Care Home: Down House Residential Care Home

Similar services:

• Flint House
• St Vincents
• The Cotswold Home
• Fairways
• Winton House
• Treloar College
• Rush Court

What the care home does well Residents live in a friendly and homely environment and have their own bedroom with their personal possessions around them. Some of the residents chose to live in the home because of it`s location in a part of the Isle of Wight they they have known for a long time and they are close to family and friends. The home is an attractive period building set in extensive and attractive grounds. Some of the staff team have worked in the home for a long period and know the residents well. Visitors are always made welcome. What has improved since the last inspection? Action has been taken to improve practice in the home: care planning has improved so that care plans reflect individual care needs, personal choices and preferences. Care plans contain sufficient detail to guide care staff on how health care needs are to be met. The handling of medication has improved so that we can easily check to see that people have received their medication, as prescribed. The home has a new manager who is registered with the commission. The manager is in the process of developing efficient systems to monitor practice in the home. Staff training and supervision has improved. This means that the home is working towards having a team of staff who will be skilled and qualified for the work they do. What the care home could do better: Improvements to practice in the home effect the outcomes for people living in the home in a positive way. The service must demonstrate that improvements will be sustained and embedded in practice in the home. The registered person must ensure that there are sufficient bathrooms and toilets to meet the needs of people in the home to ensure privacy and dignity at all times. The home must also provide suitable and safe sluicing procedures. In the interests of the safety of residents and staff, manual handling and the use of specialist equipment such as hoists, should only be carried out by staff who are trained and competent to do this. In the interests of the health and safety of residents and staff, there must be a consistent approach to promoting health and safety and safe working practice. There are some gaps in staff training, although these are being addressed. Key inspection report Care homes for older people Name: Address: Down House Residential Care Home Alum Bay New Road Totland Isle Of Wight PO39 0ES     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Annie Kentfield     Date: 1 3 1 1 2 0 0 9 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 33 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 33 Information about the care home Name of care home: Address: Down House Residential Care Home Alum Bay New Road Totland Isle Of Wight PO39 0ES 01983752730 01983753624 clacktmc@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Trina Marie Clack Name of registered manager (if applicable) Miss Louise Claire Barr Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 17. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Down House Residential Care Home provides care for up to 17 older people. The new owner of Down House took over the home in December 2007. The home is a period property set in spacious grounds and provides bedrooms on the ground and first floors with a passenger lift to access the first floor. The home has two small sitting rooms Care Homes for Older People Page 4 of 33 2 8 0 4 2 0 0 9 17 0 17 Over 65 0 17 0 Brief description of the care home and a dining room that has recently been extended and refurbished. Residents have access to a sunny garden area with seating and tables. The fees vary according to the care provided with additional charges for chiropody and hairdressing. Other additional charges are listed in the service user guide. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Two inspectors made an unannounced visit to the home on 13 November between 10 am and 5 pm. Seven of the eight residents, the registered manager, registered provider and two members of staff were involved in the inspection visit. Care records, medication records, staff training and recruitment records were looked at and time was spent looking at areas of the home such as bedrooms, toilets and bathrooms, and communal areas of the home. Comments and feedback received from residents and staff during the visit were all positive. We also visited the home on 21 July 2009; this was with an inspector and a specialist pharmacist inspector. The visit was to assess whether the home had met a Statutory Requirement Notice and assess the handling of medicines in the home. We issued the notice because we had serious concerns about poor practice in the home in important areas of care planning, managing risk, and administration of medicines. Poor practice had the potential to place people living in the home at risk of not having their health Care Homes for Older People Page 6 of 33 care needs met. The visit of July 2009 found that although some aspects of medication practice had improved, the lack of comprehensive records of care placed people at risk. We wrote to the registered provider with a warning that key areas of practice in the home must be improved to safeguard the health, safety and well being of people living in the home. A voluntary agreement meant that new residents would not move into the home until the service was able to demonstrate that people would be safe and their health care needs consistently met. Care Homes for Older People Page 7 of 33 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 Care Homes for Older People Page 8 of 33 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has developed a comprehensive and person centred assessment form for identifying the care needs of prospective new residents. When this is put into practice, residents should be confident that the home will be able to identify and confirm that they can provide the care that new residents require. There is written information about the home to enable prospective residents and/or their representatives to make an informed decision about moving into the home. Evidence: At the last two inspections of the service we found that the process for assessing and identifying the care needs of new residents was not organised and thorough. This meant that people moving into the home were at risk of not receiving the care they needed and staff did not have all the information they must have to be able to meet peoples care needs. We also had concerns that practice in the home was not safe and residents may be at Care Homes for Older People Page 11 of 33 Evidence: risk of harm from poor care planning and poor medication practice. The registered person voluntarily agreed that the home would not admit any new residents until action had been taken to demonstrate that peoples care needs could be met safely and consistently. The service sent us an improvement plan to tell us what they were doing to improve practice and make sure that residents safety and well being was protected. The improvement plan told us that an organised assessment process had been developed, care planning had been reviewed and improved, medication practice had been reviewed, and there is now a staff training programme in place to ensure that staff have the skills and qualifications they need for the work they do. The visit of November 2009 confirmed that action has been taken to develop a comprehensive and person centred assessment form. The new form will gather all relevant information about new residents to ensure that the home is able to provide the care people need, before they move in. The new assessment process has yet to be put into practice. The assessment form does not clearly identify a link between peoples care needs and the number of staff and any specific skills and/or equipment required to meet peoples care needs. The manager told us that this would be developed in the assessment of peoples care needs and be recorded to demonstrate this. We looked at the information about the home that is given to prospective residents and their families. The information has been updated and is available in a written format. The home should demonstrate that they are able to fully consider peoples communication needs and ensure that information about the home is available in formats to meet individual needs. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents now have an individual plan of care that generally reflects their personal preferences and choices and provides guidance for care staff on how care is to be provided. This will ensure that people receive the care they need. Residents medication is organised and safely dispensed and systems are checked to ensure that residents receive their medication, as prescribed, at all times. The privacy and dignity of the residents may be compromised by lack of choice and access to suitable bathrooms and toilets. Evidence: Previous inspection visits found that residents were at risk of their health care needs not being met because there was a lack of awareness in the home of poor practice and the potential effect on the health of the residents. The service were asked to provide an improvement plan to tell us what they were doing to address all of these concerns. The home has reviewed the way that care plans are developed and we saw evidence of individual plans of care that are more person centred and contain clear guidance for care staff on how peoples care needs are to be met. For example, one care plan Care Homes for Older People Page 13 of 33 Evidence: contained specific and detailed information for care staff on what a resident is able to do for themselves with regard to personal care. Another care plan contained details of how many staff are needed to assist a resident with personal care and that the resident preferred to receive personal care from a female carer. The care plans contained detailed information about how risks are to be minimised or events managed. We also noted evidence to demonstrate that the plans of care have been read and discussed with each resident and/or their representative and agreement signed and recorded, with comments, where relevant. The home now has a system for reviewing care plans at least monthly with comments recorded where care needs have changed and why. All of the records relating to the care of each resident are easily accessible in one file and include daily records of care provided, and details of any contact with GPs, Community Nurses, or other health care services. The manager told us that the home now has a handover system so that staff are aware if there are changes to peoples care needs. However, one plan of care did not have specific information for staff with regard to fluid intake, staff are told to ensure adequate fluid intake and staff did not have specific guidance on the amount of fluid required and whether this should be separately monitored or not. This means a resident could be at risk of not receiving the care and fluids they need to promote their health and well being. One care plan did not contain clearly recorded preferences and a risk assessment with regard to privacy and having a bedroom door left open. The home must demonstrate that personal preferences with regard to privacy and dignity are clearly agreed and recorded in the care plan. This means that residents may be at risk of their privacy and dignity not being promoted and different staff may work in different ways. Residents may also be at risk if their bedroom doors are wedged open as this means that doors would not automatically close in the event of a fire. The care plans contained relevant and detailed information about aspects of care such as continence care, mobility, and specific care and equipment needed to prevent pressure sores. For example, one care plan informed staff about the continence plan for a resident and what equipment was needed, and when. Where people need to be assisted using a hoist, the manager must ensure that a specific and individual assessment has been carried out to make sure that the hoist sling being used is correct and the right size. Otherwise residents may be at risk of harm from poor practice in manual handling and the use of essential equipment. The care needs of one resident have very recently changed and the manual handling plan had not yet been updated. The record of falls had not been updated. The manager told us that a specialist assessment would be requested to ensure that the hoisting Care Homes for Older People Page 14 of 33 Evidence: equipment being used is correct and the right size for the needs of the residents. Not all of the staff have updated their training in manual handling. Although this is being addressed, residents and staff may be at risk from poor practice if staff are not trained and supervised in the safe use of equipment being used to assist residents. The manager told us that one member of staff is on duty at night. On those occasions when two carers are needed to provide care; the registered provider is on call and acts as an additional carer. Improvements in care planning and practice in the home confirm that the home has complied with regulatory requirements. This means that the outcomes for people living in the home have improved because the home is able to demonstrate that peoples health care needs are being met in an organised and consistent way. The home must ensure that improvements are sustained and embedded in practice in the home for the benefit of residents. We have previously made regulatory requirements about medication practice in the home because people were at risk of poor practice and records did not demonstrate that people were receiving their medication, as prescribed, at all times. We found that people living in the home receive their medication in an organised and safe way and we were able to confirm this when we looked at the medication records. We saw records to confirm that the manager now carries out a weekly audit of medication to ensure that residents have received their medicines and there is a stock balance of medication received, dispensed or returned. People who have been prescribed a medicine to be taken as and when required have a specific care plan for this. This means that staff have clear written guidance on when and why this medicine is to be offered when needed. The care plans also identify if residents are able, or not, to manage their own medication. This means that people living in the home receive their medication consistently and in the same way from all of the staff. The manager confirmed that all staff have now completed training in the safe administration of medication. The home has demonstrated that improvements have been made to the way that medication is organised in the home and this means that residents are not at risk from poor practice. The home must ensure that improvements are sustained for the benefit of the health and well being of the residents. Care Homes for Older People Page 15 of 33 Evidence: Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered choices of wholesome meals to be eaten in pleasant surroundings. Visitors are welcome at any time. Residents have the opportunity to take part in social and leisure activities. Evidence: On the day we visited the home, some of the residents were watching television in the sitting room and a member of staff was playing a board game with a resident. We were told that people enjoyed organised reminiscence sessions, musical entertainment and occasional parties. One person told us that they had recently enjoyed a clothes party that had been organised by the home. Another person told us that they had enjoyed sitting in the garden during the summer months. The home has an extensive area of garden and grounds providing residents with a pleasant view from the sitting room and some of the bedrooms. Seats and tables are available in the warmer weather for residents to sit outside. Staff told us that a religious service is arranged in the home, usually monthly, and residents can take part if they choose to. Care Homes for Older People Page 17 of 33 Evidence: We were told that a Christmas party is being planned for residents and their friends and families. A Christmas raffle is already underway. Visitors are always welcome and are asked to sign the visitors book. The new care plans that have been developed by the home contain more information about individual and personal preferences and choices as to what activities people like to do. This could be developed further to demonstrate in a person centred way how the home meets individual needs and choices for social and leisure activities. The home keeps a record of activities that take place each week. The manager told us that monthly meetings with the residents have been taking place to give people the opportunity to say what they would like to do or make comments on food and menus. Not all of the residents are able, or wish to, participate in group meetings and activities. It was evident that with a small group of residents, staff interact flexibly and informally with residents they know well. A more formal structure to social activities may be needed when there are more residents in the home and new staff are working in the home. The registered provider is temporarily acting as cook in the home and we observed staff asking residents what they would like for lunch and tea. It was evident that residents have a choice for their main meals and there was a choice of sandwiches or a cooked snack at tea-time. Special dietary needs and personal preferences are recorded in peoples care plans. Meals are freshly prepared in the home and the dining room is homely and comfortable. Hot or cold drinks were provided at regular intervals during the day. Residents we spoke to told us the food in the home is good. We observed staff offering individual assistance to those residents who require help with eating and the care plans contained information for staff if residents need special diets or special equipment for eating. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to information about the homes complaint procedures. Policies and procedures are in place for responding to concerns about the safety of people living in the home. However, knowledge and practice of procedures is inconsistent and this has the potential to place residents at risk of harm. Evidence: A written complaints procedure has been made available if or when this is required. This is included in the information about the home. A comment box has been set up in one of the sitting rooms, along with information leaflets that may be useful to residents and their visitors. The manager told us that the home wants to welcome feedback and comments so that improvements can be made for the benefit of the residents. This means that comments can also be made anonymously, if people wish. No complaints have been received but the manager has developed a system for formally recording and responding to complaints, when appropriate. There have been previous safeguarding concerns about practice in the home. These have been investigated by the Local Authority Social Services Safeguarding Team. We have received information from Social Services that immediate action was taken by the home to address these concerns. There is currently no safeguarding concerns Care Homes for Older People Page 19 of 33 Evidence: about the safety and well being of people in the home. Some staff have had training around safeguarding awareness. Where there are gaps in staff training, these are being addressed. However, some staff who have not yet done any training may have limited understanding in this important area. This could lead to inconsistent knowledge and practice within the home. We spoke to two members of staff who said they felt more confident about reporting concerns if they affect people living in the home, as a result of recent training in safeguarding awareness. The staff recruitment procedures have improved and these now demonstrate that suitable checks on new staff are carried out. This means that staff are suitable to work in the home people in the home are protected from the risk of harm. Care Homes for Older People Page 20 of 33 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 home is generally clean, comfortable and pleasant for the benefit of people living in the home. However, limited bathroom and toilet facilities could compromise the privacy and dignity of the residents. Infection control procedures and sluicing facilities are not well organised and practice may put people at risk of harm. Evidence: When we visited the home in April 2009 we found poor hygiene and cleaning practice, particularly evident in the toilets and bathrooms. At the time, the home did not have a designated cleaner or cleaning programme. We made an immediate requirement for toilets, commodes and other equipment to be cleaned and maintained in a hygienic manner. During this visit we found that generally the home was clean and pleasant. However, one bedroom had a slight odour of urine. The manager told us that this would be addressed. Another bedroom had a strong odour of aerosol spray. This was pointed out to staff for immediate investigation because of the potential risk to residents who may have respiratory problems. Some of the commodes being used in bedrooms are old and rusting in places. This is Care Homes for Older People Page 21 of 33 Evidence: an infection risk because rusting surfaces cannot be properly cleaned. The commodes are also not pleasant for residents to use. The registered provider told us that she plans to replace the old commodes. During our last visit we had concerns about the risks to residents from poor practice and lack of awareness of infection control procedures, particularly in relation to the sluicing procedures and cleaning of commode pots. The practice of the home is to clean commode pots daily with a twice weekly immersion in bleach. This is done in a first floor bathroom that is not used by residents. However, the bathroom is not lockable from the outside and this practice may put residents at risk when the bath is full of bleach. This also means that there is only bathroom for residents to use. At the moment there are 8 residents in the home with an assisted bath and toilet on the first floor and two toilets on the ground floor. There is an additional staff toilet on the first floor that residents can use, although this toilet is not easily accessible for residents who need assistance or need to use specialist equipment. There is a risk that residents privacy and dignity may be compromised because of the lack of available bathrooms and toilets with no choice about using commodes in bedrooms. The laundry is located on the ground floor with access through the dining room and kitchen. All cleaning liquids are locked in a cupboard in the laundry room. The manager told us that the home has asked for specialist advice from an infection control nurse and is awaiting further information, with regard to sluicing procedures. During our visit, seven of the residents were in the ground floor sitting room. Although the sitting room is pleasant and homely, the space is very limited and some of the bedrooms are accessed by going through the sitting room. When the home has more residents this could present some difficulties of access and space for residents in the home and the safe storage of mobility equipment. The registered provider has an ongoing maintenance programme for the home and extensive decoration and repair has been carried out both internally and externally. Some of the bedrooms and other areas of the home have been re-decorated. Bedrooms were seen to be personalised with residents own possessions and bedroom and bathroom doors are lockable to ensure privacy. Care Homes for Older People Page 22 of 33 Evidence: The first floor bathroom has an assisted bath for residents, and records of bath water temperatures are maintained to ensure residents safety. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A staff training programme is being developed to ensure that the needs of the residents will be met by staff who are trained and qualified for the work they do. Staff recruitment procedures have improved and this helps to protect people in the home from the risk of harm. Evidence: The staff rota shows that there are two carers in the home between 7.30am and 10pm with three carers on some days. Between 10pm and 7.30am there is one member of staff and the registered provider is on call when required. There is a staff team of eight people including the registered manager and the registered provider. The home also employs a cook who works 5 days each week with the registered provider cooking at weekends. At the moment there are eight people living in the home. The current staffing levels would not be sufficient or safe if and when more residents move into the home. The manager told us that two new staff are waiting to start work when the home has confirmed satisfactory employment checks. We looked at the recruitment records for the new staff and these confirm that the home is now operating thorough recruitment procedures. This demonstrates that staff are suitable to work in the home and protects people living in the home from the risk of harm. Care Homes for Older People Page 24 of 33 Evidence: Opportunities for staff training have increased. The manager is aware that there are some gaps in the training programme and plans to deal with this. The manager has been appointed and become a registered manager in the last few months. It is evident that work has been done since we last visited the home to implement and organise a staff training and supervision programme for the home. This needs to be sustained and further developed. This will ensure that staff obtain the training and qualifications needed for the work they do, and ensure that people are cared for by staff who get the relevant training and support. The training records show that some staff have not yet completed all areas of mandatory and basic training: infection control, food hygiene, manual handling, health and safety, fire safety, safeguarding people, and safe administration of medication. Where there are gaps in training, we saw evidence of training sessions that have been booked and staff signed up to do this. If staff do not receive training and support there is a risk of poor practice and people living in the home may not receive safe and consistent care. The training records did not include the registered provider who works as part of the staff team. The registered manager must ensure that all staff who work in the home have received appropriate training for the work they do. Care staff who work at night have completed less training than day staff. Residents may be at risk from poor practice if staff have not received suitable training in safe working practice, particularly staff who are working alone. Some but not all of the staff have done other relevant training in addition to the basic requirements. Three staff have completed training in dementia awareness this year, and 3 staff have completed some training in the Mental Capacity Act. The manager told us that training is also planned in good practice in preventing trips and falls. All but one of the staff team have achieved an NVQ (National Vocational Qualification) in care, at level 2 or 3 and the manager has achieved an NVQ in care at level 4. At the last inspection, we found that the home did not have an organised system for supporting staff or arranging work appraisals. There is now a system in place for staff to have four supervision sessions each year. Records show that the manager has developed a suitable staff supervision form to demonstrate that practice and progress is being monitored and reviewed. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has not been consistently effective and organised and this has affected outcomes for people living in the home. However, the home now has a new registered manager. The registered manager is improving and developing systems that monitor practice and compliance with policies, procedures and legal requirements. More work is needed in this area to ensure that peoples care needs are consistently met. Evidence: The management of the home has not been consistent and there has been three changes of manager. This has had the potential to place residents at risk of harm because of poor and inconsistent practice. The registered person has previously failed to comply with regulatory and legal requirements in the timescales given. This means that the home has not been efficiently monitoring the quality of service they provide to ensure that people receive a consistently high level of care. Improvements to practice have been reactive and the Care Homes for Older People Page 26 of 33 Evidence: service does not effectively monitor their compliance with legal requirements. In the interests of protecting people who live in the home, a voluntary agreement has been in place that new residents will not move into the home until such time as the service is able to demonstrate that residents are safe and practice in the home has improved. Since we last visited the home a new manager has been appointed and has become registered with the commission. The registered manager has an open and organised approach to managing the home and has demonstrated that practice in the home has improved, for the benefit of people living in the home. For example, the manager understands person centred care planning and individual care plans have been reviewed and updated and are more person centred. The new care plans provide guidance for care staff on how peoples care needs are to be met and there is evidence that peoples health care needs are being met. The care plans also demonstrate that residents and/or their representatives have been consulted about the care plans and risk assessments. In addition, the care plans reflect evidence of personal choices and preferences being promoted and protected. An organised process for assessing and identifying the needs of people before they move into the home has been developed although this has yet to be put into practice. This will mean that people will not move into the home unless the home has properly assessed their care needs and can confirm that people will receive the care they need. Medication practice and record keeping has improved. This means that we can easily check that people are receiving their medication, as prescribed, at all times. The manager is improving and developing systems that monitor practice in the home. For example, there is a weekly audit of medication, a communication system for staff including handover book, staff meetings and staff supervision. The manager has set up a comments box for residents, staff and visitors to provide feedback about the home. The manager plans to develop further quality assurance systems such as a satisfaction questionnaire. This means that practice in the home is more effectively monitored and reviewed to ensure that people are receiving a consistent level of care. There is a programme of staff training and the manager has identified gaps in training and these are being addressed. This means that the service is developing a staff team who will be skilled and qualified for the work they do. Care Homes for Older People Page 27 of 33 Evidence: The manager is aware of the need to keep up to date with her own professional practice; and continuously develop management skills, for example, the manager has identified some short term and long term training needs including supervisor training and further management training. An organisational plan has yet to be developed. Policies and procedures have been reviewed, updated and additional policies added. This means that the manager is aware that policies and procedures provide a statement of intent for practice in the home and also provide good practice guidance for staff in the home. The home has a policy that people living in the home manage their own monies or with independent support. Any expenses occurred on behalf of residents are invoiced and paid for separately. The promotion of health and safety and compliance with legal requirements is not consistent and this could put people living in the home at potential risk from unsafe practice. For example, not all of the staff team have completed training in safe working practice in manual handling, fire safety and infection control. Although gaps in training are being addressed, this means that residents and staff may be at risk because of a lack of awareness from staff on how to work safely. A stand alone electric heater in the sitting room has not been assessed for any possible risk to residents and staff when in use. The registered person has not confirmed that the people who cook meals for the residents have the appropriate and recommended levels of food safety qualification. Procedures in the home for cleaning commodes are temporary and there are times when the bathroom being used to bleach commode pots is not locked. This could put residents at risk, particularly people who may be frail or confused. A bedroom door was wedged open and was not fitted with an approved self-closing device. This means that residents safety may be at risk in the event of a fire. Observation of practice in the home, and comments from residents and staff, confirm that staff are generally knowledgeable and aware of the need for practice that respects privacy and dignity. However, one care plan did not clearly record and document preferences for having a bedroom door kept open or not and this could compromise residents rights and choices. Care Homes for Older People Page 28 of 33 Evidence: Privacy and dignity may be compromised by the lack of suitable bathrooms and toilets. We found evidence in the care plans that the home works in partnership with families and close friends of people in the home, and with health and social care professionals who are involved in the care of the residents. We received the Annual Quality Assurance Assessment (AQAA) from the registered provider at the beginning of 2009 and comments were made about the AQAA in the inspection report of April 2009. The AQAA did not contain sufficient information to provide us with a clear picture of the service, with minimal evidence to support any of the statements made within it. We will be asking for another AQAA to be sent to us in 2010. Some of the staff have completed training in the Mental Capacity Act. Information leaflets about how the legislation may potentially affect people living in the home, are available in the home. Further training for staff is planned. This will ensure that staff have the knowledge and skills about how the mental capacity act will work in practice, for the benefit of people in the home. Care Homes for Older People Page 29 of 33 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 30 of 33 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 13 Ensure suitable arrangements to provide a safe system for moving and handling people living in the home. Ensure residents and staff are safe by means of staff training and supervision. Individual assessment to ensure equipment is safe and suitable for specific needs. 31/12/2009 2 10 12 Conduct the home in a 31/12/2009 manner which respects the privacy and dignity of people living in the home. Preferences and choices must be clearly agreed and recorded in the individual care plan. Provide choice, privacy and dignity by ensuring there are sufficient bathrooms and toilets for residents to use. Care Homes for Older People Page 31 of 33 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 3 21 23 The home must provide sufficient numbers of bathrooms and toilets to meet the needs of the people living in the home. The privacy and dignity of the residents must be maintained. Residents must have access to suitable toilets and bathrooms. 31/12/2009 4 21 23 The home must have suitable sluicing facilities. Sluicing facilities should be located in a place that is safe and appropriate. 31/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 When assessing the needs of prospective residents, demonstrate a clear link with staffing levels and staff skills and competencies. This will ensure that the home can provide the care and specialist equipment/skills that people may need. Develop person centred care planning to include preferences, choices and plans for social, cultural and leisure interests and activities. 2 7 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 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) 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!