standard of communication between the staff and relatives , concerning the quality of information given about individuals in the home and if there have been any changes. Two surveys received detailed comments about improvements needed in this area, however two other surveys received expressed satisfaction with the standards of communication, as did conversations with two relatives during the visit. We passed these concerns on to the owner who confirmed that she would address the consistency of information passed on. The way medicines are handled and stored in the home keeps people safe. The staff make sure that the recording of the medication is up to date. All medications are safely stored in the office on the first floor. There was no refrigerated medication in use. Storage and administration of controlled medication was also checked and found to be satisfactory. There was evidence that the staff are proactive in ensuring that individuals medication is reviewed by the G.P. Systems are in place to support self medication, there were no individuals self- medicating at the time of the visit. All of the staff who give out medication have had the proper accredited training and we saw certificates which confirmed this. Those staff who completed the course some time ago Care Homes for Older People Page 14 of 31 Evidence: undergo competency checks from the manager which involves observation of medication rounds. There are systems in place to support end of life care at the home, the AQQA detailed We have introduced the End of Life Care Planning into the home and incorporated the principles in our care planning. We saw evidence of this in one individuals care plan, the home had consulted with the individual, their relatives and G.P. to develop a detailed support plan. The owner and manager had both attended courses on palliative care earlier in the year. 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 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 interesting things for people to do, but some people might like to do more. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: There was evidence that people could make choices about aspects of their lives and staff in discussion were clear about how they ensured people made simple choices. During the visit people were observed spending time in the garden, reading, watching T.V and two individuals enjoyed making birthday cards. The hairdresser was making her weekly visit, she clearly has a very positive rapport with many of the ladies who really enjoyed having their hair set and chatting with her. Staff appear to know the people they look after very well and understand specific behaviours shown by people. The atmosphere is relaxed, warm and friendly. Most people spoken to said they are very happy in how they spend their time, one individual told us that she would like to do a bit more. Peoples social needs are identified on assessment and plans of care are in place however these could be improved to describe more fully how people want to spend their time and what they enjoy doing. Life histories have been compiled for each individual although many of Care Homes for Older People Page 16 of 31 Evidence: these seen were very minimal and did not provide much information for staff about peoples backgrounds. At the last key inspection, two years ago a recommendation was made to review the activity programme to ensure more regular sessions were provided for individuals, which suited their needs, preferences and capacity so that the people who use the service were appropriately fulfilled and stimulated. Information gathered from the surveys and discussions with people who use the service, their relatives and from observation during the day evidenced that there had been little consistent improvements made. There is a programme which details a variety of organised events and activities such as a motivational therapist, reminiscence, games, crafts, Bingo and trips out for lunch.We looked at the records of what sort of activities have been done and who has been taking part in them, there were lots of gaps in the records. Feedback from the surveys we sent out was mixed, two people said there were always activities arranged that they could take part in and three said usually and one said sometimes. Feedback from peoples relatives was also mixed, some felt that the level of activities was generally good, whilst others told us that they felt there should be more. One relative wrote The home needs to cater to residents needs in lifestyle i.e. stimulation, entertainment and hobbies. And another wrote Individual tastes and needs are well catered for. The home does not have a dedicated activity organiser, all staff have responsibility for support in this area at present however the manager confirmed that an activity co-ordinator will be employed to work in the home for two days per week, and will be commencing this role in the near future. We think it would be a good idea for the manager to take a fresh look at the activities calendar, as part of this review it would be helpful to ask some people if there is anything new and different they would like to do and staff should be directed to document more about how people have spent their day and the one to one sessions they have. Relatives and visitors spoken with during the visit told us that they can visit at any time and that the staff are friendly and welcoming, they are always offered refreshments when they arrive at the home. Discussions and surveys from relatives identified that there is an issue with accessing and leaving the building at present as the key pad lock to the front door had been broken for some time and they have to rely on staff to let them in and out when they are free. The owner confirmed that the lock had been repaired previously but the maintenance person was scheduled to carry out further repairs this week. The meals provided looked well prepared and presented. The majority of people Care Homes for Older People Page 17 of 31 Evidence: spoken with stated they liked the food, we discussed some negative comments received from one relative with the owner, who provided evidence that the home is working with the individual concerned and their family to meet any specific dietary requests. There are cooked options available at all meals, although staff told us few people choose the cooked breakfast which had been trialled again recently. Staff were heard asking people what they would like to eat, so the meal of their choice could be catered for. The dining room is nicely set out and most people choose to have their meal there. The meal looked hot and appetising and smelt very good. Comments from people included The food is lovely and I like all the meals, the cook is very good. People are given appropriate assistance in an unhurried way, and they are provided with aids, such as special plates, to maintain their dignity and independence during mealtimes. A number of individuals are receiving fortified diets, their weights are monitored regularly and any concerns are referred to community health services for support. Menu boards in the room display the weekly choices however it was noted that the wrong one was displayed for that week. The kitchen facilities have been upgraded since the last inspection visit. The kitchen areas in the home had achieved a five star rating from the Environmental Health Department at their last inspection, this is a very positive achievement. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are happy living in the home but feel able to complain if required. There are suitable policies and practices within the home to ensure people are safeguarded from harm and abuse. Evidence: People and their representatives have been provided with a copy of the homes complaints procedure, which is also on display in the entrance hall. People spoken to during the visit, told us who they would speak to if they were unhappy about something. Visitors told us that they speak to the manager or owner if they have any issues. One relative commented in a survey that a complaints book was not available which had been promised, we discussed this with the owner , who confirmed that she would provide the comment and compliment slips as agreed at the last residents and relatives meeting. The owner and manager have recently attended courses at the local PCT in complaint management. No complaints have been made to the home or the CQC in the last twelve months. There have been no referrals made to the safeguarding team about this service. There are policies and procedures in place to reduce the risk of abuse. Staff have had training on safeguarding adults which ensures they understand their role and responsibilities in reporting any concerns or suspicions of abuse. It was clear from discussions with staff that they know what to do if there is a safeguarding issue.Staff Care Homes for Older People Page 19 of 31 Evidence: have accessed training on The Mental Capacity Act and further training on the Deprivation of Liberty Legislation is currently being arranged. Staff were observed throughout the visit listening to what people said and treating them with dignity and responding to their wishes. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant improvements to the facilities mean that people are provided with very clean, comfortable and nicely decorated surroundings, although some felt that the garden areas should be better maintained. Evidence: The home provides and maintains very comfortable facilities. All areas of the home have been upgraded and refurbished with very positive results, consideration has been given to the character of the property and many of the original features have been retained. The upgrade works include the provision of a first floor extension with two single en- suite rooms, alterations to shared rooms to provide single, en- suite accommodation, new bathing /shower facilities, an extension to the lounge and redecoration and refurbishment throughout. Along with this work the electrical and plumbing systems in the home have been upgraded, new laundry equipment installed, the dining room has been enlarged, lighting in the communal areas improved, storage and staff facilities provided in the loft space. Works to improve the outside of the property have included repainting all the woodwork, resurfacing of the drive and ramp provision to the doors to enable easier access. There was good evidence that people who use the service had been consulted on their choice of decor and the owner confirmed that this had been taken into consideration where possible. People and their relatives commented on the improvements to the facilities in the home, one relative told us Mum is really pleased with her room, the place looks lovely. We received Care Homes for Older People Page 21 of 31 Evidence: comments in a relatives survey about the lack of call bell facility in the lounge and concerns that the new ramp was steep and slippery in the wet weather. We spoke to the owner about the comments, there is a call bell in the lounge however portable bells can be provided for individuals to use and the ramp specifications were included in the inspection from building control, following completion of the works programme, however the owner will look into any risks to peoples safety arising from the steepness and surface changes during wet weather. A walk round the home found it to be very clean and tidy and smelling fresh. Comments from surveys and people during the day include The home is always very clean and tidy and the accommodation is very clean and there is a lack of odour in the premises. The home is involved in the improvement foundation with the local Care Trust around infection control. We observed good infection control practices over the course of the visit. Specialist equipment is provided where necessary for individuals and to meet requirements to move and handle people safely or reduce the risk of pressure sores. Training is provided in its use. To protect the safety of the people who use the service a key coded access facility to the door ensures people cant leave the home unsupervised, as detailed in section three of the report, a number of relatives expressed concerns that this facility had been broken for sometime, however the owner confirmed that the lock repair was scheduled later that week. A number of relatives and one individual told us that they were disappointed with the garden facilities. The rear garden has not been maintained properly and garden furniture has not been provided. During the visit we observed that one individual and their relative were sitting out in arm chairs from the lounge, and having to rely on staff assisting them with this. The lack of upkeep with the garden does detract from the otherwise excellent standard of facilities the home provides. 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. The home ensures that care staff are well trained in order to support people with their assessed needs. Shortfalls in staffing numbers recently and changes in peoples dependency levels has meant that the staffs ability to monitor people properly has at times been compromised. Recruitment procedures generally offer protection for people, but where staff are employed without full police check clearance they must be supervised appropriately. Evidence: On the day of the visit ten people were residing at the home. All surveys received from staff, people living in the home and their relatives indicated that they were generally satisfied with the staffing levels in place. One relatives survey detailed Good ratio of staff to residents, each resident is known well. The owner and staff told us that staffing levels of three care staff in the morning, two staff in the afternoon and two staff during the night shift were being maintained, however inspection of the staff rotas showed that only two staff were on duty for many of the morning shifts. The owner confirmed that the dependency hours calculated under the Residential Forum were not available. We observed during the visit that two individuals needs were now very dependent ( one individuals needs had changed significantly overnight) and they required at times the support of two care staff, which meant that at times during the day, there was no staff member on the floor to support other individuals. During the Care Homes for Older People Page 23 of 31 Evidence: visit the owner reviewed the staffing levels and increased the numbers of staff on day duty. It is important that the staffing levels are reviewed regularly to meet peoples changing needs. The manager of the home works a proportion of her time on the floor, the time she spends on administration and management work is detailed on the rota. The home has been without a cleaner for some time, the care staff have covered this work however the owner confirmed that a new cleaner had been recruited and was scheduled to start work soon. A cook is employed to provide the breakfast and lunch meals. People said that they liked the staff, for example comments included The staff are great, they know how to care for mum and I am well cared for. Staff told us that they enjoy working at the home, one survey detailed Its a friendly home, the management are good and we all work well together. The home provides a stable workforce of experienced carers. The management and care staff show an excellent commitment to NVQ training: 84 of staff have achieved NVQ 2 in care or equivalent and further staff are continuing with level 3. The manager keeps an overview of the staff training to assist her in the planning of training in the home. The home provides a good staff training programme with staff accessing annual updates in statutory courses and a good variety of general and service specific courses, staff had recently accessed training in infection control, continence, age related changes, risk management and dementia. Staff at interview and in surveys were very complimentary about the training they received, comments included We have regular updates and if there are any specific courses we want, the manager arranges these. The homes induction programme includes the national standards for care. There was evidence in staff files that new care staff to the service completed induction training. One new staff member told us that their induction training had included shifts where she was extra to the staff rota so she could shadow staff and get to know peoples routines. Staff personnel files were checked to make sure that all of the appropriate safety checks had been completed before they were employed to have any contact with people living in the home. Two new staff members had recently been employed but neither file contained a CRB disclosure, the home had obtained a protection of vulnerable adults (POVA first) check, however staff employed without the full CRB Care Homes for Older People Page 24 of 31 Evidence: disclosure should be working with another member of staff when undertaking any personal care, and there was no evidence that this was in place. The manager must ensure that appropriate support is put in place to protect people until the home receives the full CRB disclosure. All the staff files seen contained a photograph, two written references, application form, proof of identification, a contract and terms and conditions of employment. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is approachable and understands the needs of the people. They consult regularly with people who live in the home and their relatives on a regular basis although some recent suggestions have not been implemented in a timely way. The safety of people who use the service and the staff at the home is promoted and protected. Evidence: The homes management has changed in the last few months, the deputy manager has been appointed to the managers position following the move of the owner to the sister home. The manager has the required experience and qualifications and her application for registration with the commission is currently being processed. The manager was on leave at the time of the inspection and the homes owner was covering in her absence. People, staff and relatives spoken with during the visit all told us that there had been no issues with the management changes in the home. The home has a system for monitoring the quality of care in the home, however there Care Homes for Older People Page 26 of 31 Evidence: was evidence to suggest that the programme had not been fully maintained over the last few months. An audit plan has been developed for the year however many of these had not been completed and the most recent surveys that had been sent out to people who live in the home, relatives and health care professionals had not been evaluated, action planned or published. The owner told us that the results of surveys were discussed with people at meetings. There were records available to evidence that regular meetings were held at the home for staff, people using the service and their relatives. Records showed that people were able to air their views on aspects of the running and development of the service, however relatives commented to us that some of the suggestions had not been put in place, such as the provision of garden furniture and concern /compliment forms. We discussed with the owner the importance of following up suggestions raised by people when they have been agreed. Some peoples personal money is held for safe keeping. The systems for keeping and recording were discussed to make sure that money is safe and properly accounted for. Two peoples records were checked and receipts for all purchases were held to support the transactions. Based on this, people can be assured their money is well looked after and accounted for. The staff supervision and appraisal programmes have been well maintained with evidence that the staff are receiving the appropriate number of sessions and that they are linked to the staff development programme. The AQQA confirmed that regular safety checks are made of the facilities and equipment to make sure the home is a safe place to live and work. Staff are trained in safe working practices and are updated on a regular basis. We looked at some of the records of safety checks, like fire safety, and these were found to be up to date.The Fire Safety Officer had visited the home in May and six areas of deficiency were identified, there was evidence at this visit that five of the requirements had been fully actioned and work was in progress to address the sixth. Accident records were also seen and these are audited by the manager to see if measures can be taken to reduce the risk of accidents. Hot water temperatures in the home continue to be managed safely. Bed rails were in use to support the care for two individuals, detailed risk assessments are in place however it is also recommended that staff check the bed rails regularly to ensure people are kept safe. The homes kitchen facilities had recently been inspected by the Environmental Health Officer and had gained a five star quality rating which is a very good achievement. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 The activity programme must be reviewed to ensure more regular sessions are provided for individuals, which suit their needs preferences and capacity. This will better ensure that the people who use the service are appropriately fulfilled and stimulated. 30/11/2009 2 27 18 There must be sufficient staff on duty and staffing levels must be regularly reviewed to meet any changes in dependency levels. This will ensure all peoples care needs are safely met. 07/10/2009 3 29 19 Full checks, for example CRB 07/10/2009 checks must be in place prior to the start of staffs employment and if they are to commence after a Pova First check but prior to the full Criminal Record Bureau Page 29 of 31 Care Homes for Older People 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 check, stringent supervision must be in place. This will ensure that only appropriate people are employed to work with vulnerable adults and peoples safety and welfare is properly protected. 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 19 The garden should to be properly maintained so it looks attractive for people living at the home and suitable garden furniture provided for people to use. They should make sure that they address maintenance problems in the home quickly such as the key pad lock on the front door so that visitors have ease of access. The homes quality monitoring systems should be better maintained to ensure that the home continues to develop. Following comments received, the management should review the safety of the ramp provision to the door. Regular safety checks on all bed rails in use should take place to ensure the equipment remains fitted correctly and is fit for purpose. 2 19 3 4 5 33 38 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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