Care Home: Creedy House

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What the care home does well There is a homely atmosphere. The Manager consults with people before they move in so that they are confident that their needs can be met. One health care assistant says, `we do try to find out about someone before they come in so that we can welcome them without having to ask too many questions about what help they want. Every one`s different and settles in at their own speed. People have to find their feet and we`re here to help them`. Most people say that in general they receive the assistance they need in ways that are right for them. One person says, `in general the staff are very good and they are nice to have around`. One health and social care professional says that, `staff relate to the residents very well`. There is a good range of special equipment such as hoists to help people who have reduced mobility. People can receive visitors whenever they wish and they can meet with them in private. The Manager keeps in touch with relatives so that they know how things are going. There are interesting and engaging social things that people can do. There are reliable arrangements for the ordering, storage and administration of medication. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. The kitchen meets the requirements of the local Department of Environmental Health. The laundry is well equipped and well organised. Security checks are completed on new nurses and health care assistants. What has improved since the last inspection? A number of improvements have been made since our last Key Inspection. The range of social activities that people can do has been extended. Eighteen bedrooms have been completely refurbished and a further eight have been redecorated. More health care assistants have completed a relevant National Vocational Qualification.A new training pack has been purchased. This enables health care assistants to take part in well organised distance learning exercises. All of these things contribute to the Service being better able to care for people in ways that are right for them. What the care home could do better: There is a shortfall in the written plan of nursing and personal care for one person. For the same person there is a shortfall in the way part of their nursing care is being provided. There is also a shortfall in an aspect of the nursing care provided for another person. These oversights might result in the people concerned not receiving all of the support they need. For some periods of the day there are not enough health care assistants on duty to enable people to promptly receive all of they assistance they need and want. Some of the health care assistants are not receiving all of the training that the Registered Provider says that they need. This might result in them not having all of the necessary skills and knowledge. There are some oversights in the systems used to store and manage some foods. There are some shortfalls in the fire safety arrangements. These might compromise the level of fire safety protection provided in the Service. There are five requirements at the end of this Report. Key inspection report Care homes for older people Name: Address: Creedy House Nether Avenue Littlestone on Sea New Romney Kent TN28 8NB     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: Mark Hemmings     Date: 2 3 1 1 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Creedy House Nether Avenue Littlestone on Sea New Romney Kent TN28 8NB 01797362248 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.1stchoicecarehomes.com 1st Choice Care Hmes T/A Creedy Number 1 LTD Name of registered manager (if applicable) Ms Anita O`Neill Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accomodated is 44. The registered person may provide the following category/ies of service only: Care home only (PC) - to service usersof the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Older People with Physical Disabilities (PD). Dementia (DE) Date of last inspection 44 0 44 Over 65 0 44 0 Care Homes for Older People Page 4 of 31 Brief description of the care home Up to 44 people who need nursing care or personal care can make their home in Creedy House (the Service). Some of the people in residence may have special needs because of a physical disability or because they have problems with their comprehension. All of the people who live in the Service can be older people. The main property is a three storey detached building that has been adapted for its present use. At the back there is a large purpose built ground floor extension. In the main building the accommodation is on all three floors. There is a passenger lift that gives step-free access to most parts of the accommodation. There are two shared bedrooms and all of the rest are singles. All of the bedrooms have a private wash hand basin and 10 of them also have their own toilet. Some of the bedrooms have overhead hoists. These are fitted securely to the ceiling. There are two main lounges and a smaller lounge on the ground floor. On this floor, there is also a sunshine gallery and a separate dining room. On the first floor there is another lounge with a library. There is a call bell system At the back of the building, there is a large and level enclosed garden. This has lawns and flower beds. There are seats both in a large gazebo and on the lawns. The Service is in a quiet residential street that is quite close to the centre of New Romney. There is a bus stop nearby and there is plenty of on-street and off street car parking. There is a general store only a short walk away. The nearest mainline railway station is in Folkestone about 13 miles away. The Service does not have its own vehicle. The Registered Provider is a private limited company that runs a number of similar services in the area. The weekly fee for living in Creedy House runs from £550.00 to £850.00. Please contact the Manager to find out more details about the charges. 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 that the people who use this Service experience good quality outcomes. We arrived unannounced at the Service just before nine oclock in the morning and we were there for about nine and a half hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). We received this on time and it is adequately detailed. Further, we considered any other information that we have recently received about the Service. We did our last Key Inspection on 21 April 2008. In the intervening period we have also done an Annual Service Review. We completed this on 5 March 2009. This was an office based activity when we reviewed all of the information that we had gathered since the last Key Inspection. Care Homes for Older People Page 6 of 31 During the present inspection, we spoke with 10 of the people who currently live in the Service. We spent time in the company of another 10 of them while they were in the lounges or resting in their bedrooms. We also met with two relatives. We spoke with the Operations Manager. She is a senior manager who oversees all of the Registered Providers services. We also spoke with the Manager, deputy manager, a nurse, five support workers, the activities coordinator, the chef, a housekeeper and the administrator. We looked around parts of the accommodation and the grounds. Also, we looked at a selection of key records and documents. These included things like the individual written plans of care, medication records, the activities plan, the menu, complaints documents, the staff roster, staff training records, financial records and various health and safety certificates. Before we visited the Service, we asked some of the people who live there, their relatives, some nurses and health care assistants and some health and social care professionals to fill out a questionnaire for us. We wanted them to tell us what they think of Creedy House. Eleven people who live there, four relatives, four members of staff and one health and social care professional kindly completed them for us. Later on in our Report, we will tell you the main things that are being said in these questionnaires. We were joined by an Expert by Experience. She has a thorough knowledge of the special needs of older people. She spent about three hours in the Service. During this time, she observed what was going on in the lounges. She also talked with people who live in the Service and with members of staff. She had a look around the main parts of the accommodation. This included going into some of the bedrooms by invitation. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? A number of improvements have been made since our last Key Inspection. The range of social activities that people can do has been extended. Eighteen bedrooms have been completely refurbished and a further eight have been redecorated. More health care assistants have completed a relevant National Vocational Qualification. Care Homes for Older People Page 8 of 31 A new training pack has been purchased. This enables health care assistants to take part in well organised distance learning exercises. All of these things contribute to the Service being better able to care for people in ways that are right for them. What they could do better: 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking of moving in are asked about what nursing and personal care they need and how they want this to be done. They are encouraged to visit the Service to get a first hand feeling of what it is like. People who want to stay for only a short time are supported to go home again. Evidence: The records show that the people who are thinking of moving in are asked about what nursing and personal care they need and want. They and their relatives are also invited to visit the Service. This is done so that they can be confident that moving in to Creedy House is the right thing for them. The Manager also talks with people such as doctors and care managers (social workers). All of this helps her to build up a really good picture of how the person can best be supported. There is a Service Users Guide. This is a brochure that gives lots of useful information about the facilities and the services that people can expect to have when they move Care Homes for Older People Page 11 of 31 Evidence: in. Nurses and health care assistants say that the Manager shares with them the information she has obtained about someone who is due to move in. This is done so that they know what care they need to provide. One health care assistant says, we do try to find out about someone before they come in so that we can welcome them without having to ask too many questions about what help they want. Over time of course we do get to know people really well and so we know how they like things done. Every ones different and settles in at their own speed. People have to find their feet and were here to help them. Most of the people who move in do so with the intention of making Creedy House their longer term home. However, someone might only need to stay for a shorter time. This might be so that they can recuperate before going back to their own home. The Manager says that she liaises carefully with relatives and health and social care professionals in order to help the person achieve their goal of moving on. 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. There are written plans of care that cover most but not all aspects of the nursing and personal care to be delivered. People are receiving most but not all of the support they need. They are treated with courtesy and respect. People have access to the medical and health care services they need. There are reliable arrangements for handling medication. Evidence: Each person has an individual written plan of care. These are intended to describe the nursing and personal care they are to receive. The plans are mostly very detailed and are being kept up to date with regular reviews. However, in relation to Person A there is an omission. The information about an important change in part of their nursing care has not been updated. Members of staff are not clear about what they should be doing in relation to this element of the care the person needs. The Manager says that this will be put right immediately. There is a requirement about this at the end of this Report. The records show that people are receiving the medical care they need. This includes Care Homes for Older People Page 13 of 31 Evidence: seeing professionals such as their doctor as and when they are needed. They also see specialist nurses who give advice to the Service about how best to respond to people who have complicated nursing care needs. The records show that most of the planned nursing care is being implemented in the right way. However, there is a significant oversight in relation to Person A and Person B. Again, the Manager has said that these will be put right without any delay. There is a requirement about these matters at the end of this Report. In their questionnaire replies, people say that they always receive the care they need. When we were in the Service people gave a range of opinions about the care they receive. One person says, the staff are very good really and theyre kind to us all. I like them and I like my home. Another person says, in general the staff are very good and they are nice to have around. Theres the odd one or two who dont really care about their job but in general the staff are the right people to have working in a nursing home. Someone else says, when staff come theyre kind and helpful, but they are rushed off their feet and people can get overlooked. One person told the Expert by Experience that, Im very happy here with nice staff. One health and social care professional says, staff relate to the residents very well. (The Service) provides a reasonably good standard of care. Complex needs are not always identified or speedily managed. One relative says, (the person living in the Service) seems very contented most of the time. Some of the health care assistants do not always seem to understand things that are important and let matters slip. I visit every week or two, but things I have mentioned often have not been attended to by the next visit, such as having their nails cut. The nurses manage medication for people. There is a system to check that the correct medicines are received from the chemist. Once in the Service, medicines are stored securely. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is given. These are being completed correctly. Care Homes for Older People Page 14 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 can take part in social activities if they want. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: On most days there is an activities coordinator. She does both small group activities and one to one sessions with people. The records show that some people choose to do artwork while others prefer to play games such as dominoes. Once a week an aromatherapist calls to the Service and once a month someone comes to play music. In the past three months there have been two organised trips out. People say different things about the calendar of social activities. One person says, I dont want to be involved in activities. I have been asked what I would like to do but Im happy in my room and want to be left alone. Another person says, it can be a long day I suppose, theres always something to see, but you have to fill your own time. When we were in the Service, two people were doing artwork and four people were playing dominoes. Other people were sitting a lot without any apparent occupation. Three people were walking around. The Expert by Experience says that there are important examples of thoughtfulness Care Homes for Older People Page 15 of 31 Evidence: and good practice. There is some child care equipment that enables people to reminisce if they wish. There is also a large fish tank in one of the lounges that is interesting for people to look at. People are free to receive visitors whenever they want. They can speak with them in the privacy of their bedroom if they wish. The records show that the Manager keeps in touch with relatives so that they know how things are going. One relative says, the Manager is good and she keeps in touch with me so that I know how (the person concerned) is. Im always made to feel welcome whenever I come and its almost like a family thing. I do feel that Im fully involved with the care that is given to (the person concerned). Its just that you do have to push for things or they mightnt get done or will get done after a longish wait. The Manager says that people are encouraged to make their bedrooms their own private space. They are helped to arrange them as they want them to be and this results in them having an individual appearance. People can use their bedrooms whenever they want. They can choose to have private time on their own or to be in company. The Registered Provider does not get involved in helping people to manage their financial affairs. Most people are helped by their families or by the local authority. The records show that there is a varied menu. The main meal is lunch and the sorts of dishes served are things like roast beef and chicken casserole. There is a cooked option for tea such as spaghetti on toast. There are drinks and cakes and biscuits served mid morning, mid afternoon and later in the evening. People can dine in their bedroom if they wish. People give a range of opinions about the quality of the meals they receive. One person says, we have good meals here and I always have enough. Ive no complaints about the food. Another person says, theyre normally okay and we have enough. Sometimes the food can be a bit cool by the time its arrived which isnt very appetising, but its okay. Care Homes for Older People Page 16 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. There is a complaints procedure. The way some complaints are recorded needs to be strengthened. There are systems in place that are designed to keep people safe. This includes people being protected from prejudice and discrimination. The local authority is looking into a number of incidents in which peoples wellbeing may have been compromised. There are some limited shortfalls in the system used to manage peoples personal spending allowance. Evidence: There is a complaints procedure that explains how someone can raise concerns in relation to the Service. The Assessment says that, all complaints are taken very seriously as they are an indication of how our service is performing. In the procedure the Registered Provider commits itself to fully investigate complaints and to resolve them as soon as possible. The Operations Manager says that all complaints are referred to her so that she can oversee how they are managed. Since our last Key Inspection the Registered Provider has received some complaints about the adequacy of various aspects of the nursing and personal care provided, about the standard of parts of the accommodation and the quality of the catering. The Operations Manager says that all of the complaints have been investigated and resolved. There should be a full record kept in the Service of how each complaint has been resolved. Some of these records are not in place. Without them it is more difficult for Care Homes for Older People Page 17 of 31 Evidence: the Operations Manager to demonstrate to us how effectively each item has been handled. She says that in future a comprehensive record of all complaints will be kept in the Service. People who live in the Service are confident that they are safe and that their wellbeing will be promoted. In their questionnaire replies everyone says that members of staff always treat them well. Nurses and health care assistants are confident that people are being kept safe. One health care assistant says, all of the residents get treated well. I always think to treat people how I would like to be treated myself. They deserve kindness and attention. We may be rushed and sometimes people have to wait until we can get around to them, but I have never seen any direct unkindness here and Im sure that (the Manager) and the company wouldnt stand for it. During the past year, the local authority has looked into five incidents when different peoples wellbeing might have become compromised. Three of these matters were referred by the Registered Provider to the local authority. The other matters were referred direct to the local authority by other stakeholders. The concerns were about various aspects of the nursing and personal care provided. They included the arrangements to promote continence, to support good skin care and to protect personal security. We understand that the Registered Provider cooperated fully with the local authority both in investigating and resolving the concerns. The Assessment commits the Registered Provider to promoting diversity in the Service. This means respecting each person who lives there as an individual. It also means making sure that no one experiences any form of prejudice or discrimination. The records show that nurses and health care assistants receive training about this subject. This is done both when they start their employment and then on an ongoing basis. The Manager says that this commitment to promoting diversity is also expressed in practical terms. For example, in the way that each person receives individualised care in ways that respect their preferences and wishes. The service helps most of the people to handle their personal spending allowance. Usually this means that relatives bring in small amounts of money that are put into safekeeping in the office. The money is then used to pay for things such as aromatherapy and for seeing the hairdresser. There is a record kept of the various transactions involved. There are omissions in one set of the records. The paper Care Homes for Older People Page 18 of 31 Evidence: balance does not match the cash balance. However, the discrepancy is only minor. Also, there is no receipt to cover one of the items of expenditure. The Manager says that both of these oversights will be corrected without delay. Care Homes for Older People Page 19 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. Most areas of the accommodation are presented to a homely standard. A number of improvements have been made to the accommodation and more are planned. There is a modern fire safety system. The kitchen is well equipped. There is enough equipment to help people who have difficulties with their mobility. There is a suitable laundry. Evidence: The building provides a suitable range of facilities for the people who live there. These are in line with what the Registered Provider has committed itself to deliver in its Statement of Purpose. This is a legal document that describes in some detail the facilities and services that are available in Creedy House. Copies of the document can be obtained from the Service. The building is well maintained on the outside and the garden is well kept. On the inside, most of the accommodation is adequately decorated and furnished. The lounges are quite comfortable spaces. Most of the corridors, bathrooms and toilets are rather bare. Some of their painted wall finishes have become scuffed and marked. One of the lounges does not have a fresh atmosphere. In the course of the past year various improvements have been made. The quiet lounge on the first floor has been completely refurbished. More generally, various new pieces of furniture and equipment have been purchased. Eighteen bedrooms have Care Homes for Older People Page 20 of 31 Evidence: been completely refurbished and a further eight have been redecorated. There are plans to finish all of the remaining 12 bedrooms next year. Most of the bedrooms now have locks on their doors. There are plans to fit locks to the remaining bedrooms next year. The bedrooms are laid out as bed sitting areas. There is a bed, a comfortable chair, bed side table and a wardrobe. Each bedroom has a television point and people can pay to have a telephone point put in if they want. There is a range of equipment to help people who have reduced mobility. There are four bathrooms. Three of these have a special rise and fall bath that is easier to get into and out of. The fourth bathroom has an ordinary bath with a fixed hoist. The Manager says that there are plans to create a wet room. This will have a special walkin shower. There are four mobile hoists that can be used in the lounges and in the bedrooms. There are other things such as special sheets to help people change position in bed. Some of the bedrooms have overhead hoists that are fitted securely to the ceiling for ease of use. There is a modern automatic fire detection system. This has been assessed to make sure that it continues to meet the national standard. The assessment indicates that a small number of improvements need to be made. The records do not show that these improvements have been completed. The Operations Manager says that she will look into this and that any remaining improvements will be done by 1 January 2010. People say that the accommodation is always comfortably warm. The radiators are cool touch. This means that their surface does not become hot enough to burn someone. The hot water system is temperature controlled. This has been done so that it cannot scald bathers. The kitchen is clean and well equipped. The local Department of Environmental Health says that the kitchen meets its requirements. The laundry has two commercial washing machines. These are fitted with a special cycle for items that need a particularly hot wash. There are two large dryers. The area is well organised and clean. There are three sluices that are used for cleaning items such as commodes. Care Homes for Older People Page 21 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. At certain times, more health care assistants need to be on duty. Health care assistants are receiving most but not all of the training they need. Security checks are completed on new nurses and health care assistants. Evidence: The records show that there are usually six health care assistants on duty from early in the morning until the afternoon when the number reduces to five. There is always at least one nurse on duty. At night time there is a nurse and three health care assistants on duty. During the day there are other people who do the housekeeping, the laundry and who work in the kitchen. In their questionnaire replies most nurses and health care assistants say that there are usually enough members of staff on duty. Two people comment that more health care assistants are needed on duty. One person says, due to lack of staff, residents dont get proper care. We should work in pairs but most of the time we work one to one. Another member of staff says, we have a very high dependency rate here with at least 20 people needing to be hoisted and taken to the toilet or changed. It is a rush and we dont have much time for anything else. We really do need more staff here because of the needs of the people we care for. Someone else says, we dont have enough health care assistants to get things done without people having to wait. Its too rushed, you have to remember that we have a very dependent group of Care Homes for Older People Page 22 of 31 Evidence: people living here. The Expert by Experience says that she observed one person having to wait about 20 minutes before they were helped to use the toilet. This delay caused the person considerable distress. She also received information that some people have to stay in bed quite late into the day because health care assistants do not have the time to assist them to get up. More generally, the Expert by Experience observes that, I saw no spontaneity between staff and the residents they cared for. There was little conversation in the lounge area, no touching of hands or gestures. Staff were busy and clearly knew their roles well but the rapport between residents needs and supporting them when needed was slow. The Expert by Experience says that questions about the adequacy of the number of health care assistants on duty need to be addressed promptly. There is a requirement in relation to this matter at the end of this Report. The records show that the necessary security checks are being completed for new nurses and health care assistants. These include things such as confirming their identity, taking up references and doing a police check. This is done to make sure that they are trustworthy people to work in the Service. The records show that nurses and health care assistants do introductory training before they join the roster. In their questionnaire replies most people say that this training met their needs very well. After their introduction, there is ongoing training in key subjects such as first aid, health and safety and how to help people who have reduced mobility. Most but not all of the health care assistants have had the training that the Registered Provider has committed itself to provide. Elsewhere in this Report, we have pointed to some limited examples of health care assistants not being confident in some parts of their knowledge and skills. There is a requirement in relation to this matter at the end of this Report. Most of the health care assistants have completed a relevant National Vocational Qualification (NVQ). This Award is designed to further develop their ability to provide people with the assistance they need. Care Homes for Older People Page 23 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 Manager is registered with us and she is a qualified nurse. The quality assurance system does not fully involve everyone who lives in the Service. There are some shortfalls in the health and safety arrangements. Evidence: The Manager is a Registered General Nurse (RGN) and the deputy manager is a Registered Mental Nurse (RMN). The Operations Manager is a Registered General Nurse and she is experienced in the management of both nursing and social care settings. Together, the management team has worked in and managed residential services for a number of years. In their questionnaire replies most members of staff say that there is good team work in the Service. There are handover meetings at the beginning and end of each shift. These are when nurses and health care assistants discuss how things are going so that they can plan Care Homes for Older People Page 24 of 31 Evidence: what needs to be done. There are also regular staff meetings. In special circumstances someone might need to have parts of their liberty restricted. There are arrangements in the Service to make sure that these situations will be properly managed to make sure that any restrictions used will be in the persons best interests. The Manager says that there are no significant restrictions in place at the moment. There are monthly meetings called the Residents Forum. These are meetings where people who live in the Service and their relatives can meet with the Manager to review how things are going. The number of people choosing to attend these meetings varies. The Assessment says that, quality assurance questionnaires are sent out to all service users or relatives each year by the company and the results are published and a copy is displayed in the home for all to read. An action plan for the home is then formulated on the results of the questionnaires. The Manager says that she has sent out some questionnaires to ask people and their relatives what they think of the Service. Only one or two have been returned and the exercise has not been taken any further. The Operations Manager says that a range of measures including questionnaires is going to be used in the future. This is so that everyone who lives in the Service will have an opportunity to contribute suggested improvements. There is a monthly newsletter called Creedy House News. Copies of this are available in the Service. Each relative is also sent a copy. The Operations Manager regularly calls to the Service to check how things are going. The records show that she completes an organised review of how things are going. She also prepares an action plan which lists the improvements that need to be made. There is evidence that these improvements are being put into effect. There is a health and safety policy. This commits the Registered Provider to maintaining a safe environment in the Service. The Assessment says that, health and safety is promoted throughout the home. As part of this the chef regularly checks that the refrigerators and freezers are cold enough to store food safely. He also checks that hot foods are cooked through. There is no system to date mark food so that it does not go beyond its use by date. The chef says that this oversight will be corrected straightaway. There are shortfalls in the fire safety training arrangements in that some people are significantly overdue their refresher training. Some members of staff need to update their knowledge of aspects of the fire safety procedure. Fire drills are not being held Care Homes for Older People Page 25 of 31 Evidence: regularly. There is a requirement in relation to these matters at the end of this Report. The records show that items of equipment such as the passenger lift and the various hoists remain in good working order. The records also show that there have not been many significant accidents in the Service since our last Key Inspection. The Manager monitors the occurrence of accidents. This is so that she can see if anything needs to be done to help prevent them from happening again. She says that nothing particular needs to be done at the moment. There is a monthly health and safety audit. This is done to help make sure that there are no hazards that might result in someone having an accident. The Manager says that there are no particular hazards that need to be dealt with. We did not notice any either. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The Registered Provider must ensure that a shortfall in the plan of nursing care for Person A is rectified. To ensure that nurses and health care assistants are supported to respond to instances when the person may become unwell. 04/12/2009 2 8 12 The Registered Provider must ensure that shortfalls in the nursing care provided for Person A and Person B is rectified. To ensure that for Person A there are reliable arrangements in place to maintain their skin integrity and that for Person B there is a suitable system in place to monitor specific aspects of their general health. 04/12/2009 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 19 38 The Registered Provider 18/12/2009 must ensure that regular fire drills are held and that all members of staff receive fire training. To ensure that members of staff know how to follow the Registered Providers fire safety procedure. 4 27 18 The Registered Provider 11/12/2009 must review the adequacy of the numbers of the health care assistants who are on duty during the day and the evening. To ensure that there are enough health care assistants on duty to promptly provide people with the personal care they need and want. 5 30 18 The Registered Provider must provide all of the health care assistants with the training it has identified that they need. To ensure that health care assistants are confirmed as having the knowledge and the skills they need. 01/03/2010 Care Homes for Older People Page 29 of 31 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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