Care Home: Deansgrove Residential Care Home

What the care home does well Deansgrove presented as a warm, comfortable and caring environment. The manager and her staff team were observed to be attentive to the needs of residents during the inspection and were seen to treat residents with respect. Residents spoken with during the inspection confirmed they were generally satisfied with the standard of care provided. Comments included: "The girls [staff] are very helpful"; "I enjoy every minute I`m here and the staff are very nice" and "I am treated very well". A visiting health care professional and a relative were also spoken to during the inspection and confirmed the standard of care provided was good. A Statement of Purpose and Service User Guide had been developed in a standard format to provide information to prospective and current service users on the service provided at Deansgrove and assessment and care planning systems had been established to ensure the needs of residents were identified and planned for. Residents were observed to receive visits from family members during the day and service users spoken with confirmed they were supported to maintain contact with family and friends and to retain as much independence as possible. The lifestyle experienced by residents appeared relaxed and flexible and residents confirmed they could follow their preferred routines. The menu provided evidence that residents received a satisfactory diet and additional drinks were served throughout the day. Feedback received from residents was generally positive about the standard of catering. Comments included; "The food is alright"; "I can`t complain about the meals. I think they are fine" and "I enjoy the meals". Staff spoken with confirmed they had access to ongoing training and development opportunities and documentary evidence of induction, safe working practice, national vocational qualifications and other relevant training was available for reference. Systems had been developed to ensure an appropriate response to complaints and suspicion or evidence of abuse. Furthermore, a basic quality assurance system had also been established and was subject to ongoing development, to ensure the service was run in the best interest of residents. What has improved since the last inspection? Since the last visit, arrangements had been made to ensure medication was administered in accordance with the prescribed instructions to safeguard the health and welfare of individual residents. Furthermore, details of the date, quantity and initials of the person receiving medication into Deansgrove had been recorded on Medication Administration Records to ensure a clear audit trail. Information on equality and diversity issues and past medical history had been taken into consideration as part of the pre-admission assessment process, to ensure an holistic assessment of needs.Further progress had been made in supporting staff to complete safe working practice training and a number of staff had completed equality and diversity training. Regulation 26 reports had been completed by the Registered Provider (owner) and the environment had continued to receive ongoing maintenance and refurbishment. What the care home could do better: The details of the new regulator (Care Quality Commission) should be included in the Statement of Purpose and Service User Guide, to ensure people have up-to-date contact information. A copy of the complaints procedure should also be displayed in the reception area of the home for visitors to view. Arrangements should be made for residents to have more involvement in monthly care plan reviews and the actual dates of reviews should be recorded. This will help to develop a more person-centred approach to care planning and provide a clear audit trail. Care plans should be updated to include more information on the frequency of routine health care appointments including oral care and the preferred routines of the people using the service. Furthermore, the outcomes of health care appointments should be recorded in more detail. This will help to safeguard the health and welfare of residents and help to improve record keeping. Risk assessments should be updated to include more detailed information on the preventative measures to safeguard the health and safety of residents. The range and frequency of activities should be further developed and include community based options to enhance each resident`s quality of life. A copy of the menu plan should be produced in large print and available for residents and their representatives to view, to ensure best practice. The health and safety checklist should be completed and retained for inspection purposes to provide evidence of the scope and frequency of health and safety checks. This will help to safeguard the welfare of the people using and working in the service. A supply of red bags should be available in the home for domestic staff to use for potentially infectious bio hazardous waste. This will help to maintain good standards of infection control. The training programme should be extended to include training in the conditions associated with old age and gaps in core training should be addressed as a matter of priority. This will help to develop the competency of staff and ensure residents are in safe hands at all times. The in-house quality assurance system should continue to be developed and reference should be made to adopting aspects of the quality assurance package purchased by the Registered Provider. This will ensure the system is robust and developed in accordance with best practice.Night staff should received fire refresher training every three months and day staff every six months and records maintained. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Deansgrove Residential Care Home 38 Bluebell Lane Huyton Knowsley Merseyside L36 7XZ     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: Daniel Hamilton     Date: 1 4 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 32 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 32 Information about the care home Name of care home: Address: Deansgrove Residential Care Home 38 Bluebell Lane Huyton Knowsley Merseyside L36 7XZ 0151-489-1356 01514898289 deansgrove@btconnect.com 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) : Mr James Edward Jenkins care home 29 Number of places (if applicable): Under 65 Over 65 29 29 old age, not falling within any other category physical disability Additional conditions: 0 0 Service users to include up to 29 OP and up to 29 PD(E) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Deansgrove is a residential care home, which is registered to provide personal care and support for up to 29 older people, including older people with a physical disability. It is located in an established residential area of Huyton within approximately a mile of the town centre. Deansgrove was not originally purpose-built but was adapted from existing properties to provide 17 places. During 2005, the side of the premises was redeveloped, to provide an additional 12 bedrooms with en-suite facilities. Care Homes for Older People Page 4 of 32 Brief description of the care home Deansgrove has two floors. Access to the upper floors is gained via a passenger and stair lift. On the ground floor there are two small lounges, a conservatory/ dining room, a kitchen, office, laundry and some bedrooms. The first floor consists solely of bedrooms. The home is equipped with a call bell system and has adequate assisted bathing and toilet facilities, which are spread evenly throughout the premises. There is a large garden to the rear of the home, which can be accessed via the conservatory. Parking facilities are available at the front of the property. Care Home Fees range from £373.94 to £393.94 per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use the service experience good quality outcomes. This unannounced inspection took place over one day and lasted approximately 9 hours. A partial tour of the premises took place and observations were made. Three care files and a selection of staff and service records were examined and the Registered Provider (owner), Registered Manager, three care staff, two visitors and seventeen residents were spoken with during the visit. Reference was also made to an Annual Quality Assurance Assessment (AQAA) which was completed by the Registered Manager. The AQAA enables a Registered Provider to Care Homes for Older People Page 6 of 32 undertake a self-assessment on the service prior to an inspection and focuses on how well outcomes are being met for people using the service and provides some numerical information about the service. What the care home does well: What has improved since the last inspection? Since the last visit, arrangements had been made to ensure medication was administered in accordance with the prescribed instructions to safeguard the health and welfare of individual residents. Furthermore, details of the date, quantity and initials of the person receiving medication into Deansgrove had been recorded on Medication Administration Records to ensure a clear audit trail. Information on equality and diversity issues and past medical history had been taken into consideration as part of the pre-admission assessment process, to ensure an holistic assessment of needs. Care Homes for Older People Page 8 of 32 Further progress had been made in supporting staff to complete safe working practice training and a number of staff had completed equality and diversity training. Regulation 26 reports had been completed by the Registered Provider (owner) and the environment had continued to receive ongoing maintenance and refurbishment. What they could do better: The details of the new regulator (Care Quality Commission) should be included in the Statement of Purpose and Service User Guide, to ensure people have up-to-date contact information. A copy of the complaints procedure should also be displayed in the reception area of the home for visitors to view. Arrangements should be made for residents to have more involvement in monthly care plan reviews and the actual dates of reviews should be recorded. This will help to develop a more person-centred approach to care planning and provide a clear audit trail. Care plans should be updated to include more information on the frequency of routine health care appointments including oral care and the preferred routines of the people using the service. Furthermore, the outcomes of health care appointments should be recorded in more detail. This will help to safeguard the health and welfare of residents and help to improve record keeping. Risk assessments should be updated to include more detailed information on the preventative measures to safeguard the health and safety of residents. The range and frequency of activities should be further developed and include community based options to enhance each residents quality of life. A copy of the menu plan should be produced in large print and available for residents and their representatives to view, to ensure best practice. The health and safety checklist should be completed and retained for inspection purposes to provide evidence of the scope and frequency of health and safety checks. This will help to safeguard the welfare of the people using and working in the service. A supply of red bags should be available in the home for domestic staff to use for potentially infectious bio hazardous waste. This will help to maintain good standards of infection control. The training programme should be extended to include training in the conditions associated with old age and gaps in core training should be addressed as a matter of priority. This will help to develop the competency of staff and ensure residents are in safe hands at all times. The in-house quality assurance system should continue to be developed and reference should be made to adopting aspects of the quality assurance package purchased by the Registered Provider. This will ensure the system is robust and developed in accordance with best practice. Care Homes for Older People Page 9 of 32 Night staff should received fire refresher training every three months and day staff every six months and records maintained. 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 10 of 32 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 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information and have their needs assessed before deciding to move into Deansgrove, so that they know their needs can be met. Evidence: A Statement of Purpose and Service User Guide had been developed in a standard format to provide information to prospective and current service users on the service provided at Deansgrove. A copy of the Statement of Purpose was available in the reception area of the home and a copy of the Service User Guide had been placed in each residents room for reference. Examination of the documents revealed that they were in need of review as the name of the new regulator (Care Quality Commission) had not been included. Previous inspection records confirmed that the home was able to produce the documents in alternative languages including braille, subject to individual need, Care Homes for Older People Page 12 of 32 Evidence: however no other formats were available for reference on the day of the visit. The Annual Quality Assurance Assessment for the Service detailed that a Referral and Admissions Policy was in place for staff to reference as previously noted. The files of three residents were randomly selected to view during the visit. Two files were for permanent residents and one was for a resident who had recently used the service for a period of respite care. Each file viewed contained a pre-admission assessment of needs. Copies of assessments and care plans completed by social workers and health care professionals had also been obtained for reference. Assessments undertaken by the manager of Deansgrove had been completed to a satisfactory standard and were clear and concise. Information on equality and diversity issues and past medical history had also been included as recommended at the last visit. At the time of the visit the home did not provide intermediate care. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people using the service are met by staff who understand how to provide care in a manner that protects peoples privacy and dignity. Evidence: The Annual Quality Assurance Assessment (AQAA) for the service confirmed a policy on Individual Planning and Review and The Control, Storage, Disposal, Recording and Administration of Medicines was in place as previously noted. The files of three residents were randomly selected to view during the visit. Two files were for permanent residents and one was for a resident who had recently used the service for a period of respite care. Each file contained a care plan that was based upon the initial assessment of needs for individual residents and outlined the needs of residents, support required from staff and the aims and objectives of the plan. Examination of records confirmed that care plans had been kept under monthly review however the dates of the reviews were vague as only the month had been recorded Care Homes for Older People Page 14 of 32 Evidence: and a number of residents spoken with reported that they were not directly involved in monthly care plan reviews. This issue should be reviewed in consultation with residents. Since the last inspection, the manager had updated care plans to include more information on the routine health care needs of the people using the service as recommended at the last inspection. Advice was given regarding the need for care plans to detail the frequency of all routine health care appointments and to include more information on oral health care / routine dentist appointments, to ensure a more pro-active approach. Supporting documentation including; daily report sheets, personal care and weight records, dietary preferences, declaration of wishes in relation to medication and a range of risk assessments had been completed subject to individual need. It was noted that some risk assessments did not contain information on the control mechanisms for identified risks as previously noted although some information had been recorded in care plans. Furthermore, the service did not have a satisfactory risk assessment in place for residents who required assistance with moving and handling. The manager sourced a suitable risk assessment tool during the visit and addressed the majority of shortfalls noted. Since the last visit Deprivation of Liberty checklists had also been introduced to safeguard the rights of residents and to ensure best practice. Medical appointment records confirmed that residents had accessed a range of health care professionals subject to individual need including opticians, chiropodists, district nurses, continence nurses, community dietitians and general practitioners. The outcome of some appointments was vague and advice was given to the manager on how to address this issue as similar issues were noted at the last visit. Examination of medication storage facilities confirmed Deansgrove continued to use a blister pack system that was dispensed by a local pharmacist. Medication was appropriately stored in medication cabinets, which were secured to the wall. A controlled drugs cabinet and register was also in place. Advice was given to the manager on how to improve the security of the chain securing the medication cabinets to the wall. A record of staff responsible for the administration of medication, together with sample signatures had been developed and a resident identification system was in place. A system to monitor the competency of staff designated with responsibility for administering medication was in use and documentary evidence of medication training confirmed staff responsible for administering medication had completed medication training via a range of training providers. Care Homes for Older People Page 15 of 32 Evidence: At the time of the inspection none of the residents self-administered medication. Declaration of wishes for the administration of medication had been completed by each resident or their representative. A number of Medication Administration Records (MAR) were viewed during the visit. Records viewed had been maintained to a satisfactory standard and accounted for the receipt and administration of medication. Appropriate systems were also in place for the storage of medication. Previous inspection records detailed that the home had developed a policy on the values of Privacy and Dignity. Staff spoken with during the visit demonstrated a satisfactory understanding of the principles of good care practice and were observed to treat the residents with respect and dignity. Residents spoken with during the inspection confirmed they were satisfied with the standard of care provided. Comments included: The girls [staff] are very helpful; I enjoy every minute Im here and the staff are very nice and I am treated very well. A visiting health care professional and a relative were also spoken to during the inspection and confirmed the standard of care provided was good. One relative expressed concern regarding some residents changing into their pyjamas early in the evening. Residents spoken to during the visit confirmed this was their choice however the manager was recommended to include more information in care plans on each residents preferred routines and wishes in regard to this issue. Care Homes for Older People Page 16 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provision of social activities requires ongoing development to ensure people have opportunities to access regular in-house and community based activities of their choice. Evidence: A programme of activities based upon the recreational needs and interests of residents had not been developed as previously recommended. Discussion with the manager and examination of the Annual Quality Assurance Assessment (AQAA) for the service confirmed that a programme had not been produced as the residents did not want a set activities routine and preferred to be asked on a daily basis which activities they would like to participate in. Examination of the activities record book confirmed a limited range of in-house activities had been provided however there was no evidence of community based activities. Records showed that recent activities provided included; listening to music, play your cards right, exercises, bingo, dominoes, karaoke, sing-a-long, board games, hairdressing and occupational therapy. Records showed there were occasions when no activities had been provided for several days and in one case there had been no recorded activities for fourteen days. Care Homes for Older People Page 17 of 32 Evidence: Residents spoken with continued to express mixed views regarding the range of activities provided. Comments included: Im not really interested in activities,Im happy with the way things are and There is enough entertainment for me. Conversely, some people reported that they would like to have more entertainment and trips out. For example; one person reported; In my opinion there is not a lot [activities] on offer and another resident said; I would like the chance to get out more. An outside entertainer continued to visit the home on a monthly basis and representatives from the local Church of England and Roman Catholic churches continued to visit residents periodically, subject to their individual religious beliefs and preferences. Since the last visit a Sky digital receiver and a Karaoke machine had been purchased following discussion with residents. The AQAA for Deansgrove detailed that policies and procedures concerning contact with and visits by family and friends had been developed. Likewise, the Statement of Purpose detailed that; Visitors are welcome at any time. Residents were observed to receive visits from family members during the day and people spoken with confirmed they were supported to maintain contact with family and friends and to retain as much independence as possible. The lifestyle experienced by residents appeared relaxed and flexible and residents confirmed they could follow their preferred routines. The AQAA for the service indicated that policies and procedures had been developed regarding food safety and nutrition and previous records confirmed the service had obtained a copy of the Food Standards Agency Guidelines for reference. A four-week rolling menu had been developed which provided a choice of meals for breakfast, dinner and tea. The manager reported that the menu plan remained as per the last inspection with the exception of changes to soups. The manager was advised to produce the menu in a large print and to display it in an area for residents to view. The menu provided evidence that residents received a satisfactory diet and additional drinks were served throughout the day. Meals were served in the homes dining room at set times however some residents preferred to eat their meals in their bedrooms and this choice was respected. The dining room was pleasantly decorated and furnished and tables were set with table mats, paper napkins, flowers and condiments. Drinks were served throughout the day and a water cooler was available at the entrance to the dining room. Care Homes for Older People Page 18 of 32 Evidence: The manager confirmed that the service was able to cater for different health, religious and cultural dietary requirements subject to the individual needs of residents. Feedback received from residents was generally positive about the standard of catering. Comments included; The food is alright; I cant complain about the meals. I think they are fine and I enjoy the meals. Care Homes for Older People Page 19 of 32 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. Systems have been established to ensure an appropriate response to complaints and suspicion or evidence of abuse. This ensures that the views of people using the service are listened to and acted upon and that people are offered protection from abuse. Evidence: A complaints procedure had been developed for Deansgrove, a copy of which was included in the Service User Guide and the Statement of Purpose. The manager reported that a copy of the complaints procedure had been given to each resident and this was confirmed in discussion with the people using the service. The manager was advised to also display a copy of the procedure in the reception area of the home for visitors to view. The Annual Quality Assurance Assessment for the service detailed that no complaints had been received by the manager since the last visit and this was confirmed by referring to the complaint records for the service. Likewise, there had been no adult protection referrals or investigations in the last 12 months. No complaints, concerns or allegations were raised by residents or their representatives during the visit and no issues of concern had been raised with the Commission since the last visit in May 2008. The Annual Quality Assurance Assessment for the service confirmed that policies and Care Homes for Older People Page 20 of 32 Evidence: procedures were in place within the home to ensure an appropriate response to suspicion or evidence of abuse as noted at the last visit. The training matrix for the service indicated that all staff had completed training in the Protection of Vulnerable Adults and overall, staff spoken with demonstrated a satisfactory awareness of the different types of abuse and reporting procedures. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within this home is good providing residents with an attractive and homely place to live. Evidence: A full time maintenance worker was employed at Deansgrove who was responsible for maintaining the home and grounds. Contractors were hired for major and specialised work as and when required. A maintenance book was in place to record work in need of attention and the manager reported that she continued to monitor the condition of the environment with the maintenance worker for Deansgrove. Examination of records revealed the weekly health and safety checklist had not been completed since July 2008. A maintenance and refurbishment plan was not in place however the registered provider continued to invest in the upkeep of the environment. The Annual Quality Assurance Assessment (AQAA) detailed that in the last twelve months two of the downstairs bedrooms and bathrooms had been refurbished and the small quiet lounge and conservatory had been repainted. The location and layout of the home was suitable for its stated purpose (please refer to Care Homes for Older People Page 22 of 32 Evidence: the Brief Description of the Service section for more information on the premises). Rooms viewed were personalised and residents were observed to have access to personal mobility aids, subject to individual needs. The AQAA confirmed policies and procedures were in place for preventing infection and managing infection control as noted at the last inspection and training records confirmed that the majority of staff had completed infection control training. Two part-time domestic staff continued to work in the home and areas viewed during the visit appeared well maintained, clean and hygienic. Residents confirmed the home was kept clean and fresh and no offensive odours were noted. It was noted that the service did not have a supply of red bags for infection control at the time of the visit and this issue was brought to the attention of the manager. Care Homes for Older People Page 23 of 32 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. Residents are supported by staff who are correctly recruited, inducted and have access to training and development opportunities. This safeguards the welfare of the people using the service. Evidence: Discussion with the manager and examination of rotas confirmed the staffing levels in the home remained largely the same as at the last inspection. Rotas viewed confirmed four care staff were on duty each day from until 10.00 pm and during the night three waking night staff were on duty. The manager was supernumerary. The rotas had been updated since the last inspection to specify the capacity of each employee. Ancillary staff including a chef, cook, two part-time domestics, and a full time handyman were also employed. It was noted that the service did not have a suitable system in place to monitor the dependency levels of the people using the service or the resultant staffing levels. Advice was given to the manager on where to access guidance from the department of health. Staff were observed to be attentive to the needs of residents during the visit and feedback received from residents confirmed they were satisfied with the standard of Care Homes for Older People Page 24 of 32 Evidence: care received. The Annual Quality Assurance Assessment (AQAA) for the service detailed that home had policies and procedures in place for the recruitment of staff and equal opportunities, diversity and anti-oppressive practice as previously noted. The manager reported that two staff (a part-time cook and a carer) had commenced employment at the home since the last inspection. The two files for the new employees were examined during the inspection and both were found to contain the necessary records required under the Care Home Regulations 2001. Advice was given to the manager concerning future student placements and the processing of in-house Protection of Vulnerable Adult and Criminal Record Bureau checks to ensure best practice. At the time of the visit the home employed 23 care staff (including the deputy manager). The AQAA and training matrix detailed that 21 (91.30 ) staff had completed a National Vocational Qualification at Level 2 or above in Care or equivalent. Progress logs and certificates of completion were available on files to confirm new staff had successfully completed the Skills for Care Induction course and were Safe to Leave and staff spoken with confirmed they had received an induction and formal supervision periodically. Examination of the training matrix and discussion with staff confirmed staff had access to induction, safe working practice, national vocational qualification, protection of vulnerable adults and medication training. Since the last visit fourteen staff had also completed equality and diversity training as previously recommended. Good progress had been made in supporting staff to access safe working practice training however training records highlighted gaps in health and safety and food hygiene training. The service should continue to address these issues and expand the range of training offered to staff to include training on the conditions associated with old age etc. Care Homes for Older People Page 25 of 32 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. Management and administration systems are subject to ongoing development to ensure the welfare of the people living in Deansgrove are promoted and protected. Evidence: Mrs Amanda Byrne is registered with the Care Quality Commission as the manager of the home and has been in post since January 2006. Documentary evidence was viewed during the visit which confirmed the manager had completed the level 4 National Vocational Qualification (NVQ) Registered Managers Award and level 4 NVQ in Health and Social Care. Certificates viewed also provided evidence of the manager having undertaken ongoing training and development that was relevant to her role and responsibilities. Prior to the inspection the manager completed a document known as an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service and provides some Care Homes for Older People Page 26 of 32 Evidence: numerical information about the service. The information in the document was very brief as noted at the previous inspection. Therefore, the importance of the document and the need for detailed information to be provided in future was stressed to the manager and registered provider during the visit, to ensure best practice. The Registered Provider did not commission an external organisation to undertake a quality assurance assessment of Deansgrove as previously noted. Records were available which confirmed the Registered Provider undertook monthly visits in accordance with Regulation 26 of the Care Home Regulations and a basic quality assurance questionnaire had been developed and circulated to residents or their Representatives during January 2009. A summary of the outcome together with an updated questionnaire and development plan was forwarded to the Commission following the inspection for reference. Advice was given to the Registered Provider on how the quality assurance process should be further developed to ensure best practice. This should incorporate aspects of the quality audit system previously purchased. Discussion with the manager and residents and examination of minutes confirmed that three resident meetings had been coordinated since the last visit and minutes viewed provided evidence that a number of issues including home improvements, activities and menus had been discussed. No team meetings had been coordinated since May 2007 and this should be addressed. The home had established a system for fees to be paid directly into the homes business account. The majority of residents looked after their financial affairs with support from family members or appointed representatives. At the time of the visit the owner and manager did not act as an appointee for any of the people living in the home. At the time of the visit the manager looked after the personal finances of two residents. Individual records were in place to record transactions and receipts were available for expenditure. Likewise, cash balances were not pooled and found to be correct. The Annual Quality Assurance Assessment (AQAA) detailed that equipment and services within the home had received regular maintenance checks. Fire records were inspected during the visit. Service records confirmed the fire alarm system and nurse call system had been recently been serviced however a certificate could not be located to confirm the fire extinguishers had been serviced during November 2008. In-house records provided evidence of weekly tests of the fire alarm system and Care Homes for Older People Page 27 of 32 Evidence: monthly visual inspections of the fire extinguishers and testing of the emergency lighting. No records were available to confirm that day and night staff had received fire instruction refresher training at the appropriate intervals as previously recommended. A fire and building risk assessment had been completed. The manager was advised to update the fire risk assessment as some gaps were noted. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The details of the new regulator should be included in the Statement of Purpose and Service User Guide, to ensure people have up-to-date contact information. The outcomes of health care appointments should be recorded in more detail in order to improve record keeping. Risk assessments should be updated to include more detailed information on the preventative measures to safeguard the health and safety of residents. Arrangements should be made for residents to have more involvement in monthly care plan reviews and the actual dates of reviews should be recorded. This will help to develop a more person-centred approach to care planning and provide a clear audit trail. Care plans should be updated to include more information on the frequency of routine health care appointments including oral care and the preferred routines of the people using the service. This will help to safeguard the health and welfare of residents. The range and frequency of activities should be developed and include community based options to enhance each residents quality of life. Page 30 of 32 2 3 7 7 4 7 5 8 6 12 Care Homes for Older People 7 15 A copy of the menu plan should be produced in large print and available for residents and their representatives to view, to ensure best practice. The health and safety checklist should be completed and retained for inspection purposes to provide evidence of the scope and frequency of health and safety checks. This will help to safeguard the welfare of the people using and working in the service. A supply of red bags should be available in the home for domestic staff to use for potentially infectious bio hazardous waste. This will help to maintain good standards of infection control. The in-house quality assurance system should continue to be developed and reference should be made to adopting aspects of the quality assurance package purchased by the Registered Provider. This will ensure the system is robust and developed in accordance with best practice A copy of the most recent service certificate for the fire extinguishers should be obtained and available for inspection to provide evidence that fire fighting equipment has been appropriately serviced and maintained. The fire risk assessment should be updated to ensure any gaps / missing information is corrected. This will help to safeguard the health and safety of the people using the service. Night staff should received fire refresher training every three months and day staff every six months and records maintained. 8 19 9 26 10 33 11 38 12 38 13 38 Care Homes for Older People Page 31 of 32 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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