Care Home: Collins House

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• Claremont House
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What the care home does well Collins House is welcoming and has a relaxed and inclusive atmosphere. Residents live in a clean and comfortable environment. There are ample communal areas for people to enjoy, including attractive garden areas with outside seating. Before people move into Collins House a member of the management team carries out a detailed assessment of the person`s support needs and preferences to make sure that the home will be able to meet their needs. There was a good range of activities available for the people living at the home. Relatives told us they were generally happy with the service and care provided at Collins House. People enjoyed the food and the dining experience at Collins House. Management are good at keeping us (CQC) informed about incidents occurring in the home. The home works well with families and other professionals involved with people`s care. Visitors are always made welcome, and are able to develop a rapport with management and staff. What has improved since the last inspection? The management and staff team have responded positively to the requirements made in the previous inspection report and have made many improvements to the running of the home that benefit the people living there. The management at the home are committed to having a skilled and well trained staff team. Since the previous inspection staff training has been ongoing, with training in moving and handling, managing behaviours that challenge, health and safety and fire awareness being undertaken. Staff now spend more time spontaneously interacting with residents during the course of the day instead of solely during specified `activity` time. Residents views have been taken into account in the refurbishment that has taken place in the home, making it more personal to them and a more pleasant place to be. Changes have been made to the dining arrangements, people now eat in smaller, more intimate groups which makes the experience more relaxing and personal. Recording of health issues such as weight monitoring and nutritional records has improved, this helps to keep people healthy and identify potential issues in a timely manner. What the care home could do better: The staff and management needs to continue the `work in progress` to ensure all peoples` care plans include clear and detailed person centred guidance and instruction for staff to follow. This will ensure peoples` individual needs are met in accordance with their wishes and preferences. The quality of daily records need to continue to improve to ensure they provide clear and accurate detail of the care and support provided for individuals. Consideration needs to be given to ensure people are able to locate their own bedrooms by clearly labelling/personalising their bedroom doors. Consideration needs to be given to updating the training provided for some of the staff team in respect of supporting people living with dementia. Most of the staff team have received this training however some dates back as far as 2003 and daily practice has evolved considerably in the interim. Key inspection report Care homes for older people Name: Address: Collins House Springhouse Road Corringham Essex SS17 7LE     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 Greaves     Date: 0 5 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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: Collins House Springhouse Road Corringham Essex SS17 7LE 01375671162 01375361065 jmckiernan@thurrock.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Thurrock Council Name of registered manager (if applicable) Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 45 The registered person may provide the following categories 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: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Collins House provides support and accommodation for up to 45 older people, some of whom might additionally have been diagnosed with dementia. The home is situated in a residential area close to local amenities and Corringham shopping centre. The home is on two floors and there is a passenger lift to enable access to both levels. There are 41 single and 2 double bedrooms, and 5 dining rooms and lounges. There is a secure Care Homes for Older People Page 4 of 31 Over 65 0 45 45 0 Brief description of the care home courtyard garden with decking and outside seating. The home has a Statement of Purpose and Service User Guide. These documents, together with the last inspection report are available to residents and visitors in the main hallway of the home. The weekly fees as at 5th January 2010 are £593.69. There are additional charges for chiropody, hairdresser, newspapers, magazines, personal toiletries and taxi fares. 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: This was an unannounced key site visit undertaken over 8 1/2 hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent us the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Before the site visit a selection of surveys had been sent to the home for distribution to residents and staff. Views expressed by visitors to the home during the site visit and in surveys responses have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. Care Homes for Older People Page 6 of 31 The management team and staff at Collins House have continuously strived to bring about improvements to the outcomes for the people living at the home. In the main, all shortfalls identified at the previous inspection have been rectified. Where some minor shortfalls remain we have confidence that the management are aware of these and are actively working with the staff team to address these. As a consequence, there are no legal requirements resulting from this inspection site visit. We would like to thank the residents, the manager, the staff team and visitors for the help and co-operation throughout this inspection process. The previous key inspection of this service took place on 19th February 2009. 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: The staff and management needs to continue the work in progress to ensure all Care Homes for Older People Page 8 of 31 peoples care plans include clear and detailed person centred guidance and instruction for staff to follow. This will ensure peoples individual needs are met in accordance with their wishes and preferences. The quality of daily records need to continue to improve to ensure they provide clear and accurate detail of the care and support provided for individuals. Consideration needs to be given to ensure people are able to locate their own bedrooms by clearly labelling/personalising their bedroom doors. Consideration needs to be given to updating the training provided for some of the staff team in respect of supporting people living with dementia. Most of the staff team have received this training however some dates back as far as 2003 and daily practice has evolved considerably in the interim. 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 moving into Collins House can be assured their health needs should be met through a comprehensive assessment. Evidence: Before people moved into the home they were provided with detailed information, enabling them to make an informed decision about whether the home would meet their needs. The Statement of Purpose clearly set out the objectives and philosophy of care, detailing the specialist services provided, quality of the accommodation, qualifications and experience of the staff and how to make a complaint. Information provided in the managers AQAA and verified at the inspection confirmed that before people moved in to the home a detailed assessment was carried out to identify peoples individual needs and preferences. Care plans of three people living in the home were looked at as part of the inspection process, all three contained the required assessments, which provided an overview of their health, personal and social Care Homes for Older People Page 11 of 31 Evidence: care needs. We met with one family whos relative had recently moved into Collins House. They told us how they had paid an unannounced visit to the home to see if they felt it was the right place for their relative. They had been impressed with the warm and caring attitude of the staff and how the home had been clean, homely and welcoming. We looked at the staff training schedule, this reflected that people working in the home had received training to provide them with the required qualifications, skills and experience to meet the needs of the people living in the home. This was tested through discussion with staff during the inspection who demonstrated a good understanding of peoples individual needs. The home does not provide intermediate care. 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. People receive care and medical support to meet their individual needs. Evidence: People spoken with, and comments included in surveys, were very positive about the care and support provided at Collins House. People living at the home who were unable to express an opinion about the service looked relaxed and well cared for. Families we spoke with were also positive about the way their relatives were cared for. Comments included: I cant fault it, (Persons name) is happy with it and The staff are lovely, they are all very kind and I have never been able to fault the care at Collins House and thats the truth. We looked at care records for three people living at the home. Two peoples care plans were written in a very person centred way providing staff with clear guidance and instruction on how individuals needed and preferred their care and support to be delivered. One of the care plans we looked at however, stated that the person needed lots of encouragement and prompting to enable them to maintain a level of independence. There was no detail to inform staff what form this encouragement and Care Homes for Older People Page 13 of 31 Evidence: prompting should take or the specific support the individual needed to maintain their independence with personal care. The care plan went on to say that the person was reluctant to bath and will need encouragement but also failed to guide staff how to best provide this encouragement. Daily records varied considerably in the quality and quantity of information documented. Some we saw clearly described the support provided for people, how people had spent their days and their emotional, spiritual and physical well being. One of the three care plans we looked at included daily records that contained statements such as all personal care given and was assisted with personal care. Given that this related to the care plan with no specific detail of the personal care that the person required or how it was to be delivered, this level of recording did not confirm that the individuals specific needs were being met. We saw an improvement plan for the service dated October 2009, this identified that further work was needed to ensure that all care plans, risk assessments and daily recording is consistently of a high standard. We saw evidence of support provided by Thurrocks Workforce Planning and Development team. A report of November 2009 identified that some of the care records within the home were too brief and did not represent a person centred approach. The outcome of this support was to improve the quality of the recording for all staff to an acceptable level that shows care is given in a person centred way at Collins House. Staff meeting minutes of 14th December 2009 showed that Daily Record Work Shops were being set up in January 2010 to support staff in recording accurate information. This showed that the service was aware of the shortfall and was actively working to provide support for staff to achieve the skills necessary to do this part of their job effectively. We looked at risk assessments, we saw that these were personalised to address areas of risk relevant to the individual. An example of the areas of individual risk assessed included: pressure sores, challenging behaviours, mobility, use of stair lift, weight and nutrition, loss of physical movement, speech, swallowing disturbances as a result of Parkinsons disease, risk of falling from wheelchair and use of bedrails. The care plans we looked at included a sheet where monthly reviews of the care regime and risk assessments were documented to confirm that consideration had been given as to whether peoples needs continued to be met effectively. Records we looked at showed that peoples health was monitored and that they Care Homes for Older People Page 14 of 31 Evidence: accessed a variety of health care professionals to meet their needs, and support their ongoing care. This included doctors, district nurses, optician, continence adviser, community physiotherapists and community mental health teams. On surveys people told us they felt that they always or usually received the medical support that they needed. We looked at systems and procedures in place to ensure that medication administration was managed safely and well. We saw that good records were maintained with no gaps in recording. Staff training records showed that staff responsible to administering medications had received training in managing medication. There were secure facilities for storing medications in each unit at the home. Night medications were stored in a trolley so that they could be easily taken around to people in their rooms. Medications were supplied to the home monthly, the majority in blister packs. Where there was too much medication supplied for the month to fit into the cabinets on the units these were stored in a central locked cupboard within the medication room. Senior staff told us that automatic prescriptions were generated from the GP each month resulting in a number of returns to the pharmacy monthly where residents no longer needed the medication or refused the medication. The manager told us that a representative from the Primary Care Trust was working with the service and liaising with the GP and pharmacy to streamline the medication ordering procedures and to ensure that a full review of each persons medication is undertaken to ensure that people are not taking excessive medications. Controlled medications were stored in a secure facility in Orchid Lounge and recorded appropriately in a register. The medical room and medication fridge temperatures were monitored daily to ensure that medications were stored safely. During the day we observed that staff were kind and caring in their approach to residents. Discussion with members of the care team highlighted that they had a good understanding of peoples rights and the need to preserve peoples privacy and dignity. Care Homes for Older People Page 15 of 31 Evidence: Care Homes for Older People Page 16 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. People enjoy opportunities for activity, good food and are able to welcome their families and friends. Evidence: The managers AQAA stated: All staff now include activities for residents in delivery of their care and see it as part of their role. Themed areas and activity boxes have been introduced and are used regularly. Activities staff have been increased to cover weekends and evenings. The activities co-ordinator has undertaken further training and development including activities for people with dementia. Collins house has supported residents to register with Transvol to promote social stimulation to allow residents to arrange trips and outings. Collins house will be recruiting another part time Activity Co- ordinator to offer further choice and stimulation to residents to ensure activities are offered throughout different times during the day and weekends. Further training for all staff in activities for people with dementia. Additional training for the Activity Co-ordinators. People living at the home now benefited from having 2 activity co-ordinators to provide them with opportunities for stimulation and engagement, this was an increase of 20 hours since the previous inspection visit. One staff member on light duties was Care Homes for Older People Page 17 of 31 Evidence: also helping with the activity provision temporarily. In surveys 5 people said there were always activities available for them to take part in, 2 said usually and 1 said this was sometimes the case. A sock box had been introduced, one resident was seen matching up various brightly coloured socks into pairs and folding them. The person was happily discussing this task with staff and residents passing by. There was a hat box, the manager told us that residents really enjoyed wearing the different hats. We saw various activity boxes in the lounges for staff to use to interact with people such as box of musical instruments and another with art and craft items within. We saw some people getting comfort from cuddling dolls. A member of the management team told us that a tool shed was being planned for the gentlemen living at the home to be able to potter in. We were provided with a schedule of the planned activities that took place at Collins House, some of these we observed taking place during the course of the day we spent at the home. Activities took place 7 days per week and included group sessions such as movement to music, singalongs, reminiscence sessions and bingo. During the afternoon we saw staff in Lily lounge facilitating a lively debate about old fashioned cures for things such as smelly feet and bed lice, residents were animated and fully engaged in the discussion. Records showed that blind fold games in order to stimulate peoples senses took place. This involved guessing objects or identifying various aromas such as perfumes, herbs, vinegar, mustard etc. Records showed that people had the opportunity to become involved in cooking cakes and pastry, to do some gentle gardening and we observed that residents went to the local shops accompanied by staff. People were also offered the opportunity of 1:1 chats where they could talk about anything they wished such as their family or anything that was concerning or worrying them. There were photograph albums strategically placed around the home so that staff could take the opportunity of a passing moment to sit and meaningfully interact with people about events that had taken place both personally and within the home. The manager told us that relatives had become more involved with activity and stimulation for the people living at the home. The manager said the ethos of Collins House had changed so that activities happen spontaneously anywhere within the home at anytime of the day and all staff now become involved with providing Care Homes for Older People Page 18 of 31 Evidence: stimulation for people. We saw that a meeting had been arranged for relatives to share the vision of the home and to appraise them of changes being made to the daily life in the home to make life more relaxed and meaningful for the people living there. Since the previous inspection of this service the dining room arrangements have been altered so that people can eat in smaller more intimate groups on the individual units. We saw nutrition sheets in each lounge to show what people had chosen for their breakfast and whether they had eaten well. Meal choices were offered to residents the evening before. Discussion was held with the manager about ways of delivering these choices nearer to the time of eating so that people could remember what they had chosen and to make the choices more meaningful. Pictorial menus with a photo of the meal and large font print were available to help people make their food choices. We were provided with copies of the 4 week rotational menu. This showed that people had a choice of two main meals daily and a choice of sandwiches or a warm option such as soup, scrambled egg, beans on toast etc for tea. The menu was varied. Relatives were offered the opportunity to take meals with their relatives at the home for a nominal charge. Relatives and residents told us they enjoyed this. In survey responses showed that 5 people said they always liked the food at the home and 3 people said this was usually the case. A resident told us: The food is smashing Relatives told us: The food is very good there, it is really lovely, you cant fault it at all and People now eat in smaller dining areas which I think is very good Care Homes for Older People Page 19 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 cared for safely and protected by practice in the home. Evidence: We looked at the complaints policy and procedure. This provided people with good information about how to raise any concerns. On surveys all 8 people responding said they knew who to speak to if they were unhappy with any aspect of their lives at Collins House. 6 people said they knew how to make a formal complaint and 2 said they did not. Staff said that they knew what to do if someone raised a concern with them. Records showed that six concerns had been raised since the previous inspection. These had been managed appropriately by staff and management. No concerns had been raised with us (CQC). We saw many cards and letters from family members complimenting the staff and management on the care and kindness afforded to residents and families. Policies, procedures, information, appropriate forms and contact information were readily available in relation to safeguarding. Staff training records showed that training in safeguarding had been undertaken. We spoke with 2 staff members about what they would do if they had suspicions about a resident being at harm from abuse, they were able to tell us confidently how they would deal with this and confirmed that they had access to the contact numbers they would need. We noted in care plans and care Care Homes for Older People Page 20 of 31 Evidence: records that some people living at Collins House could display behaviours that challenged staff. Individual care plans in most instances provided staff with strategies to manage this. Training records showed that most of the staff team had undertaken, courses to provide them with the skills to manage behaviours that challenge and to support people living with dementia. Staff recruitment processes were robust ensuring that people employed to work at the home were safe to look after vulnerable people. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment people live in supports their independence and continues to improve. Evidence: The managers AQAA told of the many improvements that had been made to the environment since the previous inspection visit in 2009. for example: We have purchased all new dining tables and chairs and twenty new armchairs. We have converted our lounge areas into lounge diners so they are more personal and homely giving the residents more choice of seating for meals. Collins House has improved the storage for wheelchairs. New signage is available around the home. A stair lift has been installed which gives residents a choice of how they move around the home and is available in the event of the lift breaking down. Collins House has purchased new curtains for the home where the residents choose the material and colours. We have purchased flower arrangements to make the home more homely. New flooring has been purchased in some of the living, dining areas and bedrooms. Some bedrooms have also been decorated. We have had a large decking area built at the back of the home so that the residents can enjoy the decking in the warmer weather. We have purchased three large plasma televisions so all the lounges now have one. We have purchased three new industrial washing machines to improve efficiency levels. A new assistive technology overlay system has be purchased and installed to improve communications from residents to staff for a prompt response. This system allows residents to talk directly to staff if needed. Collins House has installed a perimeter Care Homes for Older People Page 22 of 31 Evidence: fence to the property which allows the resident access to the gardens and grounds safely and securely. The managers AQAA also indicated improvements that are planned at the home. Introduce monthly news letters for all the residents, relatives and staff. Collins House is looking at improving the the front entrance to make it more homely and accessible. Collins House are planning to develop the garden areas by creating raised flower beds and a raised vegetable patch. We are looking at purchasing some statues, outside lights and bird houses.We will continue with the theme areas around the home. We took an unaccompanied tour of premises on arrival, overall the home was clean and fresh with no malodours. We noted general improvements in the environment since our last visit and observed that residents appeared happier and more relaxed in their home. There were many new pictures on the walls which helped to detract from the institutional appearance that was previously noted. These pictures contributed to various themed areas in the home such as old movie stars, old motor vehicles etc. We looked at resident meeting minutes, these showed that there were plans to introduce an area with a royal theme at the residents request. Peoples personal rooms had labels with their names and a photograph on them. These labels were small and in some instances quite high up, above residents eyeline. All the bedroom doors were uniformly brown combined with unclear signage would make it hard for people to find their own rooms. The manager told us that discussion had taken place with residents over this issue but that they had all indicated they wished the doors to remain as they were. Staff had undertaken training in managing infection control, appropriate hand washing facilities were sited throughout the home with stocks of aprons and gloves easily accessible for staff. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are looked after by safely recruited and well trained staff. Evidence: The managers AQAA stated: We are now managing our rotas so that we minimise the use of agency staff. However when we do use agency staff on a regular basis they cover a full rota where needed to provide continuity. Collins House will continue to recruit to any vacant posts to ensure continuity to the residents. We noted that, on the day of this inspection there were 7 staff on duty in the morning and 6 in the afternoon. Each shift had one person allocated to each of the 5 lounges with 2 people floating between the units to assist where needed. Copies of the rota taken away with us to study further confirmed that staffing levels were maintained at this level with the assistance of regular agency staff when the need arose. We saw records of agency staff working at the home, this varied between 1 person and 6 people per day over recent weeks. The manager told us that these were regular staff that attended Collins house training and received supervision from Collins House management team. The manager told us of an on going recruitment campaign that had been successful. Staff meeting minutes of 14th December reported that the home now has more permanent staff so there will be less agency staff on the shifts. Care Homes for Older People Page 24 of 31 Evidence: In surveys 4 people said there were always staff available when they needed them, 2 said usually and 2 said sometimes. We looked at the files of two staff who had been recently recruited. We saw that people living in the home were protected through robust recruitment procedures being in place. Checks such as Criminal Records Bureau (CRB), POVA first, references and peoples identification had been carried out. On staff surveys people said that their recruitment had been thorough and fair. A training matrix showed that training had been undertaken by staff in appropriate areas. There had been a noticeable improvement in this area since the previous inspection of this service with the majority of the staff team now having received training in the basic core areas such as moving and handling, safeguarding of vulnerable adults, fire awareness, health and safety and infection control. The management team demonstrated awareness of the very minor shortfalls remaining in this area of training and were able to show that they were being addressed. The managers AQAA stated: A rigorous training programme has taken place and now Mandatory training has been completed where required. Records showed that approximately 80 of the staff team working at Collins House had attended training to provide them with the necessary skills to support people living with dementia. However, we noted that much of this training dated back 4 years or more. Daily practice in supporting people to have a meaningful life while living with dementia has evolved greatly during recent years and consideration should be given to sourcing a training resource that incorporates up to date guidance for the staff team. The managers AQAA stated:Training in the conditions associated with Old Age has improved but needs to continue. Records showed that, of the 5 Residential Care Co-ordinators, 25 day carers and 5 night carers, there were 21 staff that had achieved a minimum of NVQ level 2 in care. Records also showed that, 25 staff members had completed induction in line with the Common Induction Standards, 4 were in the process of completing this and 6 had not yet started. Staff we spoke with told us they welcomed the increased training being offered and said they felt it gave them the confidence knowing they were doing the job to the best Care Homes for Older People Page 25 of 31 Evidence: of their ability with up to date practice and guidance. Visitors told us they felt the staff were trained to be able to do the best for people. Care Homes for Older People Page 26 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home. Evidence: The acting manager has been in post since October 2008 and has now applied and been accepted for the post of permanent manager at Collins House. The manager has started the process of registering with the Care Quality Commission and has achieved the Registered Managers Award and the NVQ level 4 in management. The manager has embedded an inclusive and supportive management style into the home and the overall management structure in the home has been reviewed and amended. Staff said that they felt the current management of the home was good, changes were positive and that there was a lot more training on offer. Visitors spoken to also commented that the home had improved with the new manager in post and one said that There seems to have been a lot of changes, most of them for the better. Care Homes for Older People Page 27 of 31 Evidence: We spoke with outside professionals involved with people living at Collins House, their comments included: They have improved a lot Generally the whole ethos of the home has moved forward Staff team more cohesive now, better communication and working as a team There has been a general change of attitude for the better and Feedback from relatives has been very positive The managers AQAA stated: Collins House will devise a quality assurance questionnaire to send out to health care professionals and outside agencies so feedback can be gained to identify any areas of improvement. We were provided with a copy of the Quality Assurance Framework, however, gathering the views of the people living at the home, their relatives and representatives and other interested stakeholders in the home had not yet taken place. The manager was able to assure us that this was due to take place imminently now that the framework has been agreed. We saw a copy of the County Council Monitoring Visit Report from July 2009 and the most recent report of the Providers monitoring visit from December 2009.These showed that residents and relatives were spoken to during these visits and their views were represented within the reports. People can feel confident that if they or their families asked the home to help them look after their personal monies, this would be done in a way that safeguarded their interests. Monies checked were correct, with receipts in place for all transactions. We observed that there was an open culture in the home with management and staff working as a team to meet the individual needs of residents. Staff files showed that staff supervision was ongoing and that relevant topics such as person centered care and core values were discussed. We looked at accident and incident records and found they were completed well and provided sufficient detail of what had happened, risk assessments were in place when appropriate as a result of these reports. The managers AQAA identified that systems and services were monitored and maintained. A sample of records looked at confirmed this, Health and safety certificates were up to date and in good order. A partial tour of the premises showed that the home seemed well organised, and no particular health and safety issues were identified. Care Homes for Older People Page 28 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 29 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 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 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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