Care Home: Dorrington House Residential Home

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What the care home does well There were detailed care plans. Although some needed minor adjustments, most made sure that staff were clear about the residents` needs and the ways in which they preferred to be supported. Residents and and their families told us they were happy with the care at the home. The way medicines were managed was generally safe and residents received their medicines as they were prescribed by their doctor. Staff helped residents to look nice and dress well. A family member told us that their relative looked better than they had for several years. Residents made choices about their daily lives. There were no set times for getting up and going to bed and residents spent time in their rooms if they wished to. There was open visiting at the home which helped residents to stay in touch with their family and friends. Residents were able to personalise their rooms with furniture, pictures and ornaments. The residents we spoke to said they were happy with their bedrooms, which they described as "comfortable". and "nice." The home was clean and fresh and most of the people who returned surveys said it was always like that. The home usually had enough staff on duty to meet the needs of the residents. Those who completed surveys said that staff were usually available when they needed them. Several residents and relatives praised the staff team. One wrote that staff were good at reassuring residents. Another said the staff were, "nice young people." Staff had training to help them to understand the needs of people with dementia. Over half the staff had a nationally recognised qualification in health and social care, called an NVQ. What has improved since the last inspection? After the last inspection we made a requirement that residents must be assessed before they were offered a place at the home. This was to make sure that staff understood residents` needs and were able to meet them. All the files we saw had preadmission assessments. Staff were using a new assessment document which helped them to gather detailed information. Previously we made a recommendation that residents` nutritional needs should be monitored. Everyone had a nutritional plan, which meant that staff would be able to identify if residents were not eating well enough and needed to be referred to the doctor. Most of the residents who returned surveys indicated that there were usually activities they could join, although one person said this was an area where they could do better. On the day we visited there were a few individual activities going on. The manager told us that she was hoping to try to improve this area of care. The home had introduced a formal system for monitoring the quality of the service they provided. This included sending out surveys to gather the views of people with an interest in the service and to ask for suggestions for improvements. What the care home could do better: Information given out to people thinking of moving into the home was not specific enough to give them a clear picture of Dorrington House and what it might be like to live there. The manager was already aware of this and was reviewing the service user`s guide. Some of the practices at the home did not promote residents` privacy and dignity. There were two communal toilets without locks and some of the bedrooms overlooking the car park were not very private. We made a requirement to ensure that residents` privacy and dignity were promoted. There was not enough monitoring and investigation when residents had injuries that they were not able to explain how they had occurred. We required that staff audit unexplained injuries to see whether there were any patterns or trends and investigate them to see whether they could be prevented in the future. Although most of the residents who returned surveys said they usually liked the meals, mealtimes were not completely positive experiences for all residents. Some meals were left standing before being served and two residents complained they were cold. One said their lunch was, "barely edible." After the last inspection we made a requirement to provide safety guards for the wall heaters. Although shelves had been put over the top of the heaters to prevent people from burning their hands, this was not sufficient. The front and sides of some heaters were very hot to touch and could result in severe burning should a resident fall against one. Any restrictions on work permits must be adhered to unless the home obtains written evidence to show that they are no longer valid. The service should also monitor the number of hours staff work before they have a day off. This is to protect the health and safety of the staff and the residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dorrington House Residential Home 28 Quebec Road Dereham Norfolk NR19 2DR     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: Jane Craig     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Dorrington House Residential Home 28 Quebec Road Dereham Norfolk NR19 2DR 01362693070 01362699464 dorringtonhouse@btopenworld.com www.dorrington-house.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr. Steven M Dorrington,Mrs Lorraine Dorrington Name of registered manager (if applicable) Mrs Roselyn Jayne Lawler Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Any new admissions to the home must be in the category of Dementia (over 65 years of age). Fourteen (14) Older People who are named in the Commission`s records may be accommodated. Maximum number accommodated not to exceed forty five (45). Date of last inspection Brief description of the care home Dorrington House is a care home providing residential care for up to 45 older people, most of whom have dementia. It is situated close to the centre of the market town of East Dereham. The home comprises purpose built ground floor accommodation in Care Homes for Older People Page 4 of 31 Over 65 45 0 Brief description of the care home separate wings. Each wing has its own lounge, bathing and toilet facilities. All rooms have en-suite toilet and hand basins. There are two communal dining rooms. There are enclosed garden and patio areas that are visible from some bedrooms. Information, including the weekly fees, is available from the manager. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 17th August 2007. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 4th June 2009 by two regulatory inspectors. At the time of the visit there were thirty nine residents living at the home. We met with some of them and wherever possible asked about their views of Dorrington House. We spent time observing daily routines and how staff interacted with residents. Four residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the manager, the owners of the home, staff and visitors. We looked Care Homes for Older People Page 6 of 31 around the home and viewed a number of documents and records. As part of the key inspection, surveys were sent out to people living and working at Dorrington House. Six residents were assisted by their family to complete the questionnaires. Five members of staff also returned surveys. Their responses have been taken into account when making judgements about the service. What the care home does well: What has improved since the last inspection? What they could do better: Information given out to people thinking of moving into the home was not specific Care Homes for Older People Page 8 of 31 enough to give them a clear picture of Dorrington House and what it might be like to live there. The manager was already aware of this and was reviewing the service users guide. Some of the practices at the home did not promote residents privacy and dignity. There were two communal toilets without locks and some of the bedrooms overlooking the car park were not very private. We made a requirement to ensure that residents privacy and dignity were promoted. There was not enough monitoring and investigation when residents had injuries that they were not able to explain how they had occurred. We required that staff audit unexplained injuries to see whether there were any patterns or trends and investigate them to see whether they could be prevented in the future. Although most of the residents who returned surveys said they usually liked the meals, mealtimes were not completely positive experiences for all residents. Some meals were left standing before being served and two residents complained they were cold. One said their lunch was, barely edible. After the last inspection we made a requirement to provide safety guards for the wall heaters. Although shelves had been put over the top of the heaters to prevent people from burning their hands, this was not sufficient. The front and sides of some heaters were very hot to touch and could result in severe burning should a resident fall against one. Any restrictions on work permits must be adhered to unless the home obtains written evidence to show that they are no longer valid. The service should also monitor the number of hours staff work before they have a day off. This is to protect the health and safety of the staff and the residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not admitted to Dorrington House unless their needs had been assessed and could be met by the service. Evidence: The information given out to people thinking of moving into the home was about all three Dorrington Houses and did not focus enough on the individual elements of each. Some of the brochure was presented in a way that would be helpful to people with dementia, for example, with photographs and clear sentences. However, there were still large portions of small text that could be difficult for some people to follow. The manager told us that the service users guide was under review and these issues were being looked at. Most of the people who returned surveys said they received enough information about the home to help them to come to a decision about moving in. After the last inspection we made a requirement that prospective residents should have a full needs assessment before they moved into the home. We saw that Care Homes for Older People Page 11 of 31 Evidence: residents admitted recently had assessments from health and social services professionals on their file. Prospective residents were also assessed by the manager or senior staff, to ensure that the services and facilities at Dorrington House would be suitable. The pre-admission assessment document had improved. When completed correctly, it provided sufficient information about the residents health, personal and social care needs to draw up an initial care plan. The assessments also included information about the residents abilities and personal preferences. This helped staff to understand how the person wished to be supported. Residents or their representatives were encouraged to complete parts of the pre-admission assessment to make sure that issues that were important to them would be taken into account. The quality of the assessment information was generally good. However, one had not been cross referenced with the social services assessment and a potentially important piece of information had not been added to the care plan. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of residents health and personal care needs were met in the way they preferred. Evidence: We looked at the care files for the four residents we case tracked and at other plans to check specific issues. A new care plan format had been introduced since the last inspection. Although the completed set of records was lengthy, the manager said the format made it easier to track individuals needs. Each area of health, personal and social care had an assessment, care plan and progress notes. Some of the information overlapped into other care areas but there was no cross referencing. We found this sometimes made it difficult to tell how a need was being addressed without looking at several assessments and plans. There was a summary of each care area, which staff said was a useful tool for quick reference. There was some good information about residents personal preferences on assessments and care plans. All the plans were individualised and some were very detailed, which helped to make sure staff consistently provided support in the way the Care Homes for Older People Page 13 of 31 Evidence: resident preferred. There were assessments to help staff to record the difficulties the resident experienced specifically related to their dementia. Some assessments showed that staff clearly understood the individual residents needs, such as short term memory loss and complex behaviour. Other assessments showed less understanding and focused mainly on personal care. Staff were able to describe how they supported a resident with complex behaviour but the directions in the care plan may not have been sufficient to ensure a consistent approach. This was confirmed by a relatively new member of staff, who told us that staff did things differently, which they found confusing. Care plans were reviewed every month by staff. The key workers usually wrote in the residents communication book to let families know that there was to be a review and ask for any input. One of the residents we case tracked had recently become more dependent on staff and all relevant care plans had been amended to reflect this. Another resident needed more help with their mobility. Only that specific plan had been amended, even though mobility was mentioned in other plans. This meant some of the other plans were out of date. There were risk assessments and plans relating to residents health care needs. We saw some good examples of moving and handling plans and observed staff using appropriate equipment and techniques. Care plans to monitor diet and weight were also clear. However, some risk management plans were not reviewed. For example, one plan to reduce the risk of falls indicated that staff should monitor the person when they were walking but as the resident was not receiving one to one care, and they spent time in their bedroom, this could not be achieved. The person had fallen five times in less than a month. Their plan had not been changed to show that the planned interventions were not working. Despite the lack of records, the manager told us that staff had consulted the GP, who was referring the resident to a physiotherapist for further assessment. There was evidence on all files to show that residents were referred to health care professionals as needed. We made a previous requirement to record and audit accidents and occurrences. Accidents were recorded on appropriate forms and the manager was planning to improve how they were currently audited. However, one of the residents we case tracked had a number of unexplained injuries. These were recorded on their daily progress notes but staff had not completed accident or incident reports. This meant that the injuries were not part of the accident/incident audit, which could have identified a pattern to the injuries and helped to draw up a plan to reduce them. Care Homes for Older People Page 14 of 31 Evidence: Unexplained injuries were usually recorded on the care plan but there was no evidence that they were either investigated at the home or referred to social services. On the day of the visit we observed residents to be appropriately dressed and groomed, including nail care. We noted that staff knocked on residents doors if they needed to go into their rooms, which gave people privacy. As we previously recommended, everyone had their own toiletries, kept in their bedrooms, which helped to maintain their dignity. However, there were some issues that did not promote privacy and dignity. Two of the communal toilet doors did not have privacy locks on. Some of the bedrooms overlooking the car park did not have privacy net curtains or blinds. This meant that unless residents kept their curtains closed at all times, visitors could see directly into their bedrooms. We noted that there were several bedrooms with notices to remind staff to carry out various tasks. This practice is not homely and could be viewed as undignified. We observed staff giving out medication and found their practice safe and hygienic. Medicines were stored safely and storage areas were clean and tidy. There were safe systems for ordering medication. The records of medicines received and returned to pharmacy were complete, which assisted with the audit trail. Stocks of medicines carried over from the previous month were recorded and packets were dated on opening so staff were aware of when medication needed to be re-ordered. There were gaps on a few medication administration record (MAR) charts. Stock checks indicated that the medication had been given and the error was in recording. However, one MAR chart showed that staff had signed for more medication than had been dispensed, which could be an indication that charts were not checked when they were signed. Some MAR charts were handwritten but there was no evidence to show that these had been checked, which would reduce the risk of transcribing errors. One resident we case tracked who had medication prescribed when required had a clear care plan to tell staff when the medicine was needed. This helped to reduce the risk of under or over medication. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all residents social and recreational needs were met and the mealtime experience for some residents did not meet expectations. Evidence: Assessments and care plans included detailed information about the residents likes and dislikes and their preferred routines. Some daily routines were staff led, but residents confirmed that they were able to get up and go to bed when they wished. One told us, There is no hurry to get up or go to bed. Everyone had an assessment and care plan for social interests. The standard of these were variable. The assessments we saw focused on the residents social, family history and past interests. There was little information about their current activities and interests. One of the plans stated that the residents social interests were limited because of their dementia, which could be an indication of a lack of understanding on the part of the staff. However, another residents plan indicated topics for conversation and the type of activities they liked. On the day of the visit staff organised a small group of residents to play ball games. Another member of staff was helping a resident to complete a jigsaw and we saw Care Homes for Older People Page 16 of 31 Evidence: some other one to one activities during the course of the visit. However, the progress notes for some residents showed limited activity and occupation. Residents had mixed views about activities. One told us that he watched TV all day, but said he did not mind that. One of the residents who completed a survey praised the entertainment for residents and their families, but another wrote that activities could be better. The manager told us that activities and occupation was an area she was planning to work on as a priority. There was open visiting at the home which helped residents to be able to maintain contact with family and friends. Some residents went out with their families but there was little scope for other residents to access community facilities. Five out of the six residents who returned surveys said they usually liked the meals. One commented that they were, well fed. However, on the day of our visit the lunchtime meal was not a positive experience for all residents. Lunch was served in two dining rooms approximately half an hour apart. Residents at the first sitting were seated in the main dining room, where tables had been pre-set. Residents in the other room were handed their cutlery with their meals. We were told that residents chose their meals the day before. Given that most people had some degree of memory loss, it was likely that a significant number had forgotten. There was a menu board in one of the dining rooms but the writing was too small to be able to see it clearly. A few residents were handed menu cards, which may have reminded them. However, most residents had their meal put in front of them with no communication or explanation. We did not hear anyone being given a choice of drinks. Everyone we saw was given a plastic tumbler of orange squash. We observed just one member of staff showing a resident two different types of dessert to help them make a choice. The manager told us they were working on pictorial menus which should help to give residents a more meaningful choice. Not all staff made an effort to talk to residents whom they were assisting to eat. There was very little communication from staff the whole of the time. Residents were given soup in tea cups with a spoon. One resident did not know what to do and had to be helped by another resident because staff had not noticed. Staff were giving one resident a dessert until we pointed out that she had not had a main course. Staff brought her a bowl of soup because there were no meals left but the resident was not given an explanation. Two of the residents on the second sitting complained their meal was cold. One said it was, barely edible. We were told the food had been at the correct temperature when Care Homes for Older People Page 17 of 31 Evidence: it left the kitchen but had been standing on an unheated trolley for at least 10 minutes before the first plate was served. The food was checked and the temperature was found to be consistent with food being left standing for 15 minutes. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their families could be confident that their concerns would be listened to and acted upon. Procedures and training were in place to help to ensure that people were safeguarded from abuse. Evidence: There was a complaints procedure on display and in the care file in each room. The procedure did not include timescales for response or the contact details for the Commission. We were shown a draft of the new procedure. Although it contained the right information, we discussed how it could be made more accessible to residents with dementia. Residents/relatives who completed surveys all indicated they knew someone to talk to if they were unhappy and they knew how to make a complaint. Complaints records showed that there had been five complaints about the service this year. These were mainly about the standards of care. They had been investigated and responded to within reasonable timescales. Some had been upheld. The manager had started to audit complaints to try to identify and resolve any common themes. The whistle blowing policy on display in the home did not make it clear to staff about reporting poor practice outside the home. Staff received safeguarding training in their induction and NVQ training. There was also written guidance, including the local authority adult protection procedure, Care Homes for Older People Page 19 of 31 Evidence: available for reference. A safeguarding incident earlier this year had not been managed in accordance with the appropriate procedures and there were a number of recommendations made as a result of the safeguarding investigation. Senior staff had learnt from this and, as a consequence, had reported any incidents they thought might fall within the remit of the adult protection procedure. A summary of the procedure for contacting outside agencies was on display in key staff areas. The manager and deputy had training about the mental capacity act and had cascaded this to other staff. The manager had previous experience of using the mental capacity act in order to make decisions about the best way to support a resident. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of guards on wall heaters could present a risk to residents safety. Evidence: Most areas of the home were well maintained but there were some in need of redecorating. The manager was aware of this and said there was a plan for redecoration in place. Some thought should be given, during redecorating and renewal, to following good practice guidance in relation to creating a good environment for people with dementia. There were well maintained, secure garden areas which provided residents with a pleasant place to sit. One of the residents we spoke to said they loved looking at the garden. Many residents personalised their rooms, which helped them to look familiar. Those residents we spoke were happy with their rooms. One said, Its very comfortable. Another told us, It is lovely here. All rooms were en-suite and there were also toilets near communal areas. There were sufficient assisted bathing facilities. Following a previous requirement to cover the wall heaters, wooden shelves had been put over the tops to prevent residents from being able to touch the top grill. We were told that this had resolved the problem, however, we found that the fronts of a Care Homes for Older People Page 21 of 31 Evidence: number of heaters on the corridor were too hot to touch. this meant that if a resident were to fall against any of them they could be badly injured. There were some hazard identification/risk assessments in place which looked briefly at the heaters but they did not fully assess the potential risk. Two we saw were out of date because they did not indicate the residents current level of risk of falls. The staff did not carry pagers. There was a tannoy system to communicate with staff in other parts of the home. This was loud and intrusive. It detracted from the homely feel and could also be potentially confusing for people who were already disorientated. The manager said the system may be able to be used differently and she would look into this. At the time of our visit the home was clean and most areas were free from unpleasant odours. A visitor told us they had never known it to be any different and five of the six residents who returned surveys indicated the home was always clean and fresh. Only one of the surveys we received indicated that the home sometimes smelled of urine. Staff had recent infection control awareness training in the form of watching DVDs and written guidance was available. There were hand washing facilities throughout the home. On the day of the visit we noted that residents clothing looked well kept. However, one of the issues raised in a recent complaint was that residents clothing was not always dry when it was put away. We also found reference to a similar issue in one of the communication books completed by a relative. A resident/relative also made the following comment on a survey, Some staff do not wash / dry clothing carefully enough. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient staff with appropriate training. Evidence: The proprietor told us that staffing levels were calculated by looking at residents assessed level of need and their dependency on staff. He was satisfied that there were enough staff on duty. Staff confirmed that target numbers were one senior carer and six carers during the day, which were sufficient to meet the needs of the current residents. The service did not always meet its target levels, for example, on the day we visited one of the care staff was sick and their shift had not been covered. Another carer was on escort duty for most of the afternoon. However, five of the six people who completed surveys indicated that staff were available when they needed them. We heard several positive comments about the staff team. A resident told us that staff were, nice young people and a visitor said, the staff are kind and helpful. We made a requirement at the previous inspection that staff introduced by an agency had their references and other checks validated. This had been done. We looked at the files for two staff who were from overseas. Their pre-employment checks were in place and they contained the required information and documents. However, the residence documentation indicated there was a restriction on the amount of hours that one of the staff could work. We were told that the agency had said this was no longer Care Homes for Older People Page 23 of 31 Evidence: applicable but there was nothing in writing to confirm that this had been checked. On checking the rota it was noted that the member of staff was rostered to work 27 days without a day off. In addition to potentially contravening the terms of their work permit, these excessive hours could have implications for the staffs health and safety and their ability to provide the best care. New staff completed an induction training programme. We were told that it covered all the components of the common induction standards set by the national training organisation. The training was done though a mixture of shadowing senior staff and watching DVDs on various topics. Staff had to answer questions about the topic before they were signed off as competent. The manager was planning to introduce written assessments to ensure that all staff had a consistent level of knowledge. Some external training was provided in moving and handling, first aid and dementia care. Staff who completed surveys all said they received training relevant to their role. Two commented that training and support for staff were things the service did well. The central training record was not up to date, therefore we were not able to evidence what training staff had received. We were told that most mandatory training was up to date and most staff had received dementia care training of varying levels. A visitor told us that they thought the staff understood the needs of people with dementia very well. When asked what the home could do better, a resident/relative who completed a survey wrote, Find ways to develop meaningful relationships with residents - difficult with dementia but possible, time allowing. We were told that over half the staff had an NVQ at level 2 or above. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager was working to improve the organisation and management of the home for the benefit of the people living and working there. Evidence: A new manager had been appointed since the last key inspection. The Commission was processing her application for registration. The manager had several years experience in a senior position in care services and she is nearing completion of the management and leadership course. She is a registered nurse and during the inspection visit she demonstrated a thorough understanding of the needs of older people. The manager is supported by a deputy. Both have supernumerary status, which allows them sufficient time to focus on the management and administration of the home. The manager was aware that the service had been through a period of instability and throughout the visit she showed a commitment to improving standards of care. She was able to discuss the elements she had already put into place and had clear ideas Care Homes for Older People Page 25 of 31 Evidence: for future development. The manager said she was well supported by the owners of the home, who said they had full confidence in her ability. We made it a requirement at the last inspection that the service must introduce an overall quality monitoring system. Although not all the evidence was available on the day of the visit, we were told that a new process had been introduced. This included a satisfaction survey, the results of which were being collated at the time of the visit. We saw the questionnaire, which was designed primarily for relatives and visiting professionals. We discussed, with the manager, potential ways of gathering the views of residents who were not able to complete questionnaires. The manager was hoping to source some training in dementia care mapping, which should assist in this process. There were other audits as part of the QA system, for example, complaints, medication and care plans, which helped to ensure that processes underpinning care of residents was safe. An environmental health inspection in 2007 highlighted a number of serious concerns about the way health and safety was managed in the home. Correspondence from the officer showed that limited action was taken for a number of months. However, a report from a recent visit showed that the majority of the recommendations had been completed and the rest were in the process. One of the proprietors had recently completed a health and safety course and had formed a group within the company, to take a more proactive approach to health and safety issues. However, as mentioned earlier in the report, the risk assessments with regard to the wall heaters were not thorough enough. There were certificates to evidence the servicing and maintenance of equipment and installations in the home. For example, fire safety, electrical, gas and moving and handling equipment. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 17 Unexplained injuries must 31/07/2009 be recorded and audited and the cause of the injuries should be investigated by the appropriate agency. To promote the health and safety of the resident. 2 8 15 Assessments and strategies to minimise risks to residents health and safety must be kept under review. To promote residents health and safety. 31/07/2009 3 9 13 There must be complete and 31/07/2009 accurate records of medicines administered to residents. To ensure that residents receive their medication as it is prescribed. 4 15 13 Meals must be served at an appropriate temperature. 31/07/2009 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To promote residents health and comfort. 5 25 13 Unguarded wall heaters must be assessed for the risks they pose to individual residents. Action must be taken to minimise any risks. To promote residents safety. 6 29 18 Checks must be made to ensure that staff are working within the restrictions of their work permits. To safeguard residents. 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 29/08/2009 31/07/2009 1 2 9 10 Handwritten entries on medication administration records should be checked to reduce the risk of transcribing errors. There should be privacy locks on toilet doors and residents who are accommodated in bedrooms overlooking the car park should be consulted about their wishes for privacy blinds or curtains. Residents should have opportunities to be involved in meaningful activity and occupation relevant to their individual interests and abilities. Mealtimes should be a pleasant and dignified experience for all residents. To assist residents who may wish to make a complaint, the procedure should be available in a format that is more Page 29 of 31 3 12 4 5 15 16 Care Homes for Older People 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 accessible to people with dementia. 6 19 A less intrusive and more homely alternative to the tannoy system should be found to enable staff to communicate with each other. The laundry system should be monitored to ensure that residents clothing is dry before it is put away. The amount of hours care staff work should be kept to an appropriate level to promote their own and residents health and safety. 7 8 26 27 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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