Care Home: Crowborough Lodge

What the care home does well The home provides residents with a homely, relaxed and caring environment. Residents are enabled where possible to exercise choice and control over their lives whilst resident in the home. Residents spoke positively about their experiences at the home. The staff was observed to deliver care, which maintained the residents privacy, dignity and respect. All of the residents spoken with individually overall were happy with the care provided and felt the care provided respected their privacy and dignity. Residents live in a clean and homely environment, with their private accommodation personalised to suit their taste. What has improved since the last inspection? The AQAA detailed further improvements to the environment, with a new entry phone system at the front door, residents televisions in their bedrooms being upgraded and sanitizer dispensers being placed throughout the home. A copy of the complaints procedure is in the home to reference and the Manager stated that all the residents have been given their own copy of the policy to ensure they are aware of the procedures if they wish to make a complaint. The Manager stated that environmental risk assessments are now in place. The menu has been produced in a larger print and is available to view in the dining room. New care workers induction will meet the Skills for Care induction standards. The Manager stated that it is ensured staff provide people with hot drinks to their preferred taste. Policies are dated to show when they were last reviewed. What the care home could do better: The Statement of Purpose and Service Users Guide should detail all the required information to ensure that prospective residents and their representatives have all the information to help make a decision as to where to live. Pre-admission assessments should always be recorded to ensure staff have all the information of the care to be provided. Care plans would benefit from further development and further detail individual residents requirements as to how the care is to be provided to protect residents. Risk assessments should be put in place where residents go out from the home independently to protect the residents. Changes to the storage and recording for control drugs should be put in place to meet new requirements and protect residents and staff. Activities should continue to be developed in the home. As part of the recruitment checks undertaken two written references should be received prior to a member of staff commencing work in the home in order to safeguard residents. Staff training records should be reviewed to ensure that these are up-to-date and trainingand guidance provided where required. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Crowborough Lodge 2 Crowborough Road Saltdean East Sussex BN2 8EA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judy Gossedge     Date: 2 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Crowborough Lodge 2 Crowborough Road Saltdean East Sussex BN2 8EA 01273302614 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : pjn_evans@hotmail.com Evans Care Ltd care home 31 Number of places (if applicable): Under 65 Over 65 31 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 31. 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 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 Crowborough Lodge provides care and accommodation for older people. The home is a large detached house with sea views and is situated in a quiet residential area off the A259 main south coast road in Saltdean. Local transport, shops and other amenities are located close by. Accommodation is provided on three floors. There are four shared bedrooms and twenty-three single bedrooms. All but four of the bedrooms have en-suite facilities. Communal areas consist of a large lounge with a dining area, a conservatory, a smoking room and a small garden area to the rear of the building. Care Homes for Older People Page 4 of 31 Brief description of the care home The current fees range from 435.00 to 500.00 pounds per week. Additional charges are made for hairdressing, chiropody and newspapers. The homes Statement of Purpose, Service Users Guide and a copy of the last inspection report are available to view in the home Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001 uses the term service users to describe those living in care home settings. For the purpose of this report, those living at Crowborough Lodge will be referred to as residents. Since the last inspection an Annual Service Review (ASR) has been completed. It does not involve a visit to the service but is a summary of new information given to us, or collected by us since the last key inspection. The Provider had been asked to complete an Annual Quality Assurance Assessment (AQAA), information from which is quoted in this report. The AQAA was limited in the Care Homes for Older People Page 6 of 31 information that it gave. This was discussed again with the Manager as had been previously discussed at the completion of the ASR as an area in need of development. The Manager stated that further guidance will be sought and this would be addressed. This unannounced inspection took place between 10.30 am and 3.15 pm over four and three quarter hours on 28 May 2009. An Expert by Experience who is a person who, because of their shared experience of using services, and or ways of communicating, also attended the inspection between 10.30 am and 12.00 pm and spoke with residents to gain feedback on the care provided. The premises were viewed including the communal areas and a selection of residents bedrooms. A sample of care records were viewed and are detailed in the report. Twenty-four people were resident, with a further resident due to return to the home during the day. The Expert by Experience spoke with three residents individually in their bedroom; two residents in a communal area and eight residents were spoken with as a group in the lounge. The Inspector spoke to one resident individually in their bedroom, a number of residents as part of the inspection process and two visiting relatives. The care that four of the residents received was reviewed. The opportunity was also taken to observe the interaction between staff and residents in the communal areas. Two care workers; the cook, a domestic assistant the Provider and the Manager were all spoken with. Residents and care workers surveys were not sent out on this occasion. A social care professional was also spoken with after the inspection. What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service Users Guide should detail all the required information to ensure that prospective residents and their representatives have all the information to help make a decision as to where to live. Pre-admission assessments should always be recorded to ensure staff have all the information of the care to be provided. Care plans would benefit from further development and further detail individual residents requirements as to how the care is to be provided to protect residents. Risk assessments should be put in place where residents go out from the home independently to protect the residents. Changes to the storage and recording for control drugs should be put in place to meet new requirements and protect residents and staff. Activities should continue to be developed in the home. As part of the recruitment checks undertaken two written references should be received prior to a member of staff commencing work in the home in order to safeguard residents. Staff training records should be reviewed to ensure that these are up-to-date and training Care Homes for Older People Page 8 of 31 and guidance provided where required. 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 set out 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. There is information about the home available for residents and their representatives to view, but this needs to be reviewed to ensure all the required information is provided. Potential new residents are individually assessed prior to an admission to ensure that their care needs can be met in the home, but a written record of this assessment should always be completed. Intermediate care is not provided in the home. Evidence: The Statement of Purpose and Service Users Guide were read during the inspection. Currently these documents do not detail all the information to be included and as detailed within Schedule 1 of the Care Standards Regulations, and are in need of review. One relative spoken with confirmed their relative had been visited by staff from the home prior to their admission, that they and other members of the family had had the opportunity to visit the home on several occasions in advance of their Care Homes for Older People Page 11 of 31 Evidence: relatives admission and had received enough information about the home. The AQAA details that a pre-assessment is carried out prior to any admission. This is to ensure individual residents care needs can be met in the home and to provide staff with information on the care to be provided. A detailed pre-admissions format is in place, but for the documentation viewed for three new residents admitted to the home since the last inspection only one had this information fully completed, for another the information was partially completed and for the third there was no written record of the assessment. For one resident where the placement was arranged through a local authority there was also a copy of an assessment carried out by a care manager for the authority. Intermediate care is not provided in the home. 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. Residents have an individual plan of care in place, where all their personal, social and health care needs are identified at the start of their stay and which informs staff of the care which needs to be provided and supporting risk assessments are completed. The plans would benefit from further development to detail how individual residents personal care is to be provided and risks assessments should be in place where residents go out from the home independently. Medication policies and procedures are in place. Staff treat residents living at the home with respect and support them to maintain their dignity. Evidence: Five of the residents individual care plans were viewed. These would benefit from more detailed instruction for staff on how the residents personal care needs are to be met. This was raised at the last inspection, so a Requirement has been made on this occasion. The home maintains daily notes and these provide an effective tool for care plan reviews. Supporting risk assessments were also viewed and where there are any Care Homes for Older People Page 13 of 31 Evidence: identified risks the recording detailed how these will be managed. Where residents go out from the home independently a risk assessment was not in place to protect residents. This was discussed with the Manager to stated this would be addressed the next day, so a Requirement was not made on this occasion. All of these documents recorded they had been reviewed, but for one resident the care plan did not detail the care currently being provided. This was discussed with the Manager who stated this would be addressed. One resident commented, when I came here we drew up a care plan and thats followed to the letter. The home maintains and promotes residents health and helps them access health care services to meet their needs. Records viewed evidenced residents are registered with a local General Practitioner (GP) and have access to other health care professionals, including district nurses, via the surgeries. One resident had a visit from a district nurse during the inspection which was part a plan of regular visits to that resident. One resident commented, I couldnt be in better care. They look after me and see to all my needs, and two residents spoke of good access to their district nursing team. Residents confirmed that transport is provided to take them to hospital for check ups and a chiropodist attends on a very regular basis. Both the relatives spoken with confirmed their relatives health care needs are met in the home. The residents spoken with had different care needs, all stated that they had a flexible routine during the day and they were more than happy with their daily routine. One resident stated they had called the night staff and commented, the night staff are really good. They come quickly and theyll make me a cup of tea and talk to me. Theyre wonderful. Care workers spoken with stated that they were made aware of any changes to the residents care needs. The AQAA details the home has a policy for the handling of medication which includes receiving, recording, storage, handling, administration and disposal of medicine. The Manager stated that a pharmacist visits, the records were not viewed on this occasion, and changes were in the process of being made to the procedures and the storage arrangements are being reviewed. A dedicated refrigerator to store medication has now been provided. Residents are able to self medicate under the risk management assessment framework. One of the residents was self administering at the time of the inspection, but a risk assessment had not been put in place. This was discussed with the Manager who agreed to address this with immediate effect, so a Requirement has not been made on this occasion. Medication is stored in a locked facility and a sample of the recording of medication administered was viewed and was adequate. There was no written guidance for staff to reference when medication is administered as and when required. This was discussed with the Manager who agreed to address this as Care Homes for Older People Page 14 of 31 Evidence: part of the changes in progress , so a Requirement has not been made on this occasion. The Requirements for the storage and recording of adminisration control drugs was discussed with the Manager and a Requirement made for the necessary changes to be implemented. The two care workers spoken with who administered medication confirmed they had received medication training. Training records viewed evidenced staff that had received medication training and the Manager stated that further training for staff had been booked. All five of the residents spoken with individually were very happy that their medical needs were being met in the home The staff was observed to deliver care, which maintained the residents privacy, dignity and respect. All the residents spoken with individually overall were happy with the care provided and felt the care provided respected their privacy and dignity. One resident commented , they are lovely here, very pleasant. 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. Where possible residents are enabled to exercise choice in their lives whist resident in the home, there are opportunities to participate in social and recreational activities provided, but that some residents would like more activities to be provided, residents are encouraged to maintain contact with family and friends as they wish and a varied diet is provided. Evidence: The AQAA details that there is a weekly programme of activities, which includes an exercise group, quizzes, bingo and monthly visits from an external entertainer for sing-a-longs. There is a pool table in the home and a selection of DVDs which residents can watch in the lounge or in their own rooms. Residents social interests are recorded on their individual care plans. The Manager stated that some activities icluding outings from the home had had to be temporarily suspended due the person who ran these activities being unable to attend the home. But were due to restart and activities were in the process of being planned. The Provider stated that a more in depth survey is being carried out individually with the residents to look at how the activities in the home can be further improved and acknowledged this was still an area which continued to be developed in the home. On the day of the inspection during the Care Homes for Older People Page 16 of 31 Evidence: morning, residents congregated in the lounge for a church service. A monthly church service is held in the home and the AQAA details that residents will be assisted to make further arrangements to ensure that their religious needs are met. One of the residents spoken with stated they preferred to stay in their room. They have a television and radio and watch television in the evenings and listen to the radio during the day. Another resident stated they spend most of the time in their room entertaining themselves with jigsaw puzzles and the television. A number of residents have a daily newspaper delivered. When residents were asked what activities there were, those who participated spoke of regular bingo sessions and of playing hangman. That there were limited activities and they would welcome more activities being provided. Residents would also benefit from information to reference in the home as to what activities are planned and when. The AQAA details that residents are free to have visitors at any reasonable time. Residents living at the home can receive visitors when they wish to and can choose to see them in one of the lounges or their own rooms. There is a pay phone in the hallway and a cordless phone for residents to make private calls. Both the relatives spoken with confirmed there was flexible visiting, that staff are very welcoming and they could see their relative in private if they wished. Residents living in the home are encouraged to make choices and decisions for themselves. They are supported to manage their own personal money where they wish to and decorate and furnish their rooms with their own belongings. The care and support provided was observed to enable residents where possible to exercise choice whilst at Crowborough Lodge. The five residents files viewed, staff and the residents and relatives spoken with and observations on the day confirmed this. The AQAA detailed that there are choices available at every mealtime and the menu is constantly monitored taking in to account residents expressed likes and dislikes. The cook was spoken with, who works five days a week and stated she holds a basic food hygiene certificate, which she is in the process of updating and an NVQ Level 2 in catering. She commented that there was good access to training in the home. Another cook is employed to work at the weekend. A four-week menu is followed in the home that provides two choices per meal. Residents are asked what choice they would like to select in advance. Staff and residents all confirmed if residents do not like what is on the menu there are always a range of alternatives. The residents spoken with did not know what they were having for lunch with did not appear to have received a menu for that day. One commented, I had a menu, I dont know where it is. Its all in advance, but its the same thing really. If you dont like one thing theres normally another choice or a sandwich. The menu is displayed in the dining room on the board and in a larger print. It should be ensured that the menu is fully accessible to all the residents Care Homes for Older People Page 17 of 31 Evidence: in the home and further consideration given to the siting of this information. The cook stated that the menu is in the process of being seasonally changed and that residents have been able to suggest dishes to be included on the menu. Lunch on the day was fried fish, fish in sauce or egg and chips followed by fruit jelly, peaches, and fruit pie or lemon meringue with cream and or ice cream. Special diets are catered for. Water and squash were available for residents to drink. The majority of the residents were observed eating their lunch in the dining room and others chose to eat their meal in their bedroom. It was a relaxed environment taking into account the different length of time that individual residents would need to finish their meal. All the residents spoken with stated they had enjoyed their meals. Records are kept of food consumed individually by each resident to ensure they are receiving an adequate diet. The Manager agreed to seek advice as to the length of time it is required these records are held to ensure requirements are being met. The Manager also stated that procedures to ensure that all residents have access to sufficient fluids is being reviewed. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to enable residents or their representatives to raise any concerns about the care being provided and to ensure that residents are protected from abuse. Evidence: There is a complaints policy and procedure in place. The Manager stated that all the residents had been given a copy of this to reference, and this is displayed within the home for people to easily access. The AQAA detailed that one complaint had been received at the home during the last year. The residents spoken with stated they were happy to speak to the Manager and staff if they had any concerns and also that their relatives have easy access to the Manager and staff as well. Both the relatives spoken with were aware who to speak to if they had any concerns and felt it was an environment that they would feel comfortable if they wished to raise any concerns. The AQAA detailed that there are policies and procedures in place in relation to the safeguarding of vulnerable adults. The CQC have directly informed of three concerns in relation to the care provided at Crowbourgh Lodge, which have been investigated under safeguarding adults procedures. Two were confirmed as substantiated and one is in the process of being investigated. The Manager and staff spoken with confirmed that changes have been made to procedures in the home following these complaints. Training records viewed did not evidence all staff had received safeguarding adults Care Homes for Older People Page 19 of 31 Evidence: training or an update and the Manager stated that further training has been booked for staff to attend. The two care workers spoken with confirmed they had attended this training and demonstrated an awareness of the policies and procedures. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and homely environment, decorated and furnished to a good standard. The home ensures that residents private accommodation is equipped to provide comfort and privacy and to meet the assessed needs of those people residing in the room. Evidence: The AQAA detailed there is an ongoing maintenance programme. A new entry phone system has been installed at the front door, residents televisions in their bedrooms have started to be upgraded and sanitizer dispensers placed throughout the home. That over the next twelve months it is planned to provide a further bedroom with ensuite facilities, re-decorate and re-carpet residents bedrooms and continue to upgrade the televisions in residents bedrooms. The home is decorated and furnished in a homely style. There are twenty-three single and four double bedrooms on both floors in the home, and all but four have en-suite facilities. Communal bathroom facilities are provided in the home. One bedroom was being used as double bedroom at the time of the inspection by a married couple. A number of bedrooms were viewed which had been personalised and displayed residents individual styles and interests. Residents are able to control the temperature in their own bedrooms. All bedrooms and communal areas have an emergency call bell Care Homes for Older People Page 21 of 31 Evidence: system. Two passenger lifts are available from the ground floor to the first floor. There is a large lounge with dining area and a separate smoking room which both have views out over the sea, and a large conservatory. One window in the conservatory had a large crack, which the Provider stated was due to be replaced. One occupant in the smoking lounge stated, we stay in here most of the time when we are not in our own rooms. Its like our club. Residents have access to a private and well-stocked garden at the rear of the home. One resident was observed during the afternoon sitting out in the garden with their visitors. The AQAA details that there is a policy in place for managing infection control and the Manager stated that Department of Health Guidance has been used to assess current infection control management. The home was clean and free from offensive odours at the time of the inspection. Feedback from the residents and both the relatives spoken with was that the home was always fresh and clean. The domestic assistant on duty was spoken with, who confirmed she had received training and guidance in infection control and the control of substances hazardous to health regulations (COSHH). The Manager stated that usually there would be two domestic assistants on duty but that one domestic assistant was not working that week. The domestic assistant stated that she was able to work extra hours to complete the cleaning if required. The two care workers spoken with stated that they had had infection control training and there was good access to protective clothing, liquid soap and paper towels. The AQAA detailed that all of the staff has received infection control training. The staff training matrix viewed did not detail all staff had completed this training and should be updated and guidance provided if required. Recording was viewed which detailed routine fire checks that had been carried out in the home. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A robust recruitment procedure should be fully demonstrated to be in place to ensure residents are in safe hands at all times. The staffing of the home should be kept under review to ensure that the needs of the residents continues to be met. There are good training opportunities for staff to access. Evidence: The Manager stated that staff levels are calculated according to the needs of the residents and the general function of the home. Staff rotas and staff spoken with confirmed the staffing levels in place. All staff was found to have a good rapport with residents, which promoted a relaxed atmosphere in the home. The Manager was on duty all day with two care workers. The Provider was present in the home during the morning and early afternoon. Two waking night members of staff were due on duty that night. The Manager stated that there was usually four care workers or three care workers and herself on duty during the day, and three waking night members of staff, but that due to the reduced occupancy of the home the staffing levels had been reviewed and reduced, or not all shifts replaced where a member of staff was not working. This was discussed with the Manager who stated that there was flexibility in the staffing provided and that staffing would be increased if required and with an increase in occupancy. This should be kept under review to ensure the care needs of Care Homes for Older People Page 23 of 31 Evidence: individual residents continues to be met. The Manager was also working in the home with the residents and it should be ensured that the Manager has adequate time to undertake the required management tasks. A cook is employed to work in the home seven days a week with a kitchen assistant working in the evening to help with the residents tea. Domestic staff are provided seven days a week to undertake domestic tasks in the home. The AQAA detailed that six of the fourteen care workers holds an NVQ Level 2 in care and training information subsequently provided detailed two further care workers are working towards this qualification and two care workers are working towards NVQ level 3 in care. The AQAA detailed that new staff working in the home had satisfactory preemployment checks. The documentation was viewed for the three new members of staff, who had been recruited since the last inspection. All demonstrated the completion of an application form, one had two written references in place, and two members of staff had one written reference. The Provider subsequently confirmed that a further reference had been received for one of the workers. All had completed a Criminal Records Bureau check (CRB) and a Pova First check. The AQAA details that induction training for new members of staff in place, which meets the requirements of the General Skills for Care induction standards. The Manager evidenced that further guidance had been sought and all new care workers would complete the required induction. One care worker was spoken with during the inspection confirmed they had undertaken an induction. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team have strived to create an atmosphere within the home, which is open, relaxed, homely and caring. Quality assurance systems have been developed to enable ongoing feedback about the care provided in the home, but the outcome should be collated and available to read in the home. Systems are in place to ensure a safe environment for staff and residents, but it should be ensured that staff training records are up-to-date to ensure all staff have received the required health and safety training. Evidence: There is a Registered Manager in place in the home who has completed the Registered Managers Award and NVQ Level 4 in Care. She stated she attends training courses as needed to keep up-to-date with best practice, and that she will be booking further training including training on the Mental Capacity Act and the Deprivation of Liberty. Feedback received was that the running of the home was open and transparent and there were opportunities for staff, residents and their representatives to affect the way Care Homes for Older People Page 25 of 31 Evidence: in which the service is delivered. A quality assurance system is in place. It was evidenced that feedback about the service provided has been sought from residents through residents meetings and surveys. A sample of the minutes from staff and residents meetings were viewed and it was evident that both groups are given the opportunity to influence how the home is run. Annual surveys are sent to visiting professionals and surveys are also available to be completed throughout the year at the entrance of the home. A suggestion box has been placed in the home. Feedback from the outcome of the quality assurance process undertaken in the home has not been collated and should be and available to read in the home. This was raised at the last inspection, so a Requirement has been made on this occasion. The AQAA detailed that policies and procedures are in place and that these had been reviewed. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible person external to the home. A lockable space is provided in their own rooms for personal items. When items are purchased on behalf of residents the cost is added to the monthly invoice. The records were not viewed on this occasion. Supervision for care staff is in place. A plan for supervisions to be completed during the year was viewed and a sample of the detailed records kept. The two care workers spoken with stated that they regularly met with the Manager. The Provider subsequently provided the staff training records. Care workers spoken with confirmed they have received training and updates in moving and handling, basic food hygiene, first aid and infection control within the required timescales. The training records did always detail the training staff stated they had completed and should be updated and training provided where required. The Manager stated that there is an ongoing rolling programme for training and updates of training and the AQAA detailed that medication training, palliative care training and more guidance on nutrition for staff who have not received this training is planned over the next twelve months. The Manager stated that a detailed check of the environment is regularly completed, but the records were not available to view on this occasion. Risk assessments have been completed for the general environment and also any specific risks for individuals. That following the last inspection any risks from the new bathroom door have been assessed and additional signage provided as this opens onto the top of a stairway and could present a risk to staff or people in the home. The AQAA detailed that the maintenance of equipment and services has been carried out. The Manager and staff also stated that there is regular testing of the hot water temperatures at outlets Care Homes for Older People Page 26 of 31 Evidence: accessed by residents to ensure these are being maintained at close to the recommended safe temperature of 43 degrees centigrade. The records were not available to view on this occasion. The Manager stated a fire risk assessment is in place, but this was not available to view during the inspection. Records were viewed of regular checks of the fire procedures in the home. Records viewed evidenced staff had been provided with fire training. Both care workers spoken with stated they had attended fire training and attended a fire drill within the last year. Some doors were being wedged open in the home. The Provider addressed this during the inspection and evidenced that new door closures have been purchased and are waiting to be fitted in the home to stop this practice. A sample of recording was viewed of incidents and accidents which had occurred in the home. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The Statement of Purpose is reviewed to ensure that it details all the required information. To ensure all the relevant parties have the required information to reference and to protect residents. 30/06/2009 2 1 5 That the Service Users Guide is reviewed to ensure that it details all the required information. To ensure that residents and their representatives have all the required information to reference and assist in any decision to move in to the home. 30/06/2009 3 3 14 That the pre-assessment 30/06/2009 documentation is completed. To protect residents and ensure that staff have the information to reference. Care Homes for Older People Page 29 of 31 4 7 15 That the individual care 31/07/2009 plans are further developed to detail how the care will be provided. To protect residents. 5 9 13 That suitable storage and recording is in place for control drugs to meet the new requirements. To protect residents and staff. 31/08/2009 6 33 24 That the results of the 31/08/2009 quality assurance for the home are collated and made available to residents and their representatives. To ensure residents and their representatives have adequate information about the home and enable the quality of the care provided to be monitored and demonstrate improvements made. 7 38 18 That the records of staff 30/06/2009 training evidence that staff have completed the required training courses To protect residents and staff. 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 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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