Care Home: Dresden House Limited

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What the care home does well This service consists of a mixture of Older People some needing high levels of personal care and also people with Dementia Care needs and those with Mental Health needs. some people in the last 2 categories may be below 65 years of age. Although this may not always be a good mix of needs - in this instance it works very well. There is no separation of people with differing needs and the three distinct groups of people integrate well and provide support for each other in this setting. The staff group have had training to meet the specific needs mentioned. There is a varied programme of activities. Since the last inspection when all staff had a responsibility to initiate daily activities, two members of staff have taken the responsibility of leading on activities. Obviously all staff are involved but there is now a positive lead. The activities have been extended to cover 2 periods during the day when activities are available. More external visits and contacts may now be established as well as the internal activity programme, although additional staff time for this purpose may be needed. Food provision is good, with very positive feedback from people in the home. There are choices at all mealtimes and people can request specific foods or dishes. The cook meets everyone weekly to discuss the previous and following week`s menus. Care plans seen are good with detailed information about the health, social and personal care needs of people. People are involved and sign care plans and there are regular reviews. The choices and lifestyle preferences of people are important to the service and their individual choices met. Bedrooms have all been upgraded and are well presented. This ensures that people can spend time in their rooms as they wish with good, comfortable facilities and can also receive visitors there if they prefer. Visitors tell us that this is a very friendly and relaxed setting, that they are welcomed and can visit at any time. They tell us that dialogue with staff is good, they are given detailed information about the progress of their relatives and kept informed of any changes. They give examples of positive experiences for people living in the home. Staff are relaxed and make positive contributions to inspections. It is clear from the views of people using the service, visitors and discussions with them during inspections that there is a committed staff group. What has improved since the last inspection? At the time of the last inspection phase 1 of the refurbishment programme was almost completed - the whole of the ground floor area had been totally refurbished. Some requirements were made at that inspection relating to poor conditions on the first floor but since that time Phase 2 of the refurbishment programme has been completed and the result is that the first floor now meets the improved standards seen on the ground floor at the last inspection. Concerns about staffing levels have been satisfactorily addressed. Domestic staff have now been employed and this has relieved care staff of domestic duties allowing them to concentrate upon meeting care needs. The Manager now works 5 days 9 - 5, is hands-on on the rota and available at important times. There is now a formal on-call system - the Manager is on-call Monday - Friday and a Key Carer paid to be on call at weekends. This means paid staff will be available after hours to assist with urgent situations. For example if someone is transported to hospital by ambulance they can be accompanied by the person on-call. Concerns at the last inspection about hot water exceeding safe limits have been resolved by the installation of fail-safe valves being fitted on all hot water outlets. The valves control the temperature of hot water and vastly improve safety. Additionally there is a weekly manual check of a sample of hot water outlets to ensure complete safety. Since the last key inspection all staff have received training in Dementia Care and also in Mental Health needs. This has improved the service to individuals. What the care home could do better: There is a shortfall in the area of staff training. Training is required in Safeguarding, The Mental Capacity Act and Deprivation of Liberties Safeguarding. These areas of training are important to ensure the correct procedures are followed if there is suspicion of abuse or where people may lack capacity to make decisions about their lives. Insulin should only be administered by care staff where the District Nurse has delegated the function. Staff must have training prior to administering and have been judged competent to do so by the District (or other) Nurse. Delegation must be in writing and only named individuals who have met this criteria may administer insulin. It is recommended that the method of serving drinks in the lounge areas should be reviewed. A lack of small tables, means that people are "balancing" cups of hot drinks on their knee. This would improve safety and accessibility of drinks. Key inspection report Care homes for older people Name: Address: Dresden House Limited 81 Trentham Road Dresden Stoke-on-Trent Staffordshire ST3 4EE     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: Peter Dawson     Date: 2 6 0 6 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 29 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 29 Information about the care home Name of care home: Address: Dresden House Limited 81 Trentham Road Dresden Stoke-on-Trent Staffordshire ST3 4EE 01782343477 01782335813 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dresden House Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 25. The minimum age on admission will be 55. The registered provider may provide the following categories 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: Old age not falling within any other category OP 25 Physical Disability PD 25 Dementia DE 25 Mental Disorder MD 25 Date of last inspection 25 25 0 25 Over 65 0 0 25 0 Care Homes for Older People Page 4 of 29 Brief description of the care home Dresden House is a large detached Victorian house located alongside a busy road in Dresden near to shops and community facilities. The town of Longton can be accessed via public transport; parking is at the rear of the home. Bedrooms are for single occupancy, five bedrooms at the time of this report had an en-suite facility; there are plans to increase en-suite facilities in other bedrooms. Bathing and toilets are located throughout the home easily accessed by the residents. Three lounges, one being designated as a smokers lounge provides a choice of seating and movement within the home. There has been upgrading of most areas of the home on both floors improving presentation and comfort considerably. The remaining areas are currently being upgraded to complete the transformation. Dresden house provides care for twenty-four people the majority of whom are elderly. People with mental health care needs or dementia care needs are also accommodated. The fees for care at Dresden House can be obtained directly from the home or the Statement of Purpose. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was 29th June 2007. An annual service review was completed on 29th August 2008. This was based upon our knowledge of the service and ongoing information we received about it, including a self-assessment and written feedback from users of the service. We were satisfied that the 2 Star rating was still applicable to the service at that time. This unannounced Key Inspection was carried out on one day by one inspector from 08:30 - 17:00 hours. The service completed the AQAA (Annual Quality Assurance Assessment) prior to the inspection. This is a legally required self-assessment document containing information about what the service think they do well, what progress they have made over the past year, what they think they could do better and their plans for improving the service Care Homes for Older People Page 6 of 29 over the next year. Five people using the service also sent us written feedback about their experience of the service. During the inspection all people were seen and several spoken with individually and together. Two visiting relatives were also spoken with and expressed their views about the quality of the service. - Their comments were very positive and supported the view that a good standard of care is being provided by a committed staff group. Members of staff on duty were spoken with, including carers, key carers, care trainees, catering and domestic staff. They provided helpful information about the service and demonstrated detailed knowledge of the needs of the people at Dresden House. We inspected all the communal areas of the home and also a sample of bedrooms. Records inspected included: Care plans, risk assessment, daily notes, medication records, staffing rotas and staffing records, as well as other documents relating to the inspection process. There were 24 people in residence at the time of this inspection and there was one vacancy. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? At the time of the last inspection phase 1 of the refurbishment programme was almost completed - the whole of the ground floor area had been totally refurbished. Some requirements were made at that inspection relating to poor conditions on the first floor but since that time Phase 2 of the refurbishment programme has been completed and the result is that the first floor now meets the improved standards seen on the ground floor at the last inspection. Care Homes for Older People Page 8 of 29 Concerns about staffing levels have been satisfactorily addressed. Domestic staff have now been employed and this has relieved care staff of domestic duties allowing them to concentrate upon meeting care needs. The Manager now works 5 days 9 - 5, is hands-on on the rota and available at important times. There is now a formal on-call system - the Manager is on-call Monday - Friday and a Key Carer paid to be on call at weekends. This means paid staff will be available after hours to assist with urgent situations. For example if someone is transported to hospital by ambulance they can be accompanied by the person on-call. Concerns at the last inspection about hot water exceeding safe limits have been resolved by the installation of fail-safe valves being fitted on all hot water outlets. The valves control the temperature of hot water and vastly improve safety. Additionally there is a weekly manual check of a sample of hot water outlets to ensure complete safety. Since the last key inspection all staff have received training in Dementia Care and also in Mental Health needs. This has improved the service to individuals. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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 sure that they have adequate information about the home and that their needs are comprehensively assessed before making a decision about the suitability of the home. Evidence: It was identified in the last 2 inspection reports that the Statement of Purpose needed updating. This has been done and detailed information added. It would be helpful for people considering using the service if detail could be included about the specialist services the home provides - in areas of dementia and mental health care needs. The weekly fees should also be included. We looked at care plans of people admitted to the home since the last inspection and it was clear that good practice pre-admission procedures had been followed. People had been invited to spend time in the home before making a decision about admission. The home had carried out an assessment of the needs of people in their Care Homes for Older People Page 11 of 29 Evidence: current environment and a multi-disciplinary assessment had been obtained from the social worker prior to admission. It was positive to see that an emergency admission requested immediately by the social worker had resulted in staff visiting the person at home, including the family in the assessment carried out prior to the placement ensuring the persons needs were fully known and met. A letter was also written following assessment, confirming that the home could meet the persons needs. We were able to speak to a gentleman who had been admitted to Dresden House 4 days prior to the inspection from another home, he said he already felt at home and said It is better here (comparison with previous placement). Intermediate Care is not provided by this home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of people are supported with a person centred approach and there is a safe system of medication in place. Evidence: A sample of care plans were seen and contained good information based upon assessed needs with ongoing monthly reviews in-house, charting the progress and changing needs of people. Plans are person centred. Personal and healthcare needs of people were generally well defined. We saw clear information about diagnosed medical conditions and assessments relating to nurtritional needs, food preferences, continence care and chosen lifestyles. Risk assessment were in place relating to moving and handling, pressure risk, and aspects of daily living, for example smoking. One person has a propensity to self-harm. There had been one recent incident when the plan was reviewed with external health care professionals, including Psychiatrist and Community Psychiatric Nurse and a plan established for ongoing monitoring and care with immediate referrals at any time directly to health care staff. This was handled Care Homes for Older People Page 13 of 29 Evidence: well. Social histories were part of the care planning information to facilitate engagement for staff and outline the social care needs of the people involved. There are no incidents of pressure damage in the home at this time. A recent suspect area was referred to the District Nursing Service immediately and appropriate equipment is being provided with advice about movement and management. We were able to speak to a visiting District Nurse who has visited the home over a long period of time. She confirmed that staff have a pro-active approach to health care matters and there is positive two-way dialogue between the nursing service and the home. She said that staff were cooperative and accommodating, following any instructions or advice given. She added that staff were very, very caring. As the inspection progressed it became clear that one person who has diabetes has two daily insulin injections using the pen system. This is administered by staff. There has been no training for staff in the administration of insulin and the nursing service unaware that this is taking place. Insulin can only be a given by delegation from the District Nurse (or other nursing professional), who must provide training for named staff and also to assess and authorise their competence. Only named trained staff must administer the insulin. This is a delegation and the responsibility for administering always remains with the nurse. There should also be regular reviews of competence. A person with a leg wound dressing was given a medicated cream daily for one week by care staff at the request of the District Nurse and the wound has healed. Clear written instructions should be included in the care plan to ensure correct administration of medicated creams. We reviewed a care plan of a person who has been at Dresden House for over a year. There was good and clear information about how the persons needs should be met. This person has deteriorated recently, there have been interventions by the GP, nursing service, paramedics and in recent days from the out of hours GP service. Blood tests and scans have been carried out. The person requires intermittent bed rest and the care planning information clearly defined the actions taken and support required. Two daughters of this person were spoken with whilst visiting her during the inspection. They were full of praise for the home and staff. They are both daily visitors but have been kept informed and involved in all the recent events and interventions by health care staff. They have total confidence in staff at the home saying this home Care Homes for Older People Page 14 of 29 Evidence: is excellent, my mother could not have had better care anywhere. They added that they have visited at different times of the day, sometimes at 6 am or 10 pm and staff are always friendly, helpful and care very deeply about my mother and all the residents. They instanced when visiting one evening, carers in another room with a person with dementia care needs being assisted to bed. She had become distressed but staff were singing to her as they assisted her to bed and she was joining in We inspected the medication system that is provided and supported by a local pharmacy. The Pharmacy Manager visited during the inspection and confirms that she carries out regular checks of the system and provides a report to the home. There were no matters arising from their last review of the system. There is clearly a personal and positive ongoing working relationship between the pharmacy and the home. Training in medication administration is delivered by the pharmacy and all staff involved in medication have had training. The home has an efficient medication policy supported by procedures and practice guidance, that staff understand and follow. Medication records are fully completed, contain required entries and are signed by appropriate staff. Although all bedrooms now have a lockable facility to accommodate medication safely, none of the people currently in the home self-medicate. There were no photographs with the medication administration records to identify each person. The Manager said that they were presently being updated. In relation to dying and death outcomes the AQAA states: We are well supported by District Nurses and specialist nurses for those suffering terminal illness. Families are encouraged to visit for as long as possible and meals are offered to them. For periods when relatives are unable to be with the resident, the home ensure that there is a member of staff to be with the person Care Homes for Older People Page 15 of 29 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. People can enjoy their chosen lifestyles and can engage in a range of activities provided for them. Evidence: At the time of the last inspection one member of staff was identified as responsible for providing 1.5 hours of activities each day. One carer with specific interest and abilities has now been nominated to lead activities, being the Activities Coordinator. She is a key carer and takes on the role as part of her care duties. She and another carer are to be sponsored for specific training in leading activities. There is a daily activities programme that is flexible and includes the usual indoor activities or support to visit the local shops and community facilities near to the home. People spoken with and some using the service who returned written feedback forms directly to us prior to the inspection indicated that they were generally satisfied with the activities provided. One feedback comment received from a relative stated: A great deal of effort is taken to stimulate the residents. There is a weekly food meeting with catering staff and people using the service to review and decide future meal provision. There is now a monthly meeting to discuss Care Homes for Older People Page 16 of 29 Evidence: and decide future activities. Activities are recorded in the daily notes of people in the home. A varied and balanced diet was evident from menus seen and people spoken with all expressed total satisfaction with the variety, quantity and quality of food provided for them. Dresden House provides care for variety of needs. They have registration to admit older people and those with dementia care and mental health needs. The lifestyles and choices of people are therefore quite diverse. There are 3 separate lounges. On is the allocated smoking room, used throughout the day by a nucleus of 6-8 people. The other two lounges offer a choice of seating and type, one having a small dining facility also. There is a separate dining area and some additional lounge chairs adjoining the reception area. It was pleasing to see many people accessing their bedrooms during the day as they wished. One person has meals served in his bedroom but encouraged to come to the communal areas when possible. Peoples individual choice of lifestyle are clearly being accommodated. The AQAA confirmed this with the comments: Residents are encouraged to entertain visitors in their own bedrooms in the interests of their privacy, however this not enforced as many people enjoy the company of other residents and staff in the home. Rising and retiring times are individual and flexible. It was interesting to see only 6-8 people were up and ready for breakfast at 8.30 a.m the others rising as they wished throughout the morning. It was an extremely hot day when this inspection took place. Many people were using the rear patio area throughout the day, having lunch there and drinks being served throughout the day. The mid morning drinks/biscuits were seen served in one of the lounge areas to a fairly frail elderly group. Chairs were spread around the perimeter of the room and there were a couple of small tables in front of people, but it was concerning to see that there were no tables between chairs and people were handed hot drinks and biscuits on their knee in a potentially hazardous way. This was brought to the attention of the Manager. Positive comments were received from visitors seen during the course of the inspection day, some are referred to earlier in this report. Additionally other comments made in written feedback to us prior to the inspection included: Care Homes for Older People Page 17 of 29 Evidence: They keep mum active both physically and mentally Most happy with the entertainment and activities Provide a nice friendly atmosphere and helped ....... to regain her mobility. We have lovely ladies who have always got time for us and nothing is too much trouble In answer to the question What could the home do better people replied: Nothing I am very satisfied and Nothing -keep up the good work. Care Homes for Older People Page 18 of 29 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. Updated procedures and further training in Safeguarding will ensure people are protected against possible abuse. Evidence: There is a complaints procedure in place that is clear and concise. A copy is posted in the home and available to all. There is a copy in the information in the Service Users Guide given to all people using the service. The home have not had any complaints since the last inspection and none have been received by us during that time. There were shortfalls in staff training in Safeguarding Vulnerable Adults at the time of the last inspection. From records seen it as clear that training is required for all staff in Safeguarding Adults and this should be provided as soon as possible. The home have a dated copy (2001) of the Safeguarding Vulnerable Adults procedures for people in Staffordshire and Stoke on Trent and a current copy of those procedures should be obtained. No Safeguarding referrals have been made by the home and none notified to us. Care Homes for Older People Page 19 of 29 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 improvements made to the environment mean that people live in a safe, comfortable, homely environment. Evidence: At the time of the last key inspection the upgrading of the whole of the ground floor of the building was almost completed. This is now complete and similar work carried out to upgrade the first floor to the same standard. All bedrooms are for single use and have had new furniture, beds, flooring and soft furnishings. The boiler room has now been separated from the laundry area and a new veranda from the laundry constructed where washing can be dried. This has improved the laundry facilities and also the working conditions for staff. All rooms are for single use and there are presently 5 en-suite rooms. Thermostats have now been fitted to all hot water outlets and resolved the requirement of the last report in relation to excessive hot water that presented a safety hazard. The next area for upgrading is the smoking room on the ground floor where there will be total redecoration and additional window added to improve air circulation and new furnishings, chairs and flooring will be provided. These changes are due to take place in the very near future. Apart from the bathroom areas, all other areas of the home Care Homes for Older People Page 20 of 29 Evidence: have been upgraded and present well. The bathroom areas will be upgraded in the current year and this will then complete a needed but much improved environment. Three lounge areas, a separate dining area and additional seating in the reception area provide a range of seating options for people using the service. Bedrooms are now well presented and can be used by choice to receive visitors. A sample of bedrooms seen were well personalised. As mentioned previously in this report the arrangements for serving drinks and snacks in the lounge area should be reviewed. Small tables between the lounge chairs would ensure hot or cold drinks could be served safely and are constantly available, for example, to people with low fluid intake. All parts of the home were clean and hygienic, there were no mal-odours. Responsibility for cleaning was previously a role of trainees and sometimes care staff but domestic staff are now employed each day and the results are evident. Bedrooms have been fitted with vinyl flooring and this eliminates previous mal-odours relating to continence management. Care Homes for Older People Page 21 of 29 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 confidence in the staff who care for them. Training in areas identified will further improve the service. Evidence: There were some concerns about daytime staffing levels at the time of the last inspection and a requirement was made to review staffing levels in the light of additional domestic duties required of care staff. The home did not employ domestic staff, this was carried out by trainee carers. This has been addressed and the staffing arrangements improved considerably. Domestic staff are now employed 7 days per week, relieving care staff of cleaning duties and allowing them to concentrate upon the caring role. There have also been other changes to the daytime staffing levels. The Manager now works Monday to Friday on the rota and an additional member of staff employed at weekends. Trainees who are on modern apprenticeship schemes are now employed constantly throughout the day - previously there were gaps when they were not on the rota. An extra carer is now employed from 5 - 8 each day being available at a busy time of Care Homes for Older People Page 22 of 29 Evidence: the day. On-call arrangements have changed - the Manager is now on call during the week and to allow time off duty a Key Carer is available on call at weekends and paid for this function. Addi tonally an hourly rate is paid if they need to respond to important calls. An example of the improvement is that the person on call can now come into the home and accompany people to hospital after hours or at weekends. Staffing levels are now satisfactory to meet the perceived dependency levels of people presently using the service. Staff on duty during the inspection, including care assistants, key carers and trainees, were all spoken with. They were knowledgeable about the needs of the people they were caring for and showed a positive commitment to improving the quality of care wherever possible. They were seen to provide a high level of personal care for people. There were very relaxed exchanges between carers, people using the service and visitors. Visitors told us that they were well received by friendly, helpful staff. People we spoke to in the home and also in written feedback were complimentary about the standards of care and quality of staff. Shortfalls in staff training in dementia care and mental health needs were identified in the last report and the requirement made has been met. All staff have now completed this training. Staff training records were inspected and it was clear that there had been no staff training in the Mental Capacity Act or the Deprivation of Liberty Safeguards - both pieces of legislation that have implications for assessments of peoples capacity and the circumstances under which people liberty may be curtailed. The Manager will arrange training in this area as soon as possible. Updated training is also required in Safeguarding Adults - this is referred to in this report under outcomes for Protection. Staffing records were sampled and all required documentation was present . All required checks and references had been obtained prior to employment including Protection of Vulnerable Adults and Criminal Records Bureau checks. The home recognise the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Care Homes for Older People Page 23 of 29 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. People live in a well managed home that promotes their interests and provides opportunities for people to raise any ares of concern they may have. Evidence: The Registered Manager has been awarded the Registered Managers award since the last inspection. She has the required experience and qualifcation to run the home and has a clear understanding of the key principles and focus of the service. Changes made since the last inspection have improved the service. There is an open and transparent ethos and there is a positive lead to support a strong staff team. The AQAA contained clear and relevant information about the service with supportive evidence, although staff training shortfalls were not identified. The Manager promotes equal opportunities and understands the importance of person centred care and how it will improve outcomes for people using the service. Sound policies and procedures are in place and the Manager and staff team ensure Care Homes for Older People Page 24 of 29 Evidence: they are translated into practice. Reviews of service are monitored in the following ways: Two weekly reports to the Providers by email - action taken where required. Regular, at least monthly visits by the Providers/Responsible Individual. All care plans are reviewed monthly in the home with an annual review carried out by social workers. Financial monitoring reviews by providers. Regular meetings for people in the home and also staff meetings. Completed surveys were seen on files from people using the service and their families. The AQAA states: We issue and request completion of annual survey forms from the following people: Residents, relatives and friends, professionals such as doctors and district nurse. All are asked to make a suggestion for service improvement Information gathered from surveys and reviews are available in the home. People manage their own money and the service is pro-active in ensuring people retain this responsibility wherever possible and where necessary are supported by relatives/friends. The home works to a clear health and safety policy, all staff are fully aware of the policy and trained to put theory into practice. Care Homes for Older People Page 25 of 29 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 26 of 29 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 9 13 Insulin must only be 18/07/2009 adminsitered by named staff, trained and authorised to be competent by the District Nursing Service. This will ensure people have diabetic care to the required standards. 2 30 18 Training is required for staff in the Mental Capacity Act and Deprivation of Liberty Safeguards. Peoples decision making and liberty would be further safeguarded. 31/08/2009 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 19 Review the facilities for serving drinks in the lounge areas. This will ensure hot drinks are served safely and people with hydration needs will have drinks constantly available to them. Page 27 of 29 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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