Care Home: Douglas Court

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What the care home does well Throughout this inspection observation and discussions with several people demonstrated that a positive environment was in place at Douglas Court. The atmosphere was homely and welcoming and this was reflected in the relaxed and happy disposition of both the people living at the home, their visitors and the staff team. People living at the home were happy and confirmed this in their comments. They were happy with the standard of support and services provided at the home and felt that the staff team and management were friendly, approachable and skilled in their work. People spoken with were confident that any concerns they had would be addressed promptly. One person said, "If I have any problems, I would talk to the manager". One visitor said, "I have never had to complain but I know if I had any concerns they would deal with it". The Home was found to be well maintained throughout. Comments from one visitor during the inspection visit were very positive regarding the standards of housekeeping. Their relative said it was `like being in a top hotel`. Another person living at the home said "My room is lovely, its cleaned for me". The five surveys received from people living at the home confirmed the home was `always` fresh and clean. What has improved since the last inspection? Full employment histories were now in place in the staff files that were looked at. This ensures that any gaps in employment can be identified and investigated to ensure they are accounted for. Formal monthly inspections were undertaken a monthly basis by the operations manager to ensure the quality of the care and services at the home were audited on a regular basis. The majority of the staff team were trained in emergency first aid. This ensured that a qualified first aider was on duty at the home at all times. What the care home could do better: There was good detail in the care plans that linked with the risk assessments in place. The present system used did not record that each care plan was reviewed monthly. Records were only in place when changes had been made to the care plan. The registered manager is open and transparent in informing us of incidents that have occurred at the home, she has not always been clear when an incident needs to be refereed to the Local authority as part of the local safeguarding procedures. Key inspection report Care homes for older people Name: Address: Douglas Court 1 Douglas Street Ivy Square Derby DE23 8LH     The quality rating for this care home is:   two star good 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: Angela Kennedy     Date: 2 0 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Douglas Court 1 Douglas Street Ivy Square Derby DE23 8LH 01332346060 01332208525 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Douglas Court Care Home Limited care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code OP to people of the following gender :- either, whose primary needs on admission to the home are within the following categories: Older Persons, not falling within any other category - Code OP The maximum number of people who can be accommodated is 43 Date of last inspection Brief description of the care home Douglas Court Care Home provides personal care for 43 people aged 65 years and over. It is located close to Derby City Centre and is on a major bus route from Derby. It is a purpose built two-storey building with an extension provided to the lounge. The first floor is accessed via a shaft lift and the stairs. Residents accommodation is provided all in single rooms, which are located over both floors. Communal areas are primarily located on the ground floor with a small seating/lounge area on the first floor near to the lift. The Home also has a reasonably sized welltended garden. The charges made for a room at Douglas Court range from £365 to £ 435 a week. These charges are dependent on the size of room, the facilities provided Care Homes for Older People Page 4 of 34 Over 65 43 0 Brief description of the care home and whether the Resident is sponsored by a Social Services Dept or is privately funded. Care Homes for Older People Page 5 of 34 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: This key inspection was unannounced. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people using the service and their views on the service provided. This process considers the providers and registered managers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. An Annual Quality Assurance Assessment had been completed by the service. This is a self-assessment for providers which is a legal requirement. This assessment gives the provider and registered manager an opportunity to let us know about their service and Care Homes for Older People Page 6 of 34 how well they think they are performing. The information provided in the AQAA is reflected within this report. At this inspection visit two people were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. We looked at other records to make sure that the people living at the home were kept safe and were supported to do the thing they like. We talked to some of the people that lived at the home and one visitor that was at the home.Their views of the service and the care and support provided are included within this report. Some of the staff were spoken with and their views and opinions of the care provided, the support and training given to them is included within this report. The comments provided within five surveys received from the people living at the home and five staff surveys are also reflected throughout this report. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 34 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 34 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 34 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 can be confident that the home can support them, as accurate assessments are undertaken before admission is agreed. Evidence: The providers self assessment told us that all prospective residents and relatives are invited to visit, have a tour of the home, stay for lunch and activities and were encouraged to ask any questions they may have and meet the staff, other people living at the home and their relatives. The providers self assessment told us that a full assessment of need is undertaken by the manager with assistance of the deputy and team leaders. Where the prospective resident is funded by social services a care plan is always requested prior to admission. It said that from this information a decision is made by the home manager as to whether this persons needs can be met by the home, as set out in the homes statement of purpose and category of registration. Care Homes for Older People Page 11 of 34 Evidence: The providers self assessment told us that all admissions to the home are on a trial basis and that they do not accept emergency admissions or provide intermediate care. The people case tracked had been assessed before admission was agreed. This ensured the home were able to meet their needs. The information seen within these assessments addressed all areas of health, personal and social needs and preferences. This ensured that each persons specific needs were identified to enable plans of care to be put in place to ensure they could be met. People that were funded also had assessments in place that had been undertaken by the local authority. The records seen also demonstrated that on admission, further information was obtained about each person. This provided staff with important information that enabled them to get to know each person better and the support they needed. It looked in more detail at individuals family and life history, including their working years, their interests, hobbies and beliefs and their preferences and requirements regarding meals and beverages and their daily routines. Personal information was also in place regarding the individuals. This ensured the staff had all of the relevant information required regarding the individual. Such as prescribed medication, confirmation of the G.P practice the person was registered with and details of other professional contacts such as chiropody, optician and dentist. The persons next of kin details and other family contacts. Both of the needs assessment and information obtained had been signed by the staff member that had completed it. In the five surveys we received from people living at the home they all confirmed that they received enough information about the home prior to their admission this enabled them to make an informed choice.They also confirmed that they had received Terms and Conditions of residency. In the five surveys we received from staff they all confirmed that they were given up to date information on the needs of the people they supported to ensure peoples needs were met in a way they preferred. Care Homes for Older People Page 12 of 34 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. Peoples health and personal needs are met by the service and the service supports people to take their medicines in a safe way. Evidence: The providers self assessment told us that each person living at the home had an individual care plan and risk assessments in place. It told us that the care plan sets out the action required by staff to meet the persons needs and that they are reviewed monthly or if there is a change in condition. The providers self assessment told us that each person or their representatives are encouraged to be involved in the plan drawn up and asked to sign the document. The records seen of care and support for the two people case tracked were informative and addressed areas of assessed need such as the level of support that was needed in meeting that persons personal care needs and preferences. People living at the home were supported by staff in a way they preferred. The records seen demonstrated this, such as confirming with the individual their wishes regarding the Care Homes for Older People Page 13 of 34 Evidence: gender of staff providing personal care to them. Care plans were also in place regarding social care preferences and interests and health care needs, including any health conditions and prescribed medications. The information within the care plans linked with the risk assessments in place. These assessments addressed any areas of risk that had been identified through the support plans and therefore were specific to the individual. For example one person was unable to use the nurse call system and this had been identified and the information within the risk assessment instructed the staff on the actions they needed to take to support this person safely. There were also general risk assessments in place such as, mobility, including risk of falls, pressure area care, nutritional assessments, prevention of falls and dependency assessments.The risk assessments instructed the staff on the actions to be taken to ensure each risk identified was minimised, ensuring people were supported in a safe way. The surveys returned by five people that were living at the home confirmed that they received the care and support they needed and that they got the medical care needed. Written comments include, Douglas court and all the staff are so much support to me and my mum in medical care and I can speak to someone at any time, night or day and words cannot say how well the staff look after my mum. And The level of all round care is second to none. Comments from people living at the home and visitors during this inspection visit were also positive such as, its lovely here, the staff are very good to me. and mum has been here for over a year, I cant fault the place, her health care needs are met, we are involved in her care reviews, mum thinks its like being in a top hotel The system used at the time of this visit did not record that each care plan had been reviewed monthly. Records were in place to demonstrate when changes had been made to the care plan or when a new care plan had been developed. However the system used to did not make this information easy to identify. Discussions took place with registered manager and the homes operations manager regarding new care plans that were being introduced into the home. A sample copy of these care plans was seen. These care plans had a review page attached to each area of support identified. This will then demonstrate that all areas of support provided have been reviewed each month. Records of six monthly care plan reviews were in place in the files of both of the people case tracked. The providers self assessment told us that appropriate systems are in place for people to access health services and for these services to be provided within the home if required. It said that any requirements for health aids are reviewed monthly with the care plan and accessed via the appropriate professionals. Records were in place that Care Homes for Older People Page 14 of 34 Evidence: demonstrated that health care needs were met. The information seen included each persons medical history and information on their health care. For example weight records were in place as part of the nutritional screening that was undertaken. Records were in place to support that the manager and staff worked with other professionals in ensuring peoples health care needs were met. This included health visits and appointments with doctors, district nurses and chiropodists. One visitor that was spoken with was asked if they felt their relatives health care needs were met. They confirmed that they were and said that were always informed of any concerns or issues regarding their relatives health. They told us that their had been a period of time when they had been unable to visit and said that they were confident that their relative was looked after very well by staff at the home. They said, I cant fault it here, if ... wants to stay in their room staff do regular checks on ...., they find time to sit and chat with ... Im confident that ... is looked after very well. Written comments in the staff surveys received told us our residents are cared for to the best of our ability. They are given choice and all their needs are met to the managers standards which are extremely high The providers self assessment told us that people are encouraged to be as independent as possible. This was seen in the records of both people case tracked. Their care plans not only informed staff of the support they needed but also told them what the individual could do for themselves. Sometimes this required staff to provide verbal prompts to enable people to retain their independence. The providers self assessment told us that all staff who are authorised to administer medication have undertaken both in house and external training. The training records demonstrated that all staff that were responsible for administering medication had received the appropriate training and the majority had received an update in this training every three years. The records showed that this update was overdue for three staff. People were supported to take their medication safely. The medication records of the two people case tracked were looked at and no errors were noted. Records had been completed accurately. Medications were stored correctly and all records seen were clear and accurate. A clinical fridge was in place for storing medicines that required cold storage. Records of minimum and maximum temperatures were recorded but no record of the actual fridge temperature was in place. This should be in place to enable the staff to check that the clinical fridge is running at the required temperature. Care Homes for Older People Page 15 of 34 Evidence: The providers self assessment told us that staff training included NVQ qualifications and that all health and personal care is delivered in private and with regard to individuals wishes. It also said that during staff induction training, the staff are given instructions in maintaining peoples choices and on treating them with respect and maintaining their dignity. The records seen and observations undertaken on the day of this visit confirmed that people living at the home were treated with dignity and respect by the staff team. Comments within the surveys received and from people on the day of this inspection visit also confirmed this. Comments included, oh yes they are always very respectful and polite and treat residents with respect and thoughtfulness. Support the family as well as the residents. Care Homes for Older People Page 16 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated as individuals and the home is responsive to their preferences and beliefs. People are able to keep in touch with their family, friends and representatives and have nutritious meals that are enjoyed. Evidence: The providers self assessment told us that each persons preferences regarding social activities, cultural interests, meals and mealtimes, daily living routines, relationships and religious needs were recorded in their care plans. The care plans seen confirmed this. The providers self assessment told us that there was a full and varied social programme for people living at the home and their families to participate in if they wish to. The surveys we received from the people living at the home and discussions held on the day of this inspection visit confirmed that activities took place. They said, theres activities if you want to join in you can and theres lots of activities, I have seen people playing with those large dominoes and they invite families to join in too. Like trips out, meals and entertainers, like singers. One person wrote in their survey under the heading what the home does well, entertainment and listening to the needs of the patient. One person wrote in their survey that there could be more Care Homes for Older People Page 17 of 34 Evidence: activities such as bingo and quizzes. We looked at the notice board which advertised the events and activities that were planned. The activities included, a craft shop, puzzles, hairdressing services, memory games, out door games, bingo, music mornings, table hockey and table football. It also showed us that musical entertainment was planned for the 15th February. Information was also on this noticeboard about who has received mail for collection from the office and a meeting that was organised for the people living at the home on the 21st January. The registered manager stated that activities were organised through consultation with people living at the home. There were three monthly meetings for the people living at the home and questionnaires were sent out that linked with the topic from the meeting. This ensured that everyone was given an opportunity to have their say. In the files of the two people case tracked social care plans were seen. This information covered interests, hobbies, family or carer relationships and contact details and voting preferences. Information was also gathered regarding peoples life history. This provided detailed information on the persons family, interests, pets, siblings and career. Thereby enabling the staff to get to know the person in a more individualised way,so that their care could be provided in a person centred rather than task focused way. The providers self assessment told us that people were free to choose when they get up and go to bed and how they spend their day. This information was seen in the care files of the two people case tracked. People that were spoken with on the day of this inspection visit also confirmed this. The providers self assessment told us that people were are able to receive their visitors in private if they wish. This was observed on the day of the inspection visit. One visitor spoken with confirmed that she was always made to feel welcome and was able to make a drink for herself if she wished. There was a drinks area for visitors to make drinks. The providers self assessment told us that there was a wide choice of meals available for the people living at the home with varied and nutritious meals offered at each meal time. Within the care plans of both people case tracked there was information regarding the individuals meal preferences and likes and dislikes, any dietary requirements they Care Homes for Older People Page 18 of 34 Evidence: had,their preferred place to take meals and the level of support they required at meal times. Comments from people on the day of this inspection visit and within the surveys received confirmed that meals were enjoyed. Such as the food is lovely, theres always a choice you can ask for something else if you dont fancy the choices. The menus seen demonstrated that two choices were provided. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the all information they require in order to raise concerns. The correct procedures are not always followed to enable the service to demonstrate transparencies within their practices around the Safeguarding of the people that live at the home. Evidence: The providers self assessment told us that the home operates an open door policy and that there was a clear complaints procedure which was included in the service user guide, staff handbook and posters around the home. This includes the directors telephone numbers and how to contact CQC. The complaints procedure was displayed in the home and contained all the relevant information. People spoken with were confident that any concerns they had would be addressed promptly. One person said, If I have any problems, I would talk to the manager. One visitor said, I have never had to complain but I know if I had any concerns they would deal with it. In the surveys received from five people living at the home they said they understood how to make a formal complaint and all said they had someone they could speak to if they were not happy. In the five staff surveys received they all said that they knew what to do if someone Care Homes for Older People Page 20 of 34 Evidence: had concerns about the home. The providers self assessment told us that the manager held a monthly surgery between 5.30 -7.30pm to give people the opportunity to express their views and concerns. Quarterly newsletters were also sent out, which included a suggestion slip and a suggestion box was located in the reception area. The home also promoted the procedures regarding concerns by displaying a concerns file in the foyer. It was stated in the providers self assessment that this was to enable the service to deal with any concerns swiftly and promptly. The home kept a complaints log and a concerns log. The records within the concerns log recorded six concerns in total since the last key inspection. The records demonstrated that these were minor concerns and records were in place to demonstrate that these had been addressed promptly and the outcomes were recorded. We have received one complaint from a relative of a person that had lived at the home. The nature of this complaint meant that we alerted the the Local Authorities of this under the Safeguarding Adults Procedure. The manager of the home had not referred this complaint to the Local Authority under the Safeguarding Adults Procedure. Since the last inspection visit we have received information from the registered manager of incidents that have happened at the home. These are referred to as notifications. Two of the notifications that have been sent to us should have been referred by the registered manager to the Local Authority under the Safeguarding Adults Procedure, due to the nature of these incidents. We therefore referred these to the Local Authority upon receipt of this information. On the day of this inspection visit the registered manager informed us of an incident that had led to a referral being made to the Local Authority under the Safeguarding Adults procedure by a health care service. Although the registered manager had taken the appropriate action to ensure the person concerned had received the appropriate health care treatment, she had not recognised that this incident should have been reported to the Local Authority under the Safeguarding Adults procedure. The accident and incident records held at the home for 2009 were looked at. One was seen that related to an injury and it was recorded that the cause of this was unknown. This was discussed with the registered manager and the homes operational manager as a referral should have been made to the Local Authority under the Safeguarding Care Homes for Older People Page 21 of 34 Evidence: Adults procedure, as there had been no witnesses to confirm how this injury happened. Although the outcomes for people using the service were not affected by the registered manager not following the Safeguarding adults procedure, discussions took place to clarify why they should have been reported by the home to the Local Authority under the Safeguarding Adults procedure. At time of visit the home received an updated safeguarding policy from the Local Authority. The information contained referral forms, posters, booklets and contact information for safeguarding referrals. Discussion with care staff demonstrated that they had a clear understanding of their role to report any safeguarding concerns. They were aware of the location of the safeguarding policy and stated that they received safeguarding adults training every three years. The staff spoken with also confirmed that they had undertaken training in Deprivation of Liberty Safeguards and said that this was interesting and helped them to understand issues around capacity in relation to care practices. Staff training records showed that the registered manager had undertaken Safeguarding Adults training in September 2007 and was due for a training update by September 2010. The registered manager had also undertaken training in Deprivation of Liberty Safeguards in August 2009. Fourteen staff had completed Safeguarding Adults training some in 2007 and others in 2008 and some were due for updates in 2010 others in 2011. The records showed that two staff were overdue for an update in this training. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides sufficient space and facilities to meet needs and preferences and is kept to a good standard to ensure peoples safety and well-being is maintained. Evidence: The providers self assessment told us that they offered a clean homely environment. The maintenance person and housekeeping team work hard to keep the home clean. It also said that the gardens and grounds are well maintained and used by people living at the home and visitors in warmer weather. A partial tour of building was undertaken and all areas seen were well maintained and decorated to a good standard.On the ground floor there was a large lounge with two televisions, a conservatory and a smaller lounge. On the day of the inspection visit the smaller lounge was occupied by the gentlemen that lived at the home. The manager stated that this tends to be the case during the day although the ladies that sit in the conservatory join the men in this room in the evening. It was confirmed that people are able to sit were ever they wish. People were seen moving freely around the home on the day of the inspection visit. Outside a sensory garden was provided and the garden area was enclosed and a bolted gate was in place for security. There were staff files situated in a wall rack on display in the corridor. These files had photographs to identify the staff and gave information on staff qualifications and Care Homes for Older People Page 23 of 34 Evidence: experience. The manager confirmed that no confidential information regarding the staff was kept within these files. She confirmed this information was for relatives and visitors to view if they wanted to. One bathroom seen had a Jacuzzi bath with sensor lights in and a built in music system. The manager said that this was enjoyed by many of the people living at the home. She talked about one gentleman who liked to listen to the football match whilst in the bath. The providers self assessment told us that all bedrooms are single rooms, 15 have en suite facilities.Some bedrooms were seen and were attractively decorated and personalised with individuals furnishings. All bedrooms had their own safe.This ensured that people living at the home had secure storage within their private accommodation if they required it. The laundry area was seen and housed sufficient equipment to meet disinfection standards and maintain individuals laundry requirements. The registered manager confirmed that the laundry was staffed daily. Separate domestic staff were employed to undertake the housekeeping of the home. Comments from one visitor during the inspection visit were very positive regarding the standards of housekeeping. Their relative said it was like being in a top hotel. Another person living at the home said My room is lovely, its cleaned for me. The five surveys received from people living at the home confirmed the home was always fresh and clean. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty at all times. Appropriate staff checks ensure individuals safety is maintained. Evidence: The providers self assessment told us that there are sufficient staff available day and night to ensure the needs of the people using the service are met. The rotas were looked at and demonstrated that there were sufficient staff on duty to meet the needs of the people living at the home. There were five staff on duty in the morning,four staff on duty in the afternoon, with an additional member of staff on duty from 5pm to 7pm to provide extra support at the tea time meal. Three staff were on duty throughout the night. Included in these numbers a team leader was on shift throughout the day and a senior carer was on shift throughout the night. Staff that were spoken with and comments within staff surveys indicated that the staffing levels were satisfactory in ensuring the needs of individuals were met. This was also indicated by surveys and comments made by the people living at the home. The providers self assessment told us that the home has a good mix of staff with combined skills and experience to meet the needs of the residents. This was confirmed by the staffing rotas that were looked at. Care Homes for Older People Page 25 of 34 Evidence: The providers self assessment told us that eighty percent of care staff have NVQ 2 or 3 with a further 3 carers currently undertaking training and 2 staff waiting to enrol. The training rotas showed us that fifteen staff had achieved an NVQ 2 in care and seven staff had achieved an NVQ3. People at the home can be confident in the staff supporting them. This is because checks have been done on all staff, to make sure they are suitable to care for the people living at the home. The recruitment records of two members of staff were looked at. All both had the required checks in place that were satisfactory. The providers self assessment told us that staff are encouraged to undertake training in mandatory subjects as well as other care related subjects. Training records were in place for the both the manager and the staff team. The training records were seen and demonstrated that staff training was kept up to date and refresher courses were generally provided as required. However the records did show that some staff did not have refresher training as required. For example the policy of the service was that Health and Safety Awareness training was updated every three years. The records showed that the registered managers refresher training that was due in January 2009 had not been done. Three more staff were overdue for this training, as the records showed they were due for an update in August 2009. The training records showed that ten staff were up to date with Moving and handling awareness training and that twelve staff were overdue for an annual update. The manager stated that this training was valid for 3 years but said that company liked the staff to undertake a refresher course every year. However the training records showed that there was still six staff overdue for their 3 yearly training as this was due in October 2009. The training records showed that twenty one members of staff had undertaken Infection control training and 10 were overdue for refresher training including the registered manager by about 4 months. The training records showed that all others areas of training were up to date. Staff spoken with confirmed that the training provided was regular and useful in developing their skills and knowledge. This enabled them to provide a good standard of care to the people living at the home. Satisfactory induction records were in place and demonstrated that a thorough Care Homes for Older People Page 26 of 34 Evidence: induction took place at the start of employment, to ensure new staff were supported and guided to undertake their job competently. Staff comments regarding training and induction were positive, such as we get training and if we ever have doubts on anything the team leaders and management are always there to guide and help you and offer training opportunities as well as mandatory courses, chance to improve skills . Comments from people living at the home and their representatives also indicated that the staff had training and support required to undertake their job competently. Such as, the staff are continuously being trained in skills relating to care for the elderly, which has a positive effect for the residents and They look after us very well. Care Homes for Older People Page 27 of 34 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 home is managed appropriately and peoples health and safety is maintained. However the correct procedures are not always followed to enable the home to demonstrate transparencies within their practicess to external bodies. Evidence: The providers self assessment told us that the registered manager has worked at the home for over 8 years. She is qualified to NVQ 4 in care and has a management qualification,an NVQ assessor qualification and attends relevant training for continued professional development. The training records showed that the managers training was kept up to date except as mentioned in training section. The records showed that training other than mandatory had been undertaken by the manager, such as assessors training to support staff undertaking NVQs. Other training that was specific to the needs of the people using the service had also been undertaken by the manager such as diabetes, continence care, The Mental Capacity Act and Deprivation of liberty safeguards, palliative care, pressure area care and wound care. Care Homes for Older People Page 28 of 34 Evidence: The providers self assessment told us that the manager ensures the ethos of the home is open and transparent and the manager makes herself available to staff, people living at the home and relatives. Comments from staff supported this, such as the home in my opinion has the best manager and deputy manager to work for, also they are always available for whatever problem staff or clients have, they are always at the end of the phone and will come into the home whatever the time of day or night. Comments from people that lived at the home were also very positive, such as the management at Douglas Court are fantastic, the facilities are brilliant and I think Douglas Court is run by people who care and this comes across always. As stated earlier in this report, although the manager is open and transparent in informing us of incidents that have occurred at the home, she has not always been clear when an incident needs to be referred to the Local authority as part of the local safeguarding procedures. The providers self assessment told us that there are quality assurance systems in place which ensures the home is effective at meeting the needs and wishes of the people living at the home. The manager monitors every area of the home once a month using an inspection tool. The quality assurance coordinator carries out monthly inspection meetings and internal checks. Visitors satisfaction surveys are available in reception together with a suggestion box. The quality assurance practices in place demonstrated that the home is run in the best interests of those living there. Examples of this include, three monthly meetings for the people living at the home, questionnaires that are sent out every three months, with the questions being related to the topics from the meetings. This ensures that everyone gets their say. Staff questionnaires and questionnaires for the people living at the home were also sent out by company annually these were audited and fed back to the manager with any actions that were required. The registered manager stated that the home did not hold any savings money on behalf of the people living there. Purchases such as hairdressing were paid by the home and relatives were then billed for these amounts. Supervision records were in place and demonstrated that regular staff supervision was undertaken. Staff also confirmed they received regular supervision. The providers self assessment told us that the manager ensures safe working practices are maintained for everyone within the home. A sample of health and safety certificates were examined this included maintenance checks on equipment and fire Care Homes for Older People Page 29 of 34 Evidence: safety procedures. This demonstrated that the environment is safe for people because the appropriate health and safety checks are carried out. Care Homes for Older People Page 30 of 34 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 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Evidence must be in place to 20/04/2010 demonstrate that care plans are reviewed on a monthly basis. To enable the service to demonstrate that peoples needs are regularly reviewed. 2 18 13 Any accidents or incidents of 22/02/2010 unknown origin that result in injury to a person using the service must be referred to the Local Authority Safeguarding Team. This will ensure that the home demonstrates transparencies within their practice to safeguard people from abuse. 3 18 13 All staff must have up to date training in Safeguarding Adults. 20/04/2010 Care Homes for Older People Page 32 of 34 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 ensure they are aware and understand the current practices to follow. 4 30 17 All staff must be up to date in all areas of mandatory training and evidence must be in place to support this. This will ensure that staff are working in a safe way,following up to date practices 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 20/04/2010 1 2 9 9 All staff that administer medication should receive a training update in line with the company policy. Actual clinical fridge temperatures should be recorded, to enable the staff to check that the clinical fridge is running at the required temperature. To ensure staff to have up to date current knowledge on Safeguarding Adults, all staff should have annual updates of safeguarding training. 3 18 Care Homes for Older People Page 33 of 34 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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