Care Home: Dunkeld

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What the care home does well Some people regularly go to church and to local events and various people in the community, including local schools, are invited into the home to meet people. During our visit there was no planned event but people were busy with visitors and talking to each other and later listening to music in the afternoon. Dunkeld had been awarded the Gold Standard award in 2008 2009 by Vale Royal Borough Council and the manager is a qualified caterer and also acts as the main cook. People living at the home told us how much they enjoyed the meals, and said it was all homemade and that they regularly get served three course meals. The environment offers a comfortable, homely and safe place to live that everyone likes. There is a lovely homely atmosphere and the building was well cared for and maintained. People living there told us they liked the home. They said they were very comfortable there and had everything they needed. We received four completed surveys from people living at the home. They were very positive about their experiences about living at Dunkeld. They and their relatives gave us lots of positive comments and compliments about how caring and supportive the staff were. These included, "Dunkeld and its staff provide an excellent home"and "The home has a lovely atmosphere and excels with its excellent food, cleanliness, nothing is too much trouble for the staff and I feel very safe and secure within its environment". We received five completed surveys from relatives and visitors who told us: "There is a varied social calender"; "The premises are clean and there is a residential dog which the residents like. The atmosphere always seems happy and we never hear of problems from the residents" and "Dunkeld is a small friendly home, it provides individual care and weekly meetings every week for residents, gives them a say into what they would like to happen to better the home". Other comments were: "Staff are friendly, knowledgeable and helpful"; "Everything is satisfactory"; "Everyone seems to be well cared for, comfortable and clean"; "The atmosphere always seems happy and we never hear of problems from the residents" and "food is varied and good quality". Staff working at the home sent us four completed surveys and we met staff on duty on the day of our visit to the home. They all knew what to to if someone had concerns or wanted to make a complaint. They were also knowledgeable about safeguarding procedures and knew what to do if they needed to raise concerns. The manager advised us that they do not manage any money on behalf of anyone living at the home and that everyone has a relative or nominated person to manage their finances. What has improved since the last inspection? The manager had developed an information guide for relatives and friends. There was a suggestion sheet included in the guide which could be used to help evaluate the care and support being provided to help plan further developments and improvements. What the care home could do better: We found that the record keeping in the home was not as good as it should be and have made various recommendations for action to improve this, including making sure that care files are accurate and up to date, staff files and training records are improved and that a system of regular management checks is implemented. We have recommended that the information about the home, including the complaints procedure, be amended to show up to date contact details. The procedures for checking on what people`s support needs are (assessments) before they move into a home need to be reviewed to make sure that everybody has relevant and up to date information. This will help to show that each person`s needs can be met at Dunkeld and what would need to be done to make sure these needs were met. Care plans and risk assessments for people`s personal care and their social needs should be reviewed and updated to make sure they are accurate and include the right information to help staff to support people in the right way. The care plans should show how people and their families are involved in planning their care to show that they have a say in how their care is to be provided and their social needs will be met. We have asked that those staff who had not received their updated training on safeguarding do so as soon as possible so they know the correct procedures to use to make sure that people living at the home are protected from abuse. We have also recommended that the procedures for managing complaints and concerns are reviewed to make sure these are recorded together with the action taken to deal with them. This will help to show that people`s concerns are listened to, taken seriously and acted upon. We have also suggested that a system of management checks be put into place to help make sure that records are being kept up to date and the necessary checks and assessments to make sure the home continues to be safe for people to live and work in are up to date. Key inspection report Care homes for older people Name: Address: Dunkeld 94 School Lane Hartford Northwich Cheshire CW8 1PN     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: Diane Sharrock     Date: 2 7 1 0 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 28 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 28 Information about the care home Name of care home: Address: Dunkeld 94 School Lane Hartford Northwich Cheshire CW8 1PN 0160674542 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Barbara Glenys Harrison care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code 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 - Code OP. The maximum number of service users who can be accommodated is: 13. Date of last inspection Brief description of the care home Dunkeld is situated in Hartford close to Northwich and is in easy walking distance of shops, post office, church and social amenities. The detached premises provide accommodation in nine single bedrooms and two twin rooms on two floors. The upper floor bedrooms can be accessed by the stairs or with the aid of a recently installed stair lift. The grounds include ample parking at the front of the property and a secluded garden to the rear. The home provides care for older people. The fees for Dunkeld currently range from 400.50 pounds to 470 pounds per week. 0 4 1 1 2 0 0 8 0 Over 65 13 Care Homes for Older People Page 4 of 28 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 quality rating for this service is two stars. This means the people who use the service experience good quality outcomes. We gathered information for this inspection in a number of different ways. We carried out an unannounced visit to the home on 27 October 2009. This took place over 6 hours and included reading records, meeting people and looking at the building. To give us information about the care and support people living in the home receive, we used a system called case tracking, which means we spent time talking with them, staff and looking at records to see the support they get with their daily lives, care plans, medication, activities and environment. During our visit, we met most of the people who live at Dunkeld and all the staff on duty including the manager. We also sent a selection of surveys to the home for the manager to distribute to relatives, staff, health professionals and people living there to offer people a further opportunity to let us have their views about the home. We reviewed any information we had recently received about Dunkeld. In addition, the Care Homes for Older People Page 5 of 28 manager completed a self assessment form (called an annual quality assurance assessment or AQAA for short) which we sent to her before our visit. We used some of this information in this form and the other information we had to help plan our inspection and write this report. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? The manager had developed an information guide for relatives and friends. There was a suggestion sheet included in the guide which could be used to help evaluate the care and support being provided to help plan further developments and improvements. Care Homes for Older People Page 7 of 28 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 8 of 28 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 9 of 28 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. The information given to people about the home and the processes used to help them move in make sure that they have enough information to decide whether the home would be right for them and that they settle in well. Evidence: The information the manager sent us before our visit to the home told us that they encourage prospective service users to visit as many times as possible and to call at different times in the day and night before they make their decision and choices.... . A social orientation guide has been developed to give people information about the home. This would benefit from further development to include the updated details about how to contact the commission if people wished to do this. The manager had developed an information guide for relatives and friends. This included a suggestion sheet that could be filled in, then used to help evaluate the care and support provided and plan further improvements. The manager told us that at the Care Homes for Older People Page 10 of 28 Evidence: time of our visit, no completed suggestion sheets had been received. We looked the checks that had been done to find out the needs of a person who had recently moved into the home. The document had only been partly completed before the person moved in and needed to be updated, as there was some inaccurate information in it and it was very brief. We could see that staff were providing the right care for the person but the information in their care file did not reflect this and contained out of date information. This could lead to people not receiving the right care and support to meet their needs. We received four completed surveys from people living at the home. They were very positive about their experiences about living at Dunkeld. People were able to tell us that they received enough information about the home before they moved in and of their positive experiences of being supported to visit and settle into Dunkeld. People who live at the home and their relatives gave lots of positive comments and compliments about how caring and supportive the staff were. These included, Dunkeld and its staff provide an excellent home and The home has a lovely atmosphere and excels with its excellent food, cleanliness, nothing is too much trouble for the staff and I feel very safe and secure within its environment. We received five completed surveys from relatives and visitors who told us, There is a varied social calender, The premises are clean and there is a residential dog which the residents like. The atmosphere always seems happy and we never hear of problems from the residents and Dunkeld is a small friendly home, it provides individual care and weekly meetings every week for residents, gives them a say into what they would like to happen to better the home. Care Homes for Older People Page 11 of 28 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. People told us they are happy with the care and support provided at Dunkeld but the care records need to be developed to show clearly that people are receiving the right support to meet their needs in the way they prefer. Evidence: The information the manager sent us before our visit to Dunkeld told us that six of the homes staff had received training to use the monitored dosage system to safely manage and administer medications to residents and that another four staff were due to receive this training by the end of November 2009. The information we received showed that staff had received training during the previous twelve months including moving and handling, food hygiene, diabetes awareness, fire safety training, prevention of falls, understanding Parkinsons Disease, dementia, national vocational training in care and pharmacy training. We had received four completed surveys from people living at the home who all felt that they received the care and support they needed to keep them safe and healthy. Care Homes for Older People Page 12 of 28 Evidence: We also received five surveys from relatives and visitors, who were also positive in their comments. They told us, Staff are friendly, knowledgeable and helpful, Everything is satisfactory and Everyone seems to be well cared for, comfortable and clean. We looked at the care plans of two people who live at Dunkeld to see what care and support they were receiving in order to meet their needs. The care plans were very basic and gave a minimal amount of information. Although the manager and staff could explain verbally how they supported the individual needs of each person, the records did not reflect the good practices or the care being provided. There was no information to show how each persons personal care and social needs would be met. There was also no evidence in the plans to show how each person was involved in developing and reviewing their own care plans. Involving people in reviewing and developing their care plans enables them to have a say in how their support is provided to suit them, protects their rights and shows their agreement with the plans of how their support will be provided at Dunkeld. This should include going out of the home and how people prefer to be supported in this, with appropriate risk assessments to show that possible problems had been considered and minimised in a way that did not restrict the person unnecessarily from doing their preferred activities. We discussed some entries in the daily records with the manager because they were brief and there was no further information recorded to show how specific incidents had been managed. Again staff could explain verbally what had happened but there were no records to show whether the persons concerned agreed with the way that staff had managed various issues. Care Homes for Older People Page 13 of 28 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 are given the support they need to make sure they are able to take part in a range of activities and told us the quality of the food is good so they received a varied, nutritious diet to help keep them well and healthy. Evidence: The information the manager sent us gave details of the activities and outings that had been offered to people living at Dunkeld in the twelve months before our visit there. These included, Chester Zoo, Llandudno, visits to the ice cream farm, garden party, country drives, Easter bonnet competition, family buffets, tea dances, fish and chip supper, coffee mornings, shopping trips and lunches out. People living at the home told us that they enjoy as a group daily crosswords, puzzles and discussion of news events. At the weekly meetings, they discuss past events and help to plan future activities. Staff make arrangements to provide transport to those people who want to continue to go to church. They have also introduced memory boxes during the last twelve months. The manager told us that no records are made of the weekly meetings. It would be good practice to make brief notes of what has been discussed at the meetings so staff and people who live at the home can see what was agreed. Care Homes for Older People Page 14 of 28 Evidence: The four completed surveys we received from people living at the home told us that they felt there were always activities on offer that they could take part in. We met many of the people who live in the home and visitors on the day of our visit. There were mixed comments about what activities were on offer. Some people were very pleased and satisfied with in house events but two people didnt think they went out that much. Some people felt they didnt want to do too many activities each day and were happy to read and chat and socialise with others. Some people felt they could always speak to staff whenever they wanted to raise their suggestions. We received five completed surveys from relatives and visitors who told us: There is a varied social calender; The premises are clean and there is a residential dog which the residents like. The atmosphere always seems happy and we never hear of problems from the residents and Dunkeld is a small friendly home, it provides individual care and weekly meetings every week for residents, gives them a say into what they would like to happen to better the home. Other comments were: Staff are friendly, knowledgeable and helpful; Everything is satisfactory; Everyone seems to be well cared for, comfortable and clean; The atmosphere always seems happy and we never hear of problems from the residents and food is varied and good quality. The care plans we looked at did not include plans to show how people would be supported with their social activities. This was discussed with the manager, as the people we met were able to discuss and describe various activities and events that they liked to do. Further work and development in the records will help to show how people living at the home are supported to be involved in drawing up their own plans for activities. It will also help to show how they will be supported to achieve their aims, take part in their preferred hobbies and activities and day to day social needs. We noted that some people regularly go to church and to local events. In addition, various people in the community including local schools are invited into the home to meet people. During our visit the manager stated they were to have a story time held in the sun room in the afternoon. People were busy with visitors, talking with each other and later listening to music in the afternoon. Staff were busy making arrangements for Halloween and the pumpkins had already been prepared ready to add to the Halloween party. Dunkeld had been awarded the Gold Standard award in 2008 2009 by Vale Royal Borough Council. The manager is a qualified caterer and also acts as the main cook at the home. Sample menus we saw showed a good variety of meals. Breakfast times Care Homes for Older People Page 15 of 28 Evidence: are flexible and lunch is the main meal of the day with a lighter meal provided in the early evening. Alternative meals are always available for those who dont want the main menu meals and any special diets such as diabetes and gluten free are currently provided. Hot and cold drinks are offered throughout the day. The four completed surveys we received from people living at the home were very positive about the meals and the menus offered. People living at the home told us how much they enjoyed the meals, told us that they were all home made and that they regularly get served three course meals. The manager provided menus to show that people are offered a varity of meals and three courses daily. The comments we received from relatives included the comment that, food is varied and good quality. There was a suggestion made from one relative after our visit that people living in the home should have more access to landline phones, as the use of only one phone caused some restrictions for their relative who lived at Dunkeld especially when they are unable to use a mobile phone. This suggestion could be reviewed with people living at the home, staff and relatives to look at ways of offering further access to phones in the home. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were happy and felt safe living at Dunkeld. Evidence: The manager told us that the home provides an environment where residents can feel safe and confident that their concerns will be listened to, taken seriously and acted upon. We received four completed surveys from people living at Dunkeld and we met everyone who was sitting in the lounge and the conservatory during our visit there. Overall they felt very positive that they could speak to the staff about their concerns and they felt they knew how to make a complaint. We also received four completed surveys from staff working at the home and we met the staff on duty at the time of our visit. They all felt they knew what to do if someone had concerns or wanted to make a complaint. There was no record of any complaints or concerns about the home. We discussed the benefits of regularly reviewing the management of complaints, concerns and grumbles with everyone at the home. The manager felt they never had complaints; however good record keeping would help to show how people are supported to openly express their views and what action has been taken to resolve any concerns they may have. We noticed that the complaints procedure for the home had out of date information Care Homes for Older People Page 17 of 28 Evidence: about contacting the commission. The copy on display in the home was in small type and high up on the wall. Some people may not be able to read the complaints procedure and may benefit from positioning it lower on the wall so it will be at head height and easier for people to see and read. Staff were knowledgeable about safeguarding procedures and knew what to do if they needed to raise concerns. We checked staff training records and noticed that most staff were up to date but some staff still needed to have a date identified for their refresher training on safeguarding to make sure they knew what to do to protect people living at the home from abuse. The manager told us that as a matter of good practice they do not manage any money on behalf of anyone living at the home and that everyone has a relative or nominated person to help them manage their finances. Care Homes for Older People Page 18 of 28 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. Dunkeld is well maintained so that it provides a comfortable, homely and safe place to live that is suitable for the people living there and that they all like. Evidence: The information we were sent by the manager before our visit identified that there was a redecoration plan starting in November 2009 and including the kitchen area. During the twelve months before our visit, various areas of the home have been redecorated including two bathrooms and a bedroom. In addition, a new stair lift and new ramp have been installed to help people with mobility problems move around the home more easily. We walked round the home during our visit and looked at a number of areas including all the communal spaces such as lounge and dining room. We found a lovely homely atmosphere in the home and the building was well maintained. People living at Dunkeld told us they liked the home, that they were very comfortable and had everything they needed. People told us they were happy with their rooms. We looked at a sample of maintenance certificates; these were up to date and well organised. They showed that the home was safely managed and maintained. However, during our visit we could not find environmental risk assessments for any potential hazards such as uncovered radiators, the new stair-lift, the laundry and the Care Homes for Older People Page 19 of 28 Evidence: fire risk assessment. Following our visit the manager has sent us evidence of updated environmental risk assessments to show what actions were being taken to keep everyone safe at the home. The risks assessments for the uncovered radiators have identified a need to have install some covers to help reduce risks to people living at the home. Care Homes for Older People Page 20 of 28 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. Staff at Dunkeld are well trained and supported. Many of them have worked there for a long time so they know the people who live there very well and can provide the support they know people need in the way they prefer. Evidence: The information the manager sent us before our visit showed that there is a low staff turnover at Dunkeld, which they felt helped to assure confidence and continuity of care. More than 75 of the staff hold an national vocational qualification (NVQ) in care. These are nationally recognised qualifications that show the staff have been assessed as competent to provide good quality care and support. There were plans to recruit more staff during the twelve months following our visit and staff have suggested training that they would like to have to help them in their work. We looked at two staff files to see how they were recruited, supervised and trained. The files showed that before the staff started work at Dunkeld, all the necessary checks had been carried out on them. These checks included obtaining two written references and a criminal records bureau (CRB) disclosure. These procedures help to make sure that staff are suitable to work with the people living at the home and they are protected from harm and poor practice. Care Homes for Older People Page 21 of 28 Evidence: The staff files we saw did not include a copy of the information that the staff members had used to confirm their identity, although there was evidence in one that the manager seen this. The record of staff training we saw showed some gaps and needed updating for some staff. Most of the staff had received updated mandatory training. Staff we spoke with told us they were happy with the training they had received and felt very supported in developing their skills to meet the needs of people living there. Staff records also showed they are well supported with regular supervision and guidance from their manager. The staff on duty were really happy working for the home and felt it was the best place they had ever worked for. They said that a lot of staff had worked at the home for a long time so they knew the people who lived there well, which helped them to provide the support people needed and preferred. We met all the staff on duty at the time of our visit. There were two support staff and the manager on duty during our visit. There was no information to show how the staffing levels are reviewed or how they are calculated to make sure they meet the needs of the people living there. We looked at a sample of minutes of recent staff meetings at the home which are usually every six months. They showed that staff were included in discussion about developments at the home. Staff told us they can bring any concern up at these meetings and they received regular supervision where they could also discuss any issues. Care Homes for Older People Page 22 of 28 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. Dunkeld is well managed so that it is run for the benefit of the people living there. Evidence: The information the manager sent to us before our visit shows that she is working at the home six days a week and ensures an environment where members can feel part of an extended family. The manager is also the owner and has been running Dunkeld for over twenty years. She has extensive knowledge and experience of the people she supports. Everyone works hard to provide a loving homely place that is inviting and comfortable to everyone. We looked at a sample of records and certificates which showed that regular checks are carried out on the building and equipment including the fire protection equipment and electrical installation. These checks help to make sure that the environment is well managed and is a safe place to live and work in. The manager organises six monthly staff meetings. These meetings make sure that Care Homes for Older People Page 23 of 28 Evidence: staff have a regular forum to discuss issues that may affect the service provided to people living at the home. We looked at copies of the minutes of recent staff meetings which showed various issues about the service had been discussed including records and each of the people living at the home. The manager advised that weekly meetings are held with the people who live at Dunkeld but there are no notes of these meetings. The manager and staff felt they discussed various topics with people each day and because they knew people so well they felt communication was good in the home. Discussions took place regarding how procedures and records could be improved to show how people are included in the developments in their home. Regular minuted meetings, regular care plan reviews and use of questionnaires and suggestion sheets can all offer people different ways to express their opinions and provide them with ways to influence the ongoing management and development of the home. At the time of our visit the manager did not have any overall auditing system. This was discussed as the home would benefit from regular checks to show what actions were being taken to safely manage the home and ensure good standards are offered at all times. Following our visit the manager has sent us evidence of updated environmental risk assessments to show what actions were being taken to keep everyone safe at the home and she also supplied a fire risk assessment and health and safety check list that they intended to use on a regular basis. Care Homes for Older People Page 24 of 28 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 25 of 28 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 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 1 The statement of purpose for the home should be updated with all the necessary information to make sure that people have accurate information about how the home works and who to contact if they need to. The procedures used to check on peoples needs before they move into the home should be reviewed to make sure they are fully completed and the information gathered is accurate so that staff have written information about peoples needs and how to meet them. All care plans and risk assessments for the personal care and social needs of people living at the home should be reviewed to make sure they are accurate and provide information for staff to support people in the right way. The care plans should show how people and their families, as necessary, are involved in developing their own care plans so they reflect peoples preferences, especially in going out. Further work and development of social care plans should be done to show how people living at the home will be supported and involved in planning the activities they will take part in. This will help to show how they will be supported to achieve their aims, hobbies and day to day Page 26 of 28 2 3 3 7 4 12 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 social needs. Notes of what was discussed at the weekly meetings and other discussions about the home and activities should be kept so that people living at the home and staff can see what was agreed at those meetings. 5 14 The possibility of providing further access to phones for people living at the home should be considered to make sure that they have access to a phone when they need one. The procedures for recording complaints and concerns, both formal and informal, should be reviewed to make sure that all are recorded together with information about how they were resolved. The complaints procedure should be updated to show current contact details for the Care Quality Commission so people know how to make contact. Action should be taken to make sure that those staff who have not yet had updated training on safeguarding do so as soon as possible so they know what to do to make sure people living in the home are protected from harm and abuse. Regular health and safety checks of the building should be implemented to help make sure that risk assessments are in place and up to date to show that the building is safe for the people living and working there. Staff files should include a copy of the information that staff had used to confirm their identity during their recruitment and a picture of the staff member to confirm identification to improve on current safe recruitment checks done at the home. Also, the staff training records need to be kept up to date so they show accurately all staff have received the training they need to do their jobs. Staff files should include copies of attendance certificates, training certificates and qualifications gained by staff. Consideration should be given to setting up a regular system of audits to help make sure that the records are being kept up to date and the home continues to be a safe place to live and work. 6 16 7 18 8 19 9 29 10 33 Care Homes for Older People Page 27 of 28 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. 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