Care Home: Dearnlea Park Care Home

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What the care home does well People living at the home said that they were well cared for, the staff were `Good` and they had choices in their daily routines, meals and the activities provided. The interactions observed between staff and people living at the home appeared caring and considerate. Each person had a written care plan so that staff were aware of the actions required of them to meet people`s needs. People`s health was monitored and access to health professionals was provided to maintain health. A clear complaints procedure was provided to people so that they knew what to do if they had any concerns. Staff had been provided with training in safeguarding adults and were aware of the action to take if they suspected abuse, or if an allegation was made. Staff said that they were provided with enough training so that they knew how to do their jobs and keep people safe. The training records checked showed that a programme of training was provided to staff to improve and maintain their skills. The home appeared well maintained and well decorated so that people had a pleasant place to live. Systems were checked and serviced to keep people safe. The home was well managed. All of the people spoken with said that the manager was approachable and supportive. What has improved since the last inspection? Significant improvements have been made since the last inspection, which has resulted in positive outcomes for people living at the home. The service user guide has been updated so that people are provided with up to date information about the home. All care plans and risk assessments have been audited and the majority have been updated so that they contain accurate and relevant information. Staff that administer medication have been provided with training in safe medication administration training so that people`s safety is promoted by good practice. Further activities had been provided to people living on the Dementia unit, and efforts were being made to ascertain people`s meal preferences so that these could be respected. Staff had been provided with training in `Dementia Awareness` so that they had the skills and knowledge to improve people`s quality of life. All staff have been provided with training in adult safeguarding so that they are aware of the signs of abuse and know how to respond if an allegation was made, or they suspected abuse. The complaints procedure had been updated and provided to people so that they had access to important information. Staff recruitment files had been audited and those checked contained a Criminal Records Bureau (CRB) check, proof of identity and two references. Checks on fire equipment and regular practice drills were taking place, which helped to keep people safe. What the care home could do better: Whilst the manager was monitoring care plans and risk assessments, there was no record to evidence that these checks had taken place. Some care plans still needed updating so that they contained relevant information. Controlled Drugs (CD) records did not correspond with the drugs stored. It is acknowledged that the manager carried out an immediate audit to identify errors and remedy these. One person`s refused medication had been stored before returning to the pharmacy for safe disposal. The companies recruitment application form did not specifically request full dates of previous employment. One file did not contain this information so that any potential gaps could be identified and explored. One person`s recruitment file did not contain a risk assessment to show that information on their CRB had been considered. Whilst a quality assurance report had been written, this had not been provided to people so that they knew the results of recent surveys, and the homes plans for further improvement. Key inspection report Care homes for older people Name: Address: Dearnlea Park Care Home Park Road Thurnscoe Rotherham S Yorkshire S63 0TG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janis Robinson     Date: 0 9 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Dearnlea Park Care Home Park Road Thurnscoe Rotherham S Yorkshire S63 0TG 01709893094 01709893094 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Elder Homes South Yorkshire Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 67 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum numbers of users who can be accommodated is 67 places. The registered person may provide the following category of service only Care home only - Code PC to service users of the following gender - Either Whose primary care needs on admission to the home are within the following catergories Old age not falling within any other catergory OP Dementia - Code DE Date of last inspection Brief description of the care home Dearnlea Park is a care home providing personal care and accommodation for up to sixty seven older people. Twenty three places are registered for older people with dementia and they are cared for in a separate unit with a dedicated staff group. Care Homes for Older People Page 4 of 30 Over 65 0 44 23 0 2 8 0 9 2 0 0 9 Brief description of the care home Accommodation is provided over two floors. A range of communal areas are provided. A commercial type kitchen and laundry serve the home. A passenger lift provides access to the upper floor. Sufficient bathing facilities are provided. The home stands in its own grounds and has an accessible garden area. There are car-parking facilities. The home is situated off Park Road, Thurnscoe, Barnsley. It is adjacent to a park and is close to local amenities. Main bus routes are close by. In March 2010, fees ranged from £356.77 to £386.20 per week. Written information about the home in the form of a Service User Guide is available and can be obtained from the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. This was an unannounced inspection carried out by Janis Robinson and Mike ONeil, compliance inspectors. A visit to the home took place between 9am and 4pm on the 9th of June 2010. At the time of this inspection these was no registered manager in place. The temporary manager, Josie Beswick, was present throughout this inspection. This inspection was carried out under Code B notice. This means that we found issues of serious concern. Code B gives us the power, under the Police and Criminal Evidence Act, to copy and remove records to assist in our inspection. However, the manager responded swiftly and rectified the identified concerns during the inspection. Care Homes for Older People Page 6 of 30 During the inspection staff were observed interacting with people that live at the home. A partial inspection of the environment was undertaken and some records relating to care and the running of the home were checked. We spoke with visiting health professionals and a social worker, people living at the home, the manager and staff to obtain their views. We distributed questionnaires about the home to people living there and staff. We received completed questionnaires from 6 staff and two people living at the home. Comments from these have been included in the main part of this report. We gave feedback to the manager at the end of this inspection visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? Significant improvements have been made since the last inspection, which has resulted in positive outcomes for people living at the home. The service user guide has been updated so that people are provided with up to date information about the home. All care plans and risk assessments have been audited and the majority have been updated so that they contain accurate and relevant information. Staff that administer medication have been provided with training in safe medication administration training so that peoples safety is promoted by good practice. Further activities had been provided to people living on the Dementia unit, and efforts were being made to ascertain peoples meal preferences so that these could be respected. Staff had been provided with training in Dementia Awareness so that they had the skills and knowledge to improve peoples quality of life. All staff have been provided with training in adult safeguarding so that they are aware of the signs of abuse and know how to respond if an allegation was made, or they suspected abuse. The complaints procedure had been updated and provided to people so that they had Care Homes for Older People Page 8 of 30 access to important information. Staff recruitment files had been audited and those checked contained a Criminal Records Bureau (CRB) check, proof of identity and two references. Checks on fire equipment and regular practice drills were taking place, which helped to keep people safe. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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 were provided with written information about the home, which upheld their rights and choices. A system was in place to make sure peoples needs were identified before moving into the home, to make sure these could be met. Evidence: The homes statement of purpose and service user guide had been updated so that they contained up to date information. A copy of the statement of purpose was seen in the reception area of the home, which made it available to people. Each person had been provided with a copy of the service user guide, and these were kept in peoples bedrooms. This meant that people were provided with up to date and important information about the home. At the time of this inspection an embargo on admissions was in place, which meant that were not being admitted to the home. This embargo was lifted following a safeguarding meeting that took place the week after this inspection. The meeting also Care Homes for Older People Page 11 of 30 Evidence: closed the safeguarding issue, as appropriate action had been taken by the home to resolve this. As a consequence we were unable to evidence fully if peoples needs would be assessed prior to moving into the home. However, the manager stated that a system was in place to undertake assessments prior to admission, to make sure the home could meet all identified needs. In addition, the care plans checked contained evidence that an assessment had been carried out before the person moved in. In their questionnaires, when asked if they had been given enough information to help them decide to move in, both of the respondents said Yes. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst inadequacies were found in some medication recording systems, peoples health and personal care needs were, in the main, identified and met. Evidence: The manager had undertaken a full audit of care plans to identify gaps and rectify these. Meetings had been held with senior staff, who were responsible for writing and evaluating the plans, to make sure they understood what was expected of them. Care staff spoken with said that they could influence the plans and inform senior staff of any changes needed, to make sure information was up to date. The manager said that of the thirty two care plans, all had been updated on the residential unit, and the majority had been updated on the Dementia unit. We spoke with a social worker from Barnsley Social Services, who was undertaking peoples reviews at the home on the day of this inspection. She commented that a marked improvement was seen in the majority of plans checked, and was aware that a few still required updating. She also said, Care Homes for Older People Page 13 of 30 Evidence: People and their relatives we have spoken to have expressed no concerns about the care given at Dearnlea Park. Three peoples care plans were checked. Significant improvement in the detail included in the plans was seen. The plans had been fully completed, were up to date and had been evaluated on a monthly basis to make sure all of the information was relevant. They included social history, communication, culture and religious beliefs, eating, sleeping, mobility and safe environment. The plans gave clear advice about the actions required of staff to meet identified needs. They included information on peoples likes and dislikes so that these could be respected. The plans also contained an agreed night time check, which was signed by the person to show that they had been consulted about night time routines. The plans had been signed by the person being supported to show that they had been involved in writing their plan. Staff had undertaken daily records and those seen reflected peoples well being and gave information about how they had spent their day. This made sure staff were kept fully informed. The plans contained up to date risk assessments that had been evaluated on a monthly basis to make sure they were up to date. The risk assessments covered moving and handling, continence, nutrition and pressure area care. One person was seen being moved in a wheelchair without footplates in use. Their care plan was checked, and this clearly stated that the person did not wish to use footplates and to take extra care. Peoples care plans checked contained information about health care, and visits by health professionals were recorded so that all staff were aware of any health issues. On the day of the inspection District Nurses and a Chiropodist were visiting the home. A GP was also visiting the home, and commented, The home has improved significantly in recent months. Very good care and no concerns at all. Staff are very good. When we spoke with staff they showed a good knowledge of peoples diagnosis and could verbally describe the health and personal care needs of the people they cared for. Whilst the manager confirmed that she monitored care plans to make sure they were correct, there was no evidence of this as the manager had no system to record any checks made. Care Homes for Older People Page 14 of 30 Evidence: A policy on medication was in place to provide staff with written guidance. Since the last inspection all senior staff had been provided with training in safe medication procedures so that they were aware of safe procedures to follow. Part of a medication round was observed. Medication was safely administered and the senior signed Medication administration records (MAR) after the person had taken their medication. Three peoples MAR charts were checked in detail, and others sampled. The majority had been fully completed so that staff knew if a medication had been administered. However, one record, for a PRN (as and when required) food supplement, had not been signed to say this had not been required. The drugs held corresponded with the details on MAR charts. In one medication trolley, a pot marked Waste Meds was found, containing several types of medication. An immediate requirement was issued to safely dispose of the medication, which was acted upon during the inspection. The manager later stated that she had held discussions with the senior staff, who said that they were acting on advice from the previous manager. The medication all belonged to one person, and the tablets stored had been refused by them. The records had been signed to reflect the person had refused their medication. They had periodically returned these unwanted tablets to the pharmacist for safe disposal. Controlled Drugs (CD) storage and records were checked. It was evident that systems and records had not been monitored as the records did not correspond with the drugs held. Two controlled drugs were recorded in the CD register in April and August 2009, but these not present in the CD cupboard. There was no written evidence to say that these had been returned to the pharmacy for safe disposal. In addition, one controlled drug was stored that was not recorded in the register. This leaves the storage of controlled drugs open to potential abuse. The page index of the CD register did not correspond with written records. An immediate requirement was issued to audit the CD systems within 24 hours and provide us with the results of the audit and an action plan to rectify any identified gaps. This report was sent to us within agreed timescales. The manager had spoken with staff and provided them with clear guidelines for CD storage and recording. All of the people spoken with said that staff respected their privacy. Staff were observed knocking on doors before entering peoples rooms. People looked well cared for and told us that they were. Comments included, Its very nice here. I am very happy at Dearnlea Park. Care Homes for Older People Page 15 of 30 Evidence: The carers are very good. The interactions observed between staff and people living at the home appeared caring and respectful. Staff included people in conversations and took time to talk to them. This made sure that people felt respected. It was very positive to hear staff tell us that following training they have recently received they felt that all the staff spoke to people in a more considered and person centered way and were able to offer people more choices. Despite the inadequacies with the medication procedures and documentation, evidence shows that people at Dearnlea Park experience adequate outcomes relating to health and personal care. This judgment is based on the evidence that the service has far more strengths than areas for improvement. The temporary manager had also addressed the areas in need of improvement promptly. Care Homes for Older People Page 16 of 30 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. A range of available activities and flexible routines provided choice to people. Evidence: An activities worker was employed for part of each week so that people were provided with some choice about how they spent their time. Posters and pictures were on display that showed a variety of activities were provided, such as visiting singers, arts and crafts, gardening and quizzes. People spoken with said that they enjoyed the activities provided. They told us that we had visited on a busy day, as the hairdresser was visiting that morning and they were meeting with friends from the local community that evening for a social event that would include bingo. At the last inspection a requirement was issued to improve the choices and activities for people with Dementia. Staff said that activities had improved, and people were taken to the garden or for walks more often so that they spent time out of the home in the fresh air. A Wii computer game had been purchased for people living in the Dementia unit. We saw that people on the Dementia unit were alert and interested in their surroundings. People told us that they enjoyed playing on the Wii. Staff said that the introduction of the game had created a lot more social interaction, and even if people were not playing they enjoyed watching others and were involved in ongoing Care Homes for Older People Page 17 of 30 Evidence: chat as games progressed. People said that their friends and relatives could visit them at any reasonable time, and they could choose to spend time with them in the privacy of their room if they wished. People said that they could get up and go to bed when they wished. This showed that peoples preferences were respected. The lunch time meal was observed. The meal service appeared well organised and people were given plenty of time to enjoy their food. People said that they enjoyed the food and were always offered a choice. At the last inspection a requirement was issued to ensure people with Dementia were offered choices at mealtimes. The manager stated that staff now show menu choices to people each morning so that they can decide what to eat. In addition, the cook was in the process of creating photographs and pictures of the different meals on offer, to help people make their choice. Care Homes for Older People Page 18 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding procedures promoted peoples safety and protection. Evidence: The complaints policy had been updated to include up to date information to people so that they knew who they had to contact with any concerns. The policy was seen on display around the home, and had also been included in service user guides placed in peoples rooms. People spoken with said that they could talk to staff if they had any concerns, and they would sort them out. A requirement was issued at the last inspection to ensure all complaints were recorded so that they could be monitored. The manager had developed a new complaints file, to record any complaints received, the action taken and the outcome of the complaint. This improvement made sure peoples concerns were identified and responded to, and meant that all complaints could be audited. A policy on safeguarding adults was in place. At the last inspection, a requirement was issued to provide staff with safeguarding training, so that they knew how to protect people.The staff spoken with and training records checked showed that a programme of safeguarding training had been put in place. The majority of staff had undertaken the training and further dates had been booked so that all staff had completed this. Following the inspection, we received written confirmation from the manager that the 23rd of June 2010 had been booked for this training to take place. The training matrix checked showed that 6 staff still required this training. The staff spoken to were very Care Homes for Older People Page 19 of 30 Evidence: clear of the action to take if they suspected abuse or if an allegation was made. This is a significant improvement and will help to protect people. All of the people spoken with said that they felt safe at the home. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with a pleasant and comfortable place to live. Evidence: Parts of the environment were checked. Communal areas were well decorated and appeared comfortable. Pictures and ornaments created a homely atmosphere. At the time of this inspection parts of the home were decorated with England flags to celebrate and support the World Cup. Suitable bathrooms and toilets were provided. Specialist equipment was available to assist people and equipment had been serviced to make sure it was safe. Peoples bedrooms contained personal items and reflected individuals interests. People spoken with were happy with the accommodation provided. Recommendations were made at the last inspection to replace all worn and lumpy pillows so that people were more comfortable, and to remove stored items from a toilet so that it was safe for people to use. Both of these recommendations have been met. Staff spoken with confirmed that they had been provided with Control of Infection training to promote safe practices. They said that they were provided with suitable protective clothing, such as aprons and gloves, to use when required. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training and recruitment practices, in the main, promoted peoples well being and safety. Evidence: People spoke highly of the staff team and said staff generally listened to them and acted on what they said. People said that staff were usually available when needed. Staff and the manager confirmed that staffing levels were satisfactory. There were appropriate numbers and grades of staff on duty, to provide effective support to people . We saw that staff were available to attend to peoples needs when required. This will help ensure that people receive consistent care from sufficient numbers of well trained staff. Two staff recruitment files were checked. At the last inspection a requirement was made to ensure all staff files contained all of the required information. The manager stated that a full audit of staff recruitment files had been completed. Both files contained evidence of a Criminal Records Bureau (CRB) check, two references, an application form and proof of identity. However, one application form did not give the dates of previous employment so that any gaps could be identified and explained. The application form did not specifically request that full dates were given so that this information was obtained. In addition, one file contained evidence that information on a returned CRB had been discussed with the applicant, and a decision made to employ Care Homes for Older People Page 22 of 30 Evidence: them. There was no written risk assessment alongside these notes to show that the person was considered safe to employ. The staff training matrix was examined. This showed clear improvement in the provision of training to staff so that they had the right skills to do their jobs. Training was provided on a rolling programme, with planned future dates, so that refresher training was provided to maintain staff skills. Since the last inspection staff had been provided with training in Dementia Awareness so that they had the skills and knowledge to care for people with this condition. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples well being and safety was promoted by improvements to the management, monitoring and staff training at the home. Evidence: All of the staff and people living at the home spoke very highly of the manager. Staff said that they felt well supported by her, comments included, The manager is very supportive. She (the manager) listens and tries to resolve any problems. She (the manager) is always around the home making sure everything is alright. Staff also said that regular staff meetings were held and supervision meetings had started to take place. This will ensure that staff are fully aware of information related to the home, and are suitably appraised and supported. Care Homes for Older People Page 24 of 30 Evidence: We were informed that a permanent manager had been recruited, who was suitably qualified and experienced. The permanent manager would commence working at the home on the 26th of June 2010. The temporary manager would provide handover and the area manager would provide supervision and support to the new manager so that ongoing improvements would be maintained. This has been put in writing to us. The temporary manager has worked hard to meet previous requirements and lead the staff team to make significant improvements, which were clearly evidenced during this inspection and have been commented on in the relevant sections of this report. A quality assurance system had been introduced, and surveys had been sent to people living at the home, and their relatives, to obtain their views and make sure the home was run in their best interests. The results of the survey had been audited so that further improvements could be identified. However, the results of the survey had not been made available to people so that they were aware of this information. Some monies were kept for some people. These were securely stored so that they were kept safe. Two peoples financial records were checked. The records corresponded with the amounts kept, and receipts had been kept of all spendings to verify these. Staff said that training had Improved a lot, and they had Loads of training, which included Moving and Handling, Fire Safety, Dementia Care, Infection Control and Safeguarding. The training matrix examined showed that the majority of staff had undertaken refresher training in all mandatory subjects to maintain and update their knowledge. Further training dates were booked for staff where gaps had been identified. These measures will promote peoples welfare and safety. A maintenance system was in place to make sure the home was safe. Fire extinguishers had been serviced in May 2010 and weekly checks had been undertaken on the fire alarm, extinguishers and emergency lighting. The records showed that a magnetic door safety check should be carried out weekly, but none had been recorded since the end of April. Staff confirmed that regular fire drills had taken place, and the records checked verified that the majority of staff had been provided with fire safety training, which included a practice drill. The manager stated that she would be undertaking further practice drills to maintain staff knowledge. It is important that the drills take place at different times of the day so that all staff participate in these and know how to respond in an emergency to keep people safe. Care Homes for Older People Page 25 of 30 Evidence: We were informed that plans were in place to fit a cover over a door release button in the dementia unit. This action had been taken as a result of one person pressing the button and going out onto a fire escape. Whilst staff were alerted as the alarm had sounded, it was felt that fitting a cover would be an extra precautionary measure against this happening again. The manager stated that the maintenance person had checked, and the cover met regulations. It is recommended that the local Fire Authority be consulted to verify this is safe and acceptable. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 1 9 13 All medications not required 16/06/2010 must be disposed of safely and promptly. Records of returned medication must be kept. This will ensure that safe procedures are adhered to. 2 9 13 A full audit of controlled 16/06/2010 drugs, and controlled drugs register, must be carried out. This will ensure controlled drugs are safely managed. 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 9 13 Medication administration records for PRN (as and when required) medication must be fully and accurately completed. To keep people safe 13/08/2010 2 29 19 Full employment history that 16/08/2010 includes the dates of previous employment must be obtained for all staff. This will ensure that gaps in employment are identified and explained. Care Homes for Older People Page 28 of 30 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 7 A system to record the monitoring of care plans and risk assessments should be put in place so that this can be evidenced and the manager can keep track. The ongoing improvement to care plan and risk assessment records should be fully completed so that all records are of the same good standard. Creative ways to assist people with Dementia to make meal choices should be put into operation so that thier opinion can be respected. Where gaps have been identified, staff must be provided with safeguarding training. This will ensure that all staff have the relevant skills and knowledge to keep people safe. The application form should request full dates of previous employment so that this information is not missed. The report from the quality assurance audit should be made available to people so that they have access to relevant information. The fire authority should be consulted regarding the cover planned to be fitted to a door release button, to make sure this is acceptable and safe. Fire drills should be monitored to make sure all staff participate in these and have relevant skills to keep people safe. 2 7 3 15 4 18 5 6 29 33 7 38 8 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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