Care Home: Cross Lane House

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What the care home does well People are generally happy living in the home. When asked what was the best thing about living at Cross Lane House one said `regular meals and no responsibility`. Other comments included `very good here, no complaints`. `Its good here, the staff` are very good`. People surveyed when asked what the home do well commented `everything` and `care`. Most relatives are very satisfied with the care and support received. Three relatives had very positive comments including `its absolutely gorgeous here`. `Everybody is sweet and kind`. `We loved it here from the moment we walked in, X is loved and cared for and we can`t ask for more than that`. `It`s friendly and welcoming`. `When we walked in X was so excited to show us her home that we know this place is right for her`. Staff were generally positive about working in the home. When asked what the home does well comments included `food supplied - type, quantity, drinks. Understanding of each patients background. Responses to individual needs - emergencies, medical, personal relations. Making environment comfortable - clean, bedding, clothes. Staff training. Management practical support`. `The residents are treated as human beings not just another number on a door. Its a happy friendly place to work and the manager and owners are more than happy to muck in when help is needed. The residents all think the world of Mandy and Vince (owners)`. A survey was received from a health care professional. This was positive. Under what the home does well they commented `genuine + caring for clients`. What has improved since the last inspection? The home has made good in roads to addressing shortfalls highlighted previously in care planning, medication systems and quality assurance and monitoring. However further work is required in these areas to fully meet the standards and ensure good outcomes for people living and working in the home. Robust recruitment processes are now in place to protect people living in the home. What the care home could do better: Consult and involve people in their care planning to ensure they reflect their wishes and preferences. Risk assessments should be developed to ensure clear details of how to minimised risk and ensure people are safe. Have a safe procedure for handling over the counter and homely remedy medicines. Develop quality assurance and monitoring so that improvements continued to be made and are sustained to ensure good outcomes for people living in the home. Staff must be appropriately supervised and receive a Skills for Care induction within timescales to ensure their good practise.Events and incidents must be reported to the Commission in line with legislation. Key inspection report Care homes for older people Name: Address: Cross Lane House Cross Lane Ticehurst Wadhurst East Sussex TN5 7HQ     The quality rating for this care home is:   one star adequate 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: Sally Gill     Date: 1 8 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: Cross Lane House Cross Lane Ticehurst Wadhurst East Sussex TN5 7HQ 01580200747 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: VNew490814@aol.com Mrs Amanda Patricia Newport,Mr Vincent John Newport care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category/ies of service only: Care home only - 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 - OP Date of last inspection Brief description of the care home Cross Lane House is registered to provide accommodation for up to 18 older people. Mrs Amanda Newport, one of the owners is also the registered manager and is in the process of handing over day-to-day control of the home to a new manager. The premise is a large detached converted country house. The property is set in approximately two acres of mature gardens with level walkways and seating areas. Accommodation is on three floors. There are fourteen single and two double bedrooms. The homes current policy is to offer the large double bedrooms as singles unless a Care Homes for Older People Page 4 of 31 Over 65 18 0 1 3 0 7 2 0 0 9 Brief description of the care home married couple wish to share. This means that numbers of residents does not usually go above 16. Twelve rooms have ensuite and all others have a wash hand basin. People have the use of three bathrooms, which includes one assisted bath. The home has a lounge, dining room and very large hallway with seating. The home has a passenger lift. The home has parking for several cars and is situated down a quiet road just off the main road. A bus stop is at the end of the road and train station three miles away. The village of Ticehurst is five minutes walk with its general shops, chemist, cafe, church and pubs. The staff compliment consists of a manager, care assistants, cook and kitchen assistants. Care staff work a rota that includes a minimum of three staff on duty during the morning, two in the afternoon and two at night (one of which is a sleep in). The range of fees at the time of the inspection were £450.00 to £650.00 per week. Additional charges are made for telephone, toiletries, newspapers, hairdressing and chiropody. The last inspection report can be obtained from the home or down loaded from www.cqc.gov.uk 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: one star adequate 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 previous inspection took place on 13th July 2009. This inspection was carried out over a period of time and concluded with an unannounced visit to the home between 09.05am and 4.20pm. The owner, manager and staff assisted during the visit. People that live in the home, relatives, a visiting health professional and staff were spoken with. Observations were made throughout the day. Fifteen people were living at the home on the day of the visit. Surveys were sent to the home for the owner to distribute to people living there, staff and health and social care professionals. Four were returned from people living in the home, two from staff and one from health care professionals all of whom were positive about the care and support received. The care of two people was tracked to help gain evidence as to what its like to live at Care Homes for Older People Page 6 of 31 Cross Lane House. Various records were viewed during the inspection and some parts of the home viewed. The home completed an annual quality assurance assessment (AQAA). The AQAA is a self-assessment picture of how the manager thinks they are doing against the national minimum standards. The Commission accept that outcomes for people living in the home have improved which is down to the work of the new manager. These improvements must be sustained over time. 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: Consult and involve people in their care planning to ensure they reflect their wishes and preferences. Risk assessments should be developed to ensure clear details of how to minimised risk and ensure people are safe. Have a safe procedure for handling over the counter and homely remedy medicines. Develop quality assurance and monitoring so that improvements continued to be made and are sustained to ensure good outcomes for people living in the home. Staff must be appropriately supervised and receive a Skills for Care induction within timescales to ensure their good practise. Care Homes for Older People Page 8 of 31 Events and incidents must be reported to the Commission in line with legislation. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their representatives have the information they need in order to make an informed decision as to whether this home is right for them. Information in preadmission assessments do not always allow the home to make sound judgements that an individuals needs can be met. Evidence: People have sufficient information in order to make an informed decision about moving into this home. The home has a combined statement of purpose, service user guide and contract. The owner has previously told us that parts of this are sent out when receiving a telephone enquiry and a copy of the whole document is left for people in their rooms when they move in. People surveyed confirmed they had enough information to help them decide if this home was right for them. People are protected by written contracts of terms and conditions. People surveyed confirmed they had written terms and conditions. Care Homes for Older People Page 11 of 31 Evidence: Peoples needs are assessed although better care when undertaking assessments may lead to a smoother transition when moving in. The owner has to date undertaken the pre-admission assessments for people thinking of moving in, which are recorded. Copies of these assessments are held on file. Assessments for the last two admissions were examined. One contained adequate detail and the other lacked detail in relation to equipment used in the individuals own environment for manual handling and independence. Had this equipment needed to promote independence been explored, supplied or brought in with the individual it may help to promote the individuals independence even now. In one part of the assessment the assessor should score activities and most of these had not been completed. In some cases there was a choice of answer but this had not been determined. Detail in the personal care needs was simply stated quite capable of making own decisions. In another section it was written may need help of 1 carer to lift. This is not sufficient detail for a preadmission assessment for the home to make a decision that needs can be met. Detail in pre-admission assessments must be improved. There is no place for the individual to sign to say they agree with the assessment and none were signed by the individual or their representative which would be good practise. Previously it was highlighted that the home had not obtained a copy of the local funding authority pre-admission assessment and this has now been obtained. People have the opportunity to visit the home before they move in. People spoken with confirm they had been able to visit the home, they knew of the home before moving in or a relative had visited for them. One person said they had visited and stayed for lunch. Intermediate care is not provided. Respite care can be provided vacancies allowing. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are identified within their care plan although these do not yet reflect their wishes and preferences in relation to their routines. Peoples health car needs are met. Medication systems have been strengthening but further work is required to fully protect people. The principles of respect, dignity and privacy are put into practise. Evidence: People can be confident that generally their health and personal needs are recorded in their care plan. Although further work is required to ensure they reflect peoples wishes and preferences. For example one person spoken with indicated they wanted more than one bath per week which they had previously mentioned. The manager told us this has been offered but refused although this is not recorded. Perhaps planning this with the individual into their week would achieve a better outcome for them. People spoken with were happy with the support they receive. People surveyed indicated that they always receive the care and support they need and staff are always or usually available when they need them. Most relatives spoken with felt the care meets the needs of their relative and the home gives the care they expect. Care Homes for Older People Page 13 of 31 Evidence: Since the last visit care plans have improved. A basic physical assessment is in place and this then triggers individual care plans showing care needs. In some areas they contain clear guidance to staff on the management of care and health needs although peoples preferences in relation to their routines should be better detailed. Most care plans now contain a photograph. Three care plans were examined. None were signed as agreed by the individual or evidenced their involvement in the initially drawing up or any reviews. All of which would be good practise. Since November 2009 documents have been reviewed but not all monthly as good practise. Most monitoring charts in place (personal care, bowel management) had far better detail than previously. Although the newly introduced record of food were not always completed fully. For example for one individual five days out of 14 were not fully recorded. Risk assessments in the care plans do need more work particularly moving and handling and must include a clear safe system of work for staff to follow. For example when one carer is needed to assist the technique to be used must be defined. Other risks such as storage of prescribed creams in bedrooms should be risk assessed. The manager told us a key worker system is going to be introduced. It is acknowledged that following a requirement made at the previous inspection considerable work has gone into improving care plans. The manager also has acknowledged there is still work to do. Therefore further enforcement action will not be taken at this time but the requirement reworded to be more specific as to the remaining shortfalls. Peoples health care needs are generally met. Records and discussions evidenced people have access to district nurse, chiropodist, doctors, and dentist and hospital appointments. One person spoken with confirmed a doctor is called whenever needed. People surveys indicated the home always makes sure they get the medical care they need. A district nurse was visiting during the visit. Their feedback was generally positive. They felt any advice and guidance is followed through into practise and that home has improved but still had further work to do. They felt training in health related areas such as diabetes; catheter care and bowel management may promote better health and benefit individuals. People are weighed regularly and for one individual good results have been achieved where this was a concern. There are now guidelines within care plans and good recording to monitor the management of catheter care and diabetes. Although when monitoring blood sugar levels safe levels should be defined but also the risk assessment must detail action to be taken should the levels be outside of safe. People are protected by safer medication systems although further improvements would benefit everyone. The position of the medication trolley and controlled Care Homes for Older People Page 14 of 31 Evidence: medication cupboard has been changed to provide safer storage. Medication Administration Records (MAR) charts were examined. Most contained good use of signatures, codes and stipulated the number of tablets given when a choice. The minor shortfalls were pointed out to the manager. MAR charts are now stored with the individuals photograph and date of birth. The medication policy should be checked to ensure a clear procedure for dealing with both over the counter and homely remedies. No such medicines should be administered by staff unless authorised as safe to do so with current prescribed medicines by the doctor or pharmacist. Medications are logged into the home. Medication returned is also logged although again the home is reminded good practise would be to log medicines waiting to be returned. One tube of eye ointment had not been dated on opening which is good practise. The signature list of staff authorised to administer medication needs updating as only six signatures were recorded and 12 staff have undertaken training. Some medication competency checks have been undertaken by the manager with records maintained as part of supervision. Again it is acknowledged that considerable improvements have been made in relation to medication handling and records although there do remain some shortfalls. Enforcement action will not be taken at this time but the requirement reworded to reflect the specific shortfalls. People are treated with respect and their right to privacy upheld. People spoken with feel they are treated with dignity and respect. Observations confirmed staff adopt a kind and caring approach with people. One relative told us their X is very happy with the care received and all the staff are kind and caring. It was highlighted that one person would like and did not have a key to their lockable bedside cupboard and therefore had no secure storage. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life style. There are limited social and recreational activities. People generally enjoy a variety of meals. Evidence: People continue to have limited opportunities for activities. An afternoon activities programme is in place, which is displayed. This includes bingo, board games, cross words, music and a film. An outside entertainer recently came in to sing and play music as well as local carol singers. One staff member commented both were thoroughly enjoyed by the residents although two staff felt this was an area the home could improve, one said time spent with residents could be better. Another commented the staff have enough time to look after the residents physically but not always to do activities with them. Religious services are held each month. Several people have newspapers or magazines delivered. Two people spoken with said they didnt want to participate in group activities. Another said theres enough to do. Those spoken with said they read their papers or books, do cross words or suduko, watch television or listen to the radio, walk round, have visitors or go out with relatives. One said they enjoy gardening and walk around the grounds most days. Activities records showed a limited variety of activities are happening. Staff advised that some activities are offered but refused but this continues not to be recorded. On the day of the visit Care Homes for Older People Page 16 of 31 Evidence: music was played most of the day in the inner hallway which at times was obviously enjoyed by one individual. In the afternoon people were asked if they wanted to watch a film but just after 4pm one individual was trying to turn off the television and another was asleep. The manager told us crosswords with individuals have been undertaken but also acknowledges this is an area for improvement. People surveyed indicated there were always or usually activities to take part in. Since the last visit people have completed a questionnaire regarding types of activities they would like. People are able to maintain contact with family and friends. People spoken with say they have family and friends visit and they get go out with friends and family. On the day of the inspection people were having visitors. Each bedroom has a telephone point and some people have activated this service to stay in contact with people or have a mobile phone. Most relatives were extremely positive about the home and felt staff kept them well informed. People choose how to spend their time and make day-to-day decisions about their lives. People said they are able to get up and go to bed when they wish. People were asked if they wanted to join the activity. People benefit from a varied diet. People spoken with felt the food was perfectly adequate or varied and quite good but the vegetables tend to be over cooked or super. People surveyed indicated they always or usually like the meals. Currently the home is recruiting two new cooks and once recruited the four-week rotating menu will be reviewed to incorporate peoples choices which have recently been discussed. Most people take breakfast on trays in their bedroom. Breakfast is fruit juice, cereals or porridge and toast. Lunch is the main meal and everyone is encouraged to the dining room to make it a social event. The main meal is not a choice menu but people confirmed alternatives are available followed by a desert. Supper is a light meal, sandwich or salad followed by something sweet and people are asked their choice each day. Lunch on the day of the inspection was cottage pie, carrots and cabbage followed by spotted dick pudding and custard. Care Homes for Older People Page 17 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 who use the service are able to express their concerns, and have access to a complaints procedure although this does require review. People are protected from abuse. Evidence: People feel confident any complaints would be resolved but say they do not have any at present. People confirmed who they would speak to should they have any concerns and felt confident these would be addressed. One said they had brought up an concern recently and the matter is being resolved. However this was not recorded in the complaints book possibly because it was felt it was not a full complaint. Good practise would be to record concerns/grumbles and action taken. People surveyed indicated staff always listen and act on what they say, there is someone they can speak to informally if they are not happy and most knew how to make a complaint. There is a complaints procedure displayed within the front porch although this does require review. The address of the Commission is incorrect and it advises people to take complaints to the local authority which may not be the right course of action. The manager told us there have been no complaints made to the home since the last inspection. The Commission received some concerns and in one case this resulted in a safeguarding referral being made. People are protected from abuse. The home has policies and procedures in place regarding safeguarding adults and whistle blowing. Most staff have received Care Homes for Older People Page 18 of 31 Evidence: safeguarding training and a staff member spoken with was aware of the routes to report any suspected abuse. There has been one safeguarding referral which resulted in an investigation. However the allegations were unsubstantiated. 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. People live in a light, airy, clean, pleasant and comfortable home. Evidence: People live in a generally homely, pleasant and comfortable environment which is well maintained. Since the last visit a bedroom has been redecorated and had new carpet. The parker bath has been repaired. Two evacuation chairs have been purchased as well as a new hoist. Some fire doors have had door closures fitted and some door locks have been changed to ensure safety in the event of a fire. Some rooms do not meet all the individuals expectations or needs. Two rooms were viewed and did vary one was very personalised and homely the other was not. The room viewed which was not homely was being used for an open ended short stay however this does mean the room cannot be made more homely. For example there were several empty picture hooks and no pictures in the room. People confirmed they had been able to bring in their own things. People spoken with said they like their rooms, they were alright or OK. However when asked what could the home improve one indicated the ensuite, height of the window and the easy chair. Independence and outcomes may be maximised with better equipment. When assessing whether someones needs can be met at the home thought should go into maximising their independence and specialist equipment. For example one individual Care Homes for Older People Page 20 of 31 Evidence: has a small ensuite and grab rails could not be fitted in an appropriate place which means the individual needs assistance instead of being independent. This individuals independence may also be improved if equipment previously used at home is accessed. The home has recently commissioned an assessment of the home by an Occupational Therapist. They have made recommendations regarding improvements to ensure better wheelchair access through the front doors. The owner told us that it is intended in the future to have a shower room which two of the individuals spoken with said they prefer to a bath. When renewing furniture thought should be given to aiding independence. For example further carver dining room chairs and higher easy chairs. People are able to enjoy light and airy communal accommodation. One relative said when you walk in its just like you know their own home would be. The home is set in large grounds with pathways for walks, which in the good weather are enjoyed by people living at Cross Lane House. Most people do spend time in their rooms those that sit downstairs tend to sit in the hallway which is the hub of the home. The manager told us she has plans to make the main lounge more welcoming and homely. One staff member felt management were trying to make the home more homely by gradually de-cluttering and had introduced fresh flowers. The home was clean and generally hygienic. People spoken with confirmed their rooms are cleaned regularly and are always clean and tidy. People surveyed indicated the home is always or usually clean and fresh. One staff member felt that practical organisation of the laundry room could be better. The open top waste bin outside the office needs to be replaced with something more suitable as staff are using this to dispose of used disposable gloves and aprons which is not hygienic. 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 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 support from a staff team which is sufficient in numbers, qualified and trained. People are protected by robust recruitment processes. Evidence: Peoples needs are met by the numbers and skill mix of staff. The manager advised that there are four staff on duty 8am to 2pm which include the manager and two staff 2pm to 8pm and three 7pm to 8pm. There is one member of staff on duty at night 8pm - 8am and another sleeps in for emergencies 7pm - 7am. The home intends to increase staffing from 4pm to 7pm shortly. In addition the owners also spend considerable time at the home and currently as there are two cook vacancies one owner is undertaking cooking the main meal. There is a domestic Monday to Friday only. All comments about the staff were all positive. One person confirmed they were always around when needed and if you did have to wait it wasnt long. Another said they are on hand when you ring the bell. Most staff surveyed felt there is usually enough staff to meet individual needs. One commented the staff have enough time to look after the residents physically but not always to do activities with them. People receive care from a qualified staff team. The owner told us that six staff have obtained their National Vocational Qualification (NVQ) level 2 or above. The owner advised another five are working towards this. When completed this will meet the 50 recommended by the National Minimum Standards for good practise. Care Homes for Older People Page 22 of 31 Evidence: People are protected by the homes recruitment processes. Four staff files were examined of staff recruited since the last inspection. These showed all appropriate checks have been undertaken. People receive support from a trained staff team. An orientation induction is in place however on most staff files viewed this could not be evidenced. Staff then go onto a Skills for Care induction if they have not obtained or started an NVQ which should be completed within 12 weeks of employment. However for the one employee where this should have been completed management had not checked nor examined the content for competency. A requirement is made in relation to induction training and timescales. Staff surveyed felt their induction very well or mostly covered what they needed to know. The owner advised of training data. Most staff are trained in mandatory subjects (fire, first aid, infection control, moving and handling and food hygiene). Further training has taken place since the last inspection in fire, first aid, moving and handling and medication. Staff surveyed felt they receive the training they need for their role. One staff member spoken with confirmed that they had received a staff handbook and there has been informal training on completion of care records. 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 adequate 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 home where management has worked hard to improve procedures and systems. Further improvement is still required and quality assurance and monitoring needs to be developed further to ensure the home does continue to improve, meet standards and improves outcomes for people living at the home. Evidence: The owner/registered manager previously advised she has completed her Registered Manager Award (RMA) and has an NVQ in care level 4. She told us unfortunately she has had to complete further work and now feels she has finished the award. The home have since the last inspection appointed a manager (September 2009) who is in day to day control of the home although the owner still spends considerable time in the home and it is a case currently of team work. The owner told us the new manager should shortly be submitting an application to register with the Commission. The manager has previously been registered with the Commission and has a RMA and NVQ level 4. Feedback regarding the owners and new manager was positive. Care Homes for Older People Page 24 of 31 Evidence: Some quality assurance work has been undertaken but this needs to be developed further. Relatives had previously been sent quality assurance questionnaires to complete and these have been returned. The manager told us that any negative comments have been addressed with the individuals. No other feedback has been given and suggestions to achieve this were discussed. No resident meetings have been held since the last inspection. Although people have been asked about activities and menus. The manager told us the menu ideas will incorporated into new menus when the new cooks start. One health professional surveyed felt admin and organisation could be improved. People do not benefit from a staff team who receive supervision. Two staff meetings have been held. However the minutes are very much laying the law down to staff rather than setting an agreed agenda, giving them a voice and discussing items. The manager told us that there has been some supervision but not enough. Files examined evidenced staff had received one or no supervision since the last inspection. Some supervision minutes were examined but these reflected competency checks which is good practise but is not a substitute for supervision. The format of supervision was discussed with the manager. A requirement is made. Staff surveyed felt the manager gives them enough support and meets with them regularly or often. One staff member said they do feel supported and were confident any issues would now be sorted out. The owner advised that the home currently holds a small amount of savings for two people. These were examined and found to be in order. Improvements have been made to promote and protect peoples health, safety and welfare. A new hoist has been purchased and two evacuation chairs. Records confirmed appropriate tests and servicing for fire equipment. Since the last inspection the Fire Officer has visit the home. The report indicates that four requirements were made. The manager told us a fire risk assessment and evacuation plan is now in place. Some door guards have been fitted and some fire exit door locks changed. The outstanding requirement relates to fitting fire door seals/strips. Although there was no timescale indicated on the Fire Officers report the manager advised a timescale of eighteen months had been agreed for this work to be completed. The manager told us completed accident reports are now stored in care plan folders although the accident book could not be found during the visit. Some events are required to be reported under legislation to the Commission and although it is apparent such events have taken place the Commission has received no reports. A requirement is made. It is acknowledged that management has worked hard to improve things in the home Care Homes for Older People Page 25 of 31 Evidence: particularly medication administration, care plans and record keeping. These need to be sustained over time and remaining shortfalls addressed. Discussions with management confirm that the hard work will continue to address the remaining shortfalls and sustain improvements therefore enforcement action is not taken at this time. Management must ensure through quality monitoring and supervision that all staff have skills and confidence to maintain the homes procedures. Discussions and observations of staff highlight they can lack confidence in questioning when correct procedures are not followed and follow suit. 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 15 The registered provider 22/02/2010 must involve/consult and review with individuals regarding their care plan to ensure the plan reflects their wishes and preferences. Risk assessments clearly define the safe system of work which will minimise the risk. Regulation 15 (1) (2) requires unless it is impracticable to carry out such consultation the registered person shall after consultation with the service user or a representative of his prepare a written care plan. The registered person shall make the service users plan available to the service user: keep the service users plan under review: 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 2 9 13 The registered person must have a safe system for medication. In particular homely remedies and over the counter medication. Regulation 13(2) requires the registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines into the care home. 11/02/2010 3 30 18 The registered provider shall 11/02/2010 ensure persons employed in the care home receive appropriate structured induction training to Skills for Care specification and timescales Regulation 18(1) (c)(i) requires that the registered person shall ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they perform including structured induction training 4 33 37 The registered provider 11/02/2010 must inform the Commission in writing without delay of events as detailed in regulation 37 Care Homes for Older People Page 29 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 Regulation 37 requires the registered shall give notice to the Commission without delay of any occurrence as listed in regulation 37 (1) 5 33 18 The registered provider shall 11/02/2010 ensure that persons working at the care home are appropriately supervised. In that they receive regular structured supervision according the National Minimum Standards Regulation 18 (2) (a) requires that the registered person shall ensure that persons working at the care home are appropriately supervised. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 33 Further develop and implement quality assurance and quality monitoring systems to ensure systems for sustaining, reviewing and improving the quality of care provided at the care home. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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