Care Home: Eardley House

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What the care home does well A service is provided to people who have dementia care needs. Dependency levels of people using the service have reduced overall since the last inspection. Some areas of management have been strengthened and resulted in improved standards of care for people. We spoke to many people using the service and their relatives. They told us that they were satisfied with the care provided at Eardley House and had no complaints. We spoke with 2 visiting District Nurses who said that there were positive, professional and friendly relationships with staff at the home, who were keen to ensure early identification of health care needs and who closely followed advice and instructions to ensure good health. Staff are allocated to each smaller unit of 7-9 people with additional staff who "float" between the four units to assist in personal and daily care. People do move freely between the 4 areas without restriction providing a fairly open environment. There have been no complaints about this service since the last inspection. Safeguarding referrals have been made in a timely way and well managed. Ongoing improvements to the environment are evident and people live in a safe, homely place. The staff group is well established. There have been no changes to the care staff group since the last inspection, providing important continuity for the people using this service who all have dementia care needs. A good staff training programme ensures staff have the skills to meet the needs of the people living there. Five short-stay places are available and people are well integrated with staff that have knowledge and skills to provide the required individual support. What has improved since the last inspection? Many improvements have been made since the last inspection. Care plans have been reviewed and revised with a new care planning format that includes detailed information about the health, personal, emotional, social and recreational needs of people. - 95% of care plans have been changed to this new format. Activities were poor at the time of the last inspection, but progress has been made in this area both internally and outside the home. A more varied range and new approach to activities based upon people`s previous experiences, interests and hobbies have been introduced. External activities have commenced, in supporting people to access community activities. There is still some way to go but the home are determined to make progress in this area. Staff meetings have re-commenced and also regular supervision of all staff. Meetings for people using the service are now at least 2 monthly, allowing people and staff the opportunity to express their views about the daily running of the home. The providers have introduced a new Policy and Procedure for medication administration. This is very detailed and is supported by a comprehensive training programme for all staff administering medication. This has provided a more robust procedure and improved the safety of medication in the home. The home are working closely with the Community Outreach Mental Health Team of the PCT (Primary Care Trust). This has included discussion and advice about the complex needs of people with dementia and that team has provided advice, guidance and training for staff. This is a positive addition to the service the home provides for people with dementia care needs. Shortfalls in some areas of recording have been addressed, with new record keeping systems introduced and clearer open recording in many areas. What the care home could do better: It is important that people using the service have contracts defining the terms and conditions of their stay and are informed of their rights. The providers should ensure both funded and non-funded people have contracts. Where handwritten additions are made to MAR (Medication Administration Records) these should always be checked by another member of staff and countersigned. This also complies with the providers new medication policy and will ensure the correct medication is administered in accordance with the prescriber`s instructions. Where food and fluid intake charts are in use the amounts of fluid given should all be recorded and quantified as a means of ensuring the daily intake can be totaled and reviewed. This will more closely monitor the persons hydration levels. Key inspection report Care homes for older people Name: Address: Eardley House Moorland View Bradeley Stoke-on-Trent Staffordshire ST6 7NG     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 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Eardley House Moorland View Bradeley Stoke-on-Trent Staffordshire ST6 7NG 01782234530 01782234530 eardley.house@swann.stoke.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Stoke on Trent City Council care home 41 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 to be accommodated is 41. The registered person may provide the following category of service only Care Home only 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) 41 Physical Disability (PD) over 65 years of age (PD)(E) 41 Dementia over 65 years of age (DE)(E) 41 Dementia (DE) 5 Mental Disorder (MD) 5 Mental Disorder Date of last inspection 0 2 0 1 2 0 0 9 5 5 0 0 Over 65 41 0 41 41 Care Homes for Older People Page 4 of 28 Brief description of the care home Eardley House is a care home providing both long term and respite care for up to 46 older people with dementia. The home is owned by Stoke on Trent City Council, a unitary authority, and care is directly provided by the councils staff team from the social services department. The home is located on the outskirts of the City of Stoke on Trent, in the village of Bradeley. It has ready access to community facilities, including shops, pubs, post office and public transport. The home was originally purpose built to the standards current at the time, and consists of two storeys. Because of its large size, and to meet up to date good practice in care provision, it is now divided into four group living arrangements. Each area has its own living/ dining area. Assisted bathing and toilet facilities are strategically provided throughout the home, and other facilities include a smoke room and separate quiet room with a pay phone. All bedrooms are single. None of the bedrooms have en suite facilities. Access to the enclosed rear garden is from two lounge areas with ramps and handrails provided for safety. The garden has a patio area with seating, flowers and a summerhouse. The accommodation is generally well maintained and there is ongoing refurbishment and redecoration. Information about the fees charged for both short and long term care are available directly from the home. Care Homes for Older People Page 5 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 last inspection of this service was a Key Inspection 2nd January 2009. This inspection was an unannounced inspection carried out by one inspector on one day from 08:30 - 17:30. The service completed and returned to us the AQAA (Annual Quality Assurance Assessment) prior to the inspection. This is a legally required self-assessment that every service has to complete annually. It contains 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 over the next year. The information given was comprehensive with supporting evidence of the statements made. We found at the inspection that the service operated to the level described. Some information from the AQAA is included in this report. Care Homes for Older People Page 6 of 28 During the inspection most people using the service were seen and many spoken with. We spoke with 5 visiting relatives throughout the day. We also met and spoke in detail to two visiting District Nurses. Comments from people using the service, relatives and visiting District Nurses are included in the body of this report. The views expressed supported the view that Eardley House is providing a good service to people and that improvements and changes are ongoing. There were 35 people living at the home at the time of this inspection, this included 31 people who were permanent and 4 who were there for a period of short stay. All have dementia care needs. We inspected the communal areas of the home and a sample of bedrooms. We had access to all records, including care plans, risk assessments, medication records, accident records, staffing rotas and staff files. We inspected the system of medication in use in the home including storage and administration. The Acting Manager was present throughout the inspection and two visiting Service Managers from the Local Authority provided useful dialogue and information about the service. The results of our findings were fed-back to the Acting Manager at the end of the inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? Many improvements have been made since the last inspection. Care plans have been reviewed and revised with a new care planning format that includes detailed information about the health, personal, emotional, social and recreational needs of people. - 95 of care plans have been changed to this new format. Activities were poor at the time of the last inspection, but progress has been made in this area both internally and outside the home. A more varied range and new approach to activities based upon peoples previous experiences, interests and hobbies have been introduced. External activities have commenced, in supporting people to access community activities. There is still some way to go but the home are determined to make progress in this area. Staff meetings have re-commenced and also regular supervision of all staff. Meetings for people using the service are now at least 2 monthly, allowing people and staff the opportunity to express their views about the daily running of the home. Care Homes for Older People Page 8 of 28 The providers have introduced a new Policy and Procedure for medication administration. This is very detailed and is supported by a comprehensive training programme for all staff administering medication. This has provided a more robust procedure and improved the safety of medication in the home. The home are working closely with the Community Outreach Mental Health Team of the PCT (Primary Care Trust). This has included discussion and advice about the complex needs of people with dementia and that team has provided advice, guidance and training for staff. This is a positive addition to the service the home provides for people with dementia care needs. Shortfalls in some areas of recording have been addressed, with new record keeping systems introduced and clearer open recording in many areas. 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 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information and pre admission procedures ensure peoples needs are known and can be met. All should have written contracts outlining the terms and conditions with the home and informing them of their rights. Evidence: There is a Statement of Purpose and Service Users Guide that had been updated since the last inspection. These were readily available to people using the service and visitors. In care plans seen there was evidence of pre admission assessments being carried out prior to admission and where people visit the home prior to making a decision about admission. People are always informed in writing if the service can meet their needs. The AQAA recorded Service users are provided with a contract from the Finance Department. We found that this was not the case. None of the people using the Care Homes for Older People Page 11 of 28 Evidence: service at this time had a contract and this included contracts for five people funding their own care. We asked for clarification of the issue of contracts from the finance department during the inspection. We were told that Local Authority contracts are sent to the persons next of kin and that private contracts were not issued. This matter needs to be addressed by the providers. People using the service or their representatives should have copies of contracts and all should have private contracts if funding their own care. Care Homes for Older People Page 12 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 can be sure that their health and personal care needs are correctly assessed, recorded and are met. Evidence: We examined 3 care plans and found that comprehensive information was recorded including personal and healthcare needs and also social and emotional care needs. At the time of the last inspection some documents had not been completed and some not dated. We found on this visit all documents complete and dated. Since the last inspection 95 of care plans have been transferred to a new format giving clear and detailed information enabling carers to support people with clearly defined needs and actions required. We looked at health care plans and found good information about peoples overall healthcare needs. In relation to one person we found that weight loss had triggered further medical investigation, the GP had asked for a daily record of food and fluid intake - although this has already be initiated by the home. Food was recorded well but we found that liquid should be more clearly defined and quantified, for example Care Homes for Older People Page 13 of 28 Evidence: records recorded a cup or mug of tea. The quantity should be recorded. It was clear that some fluid had not been added to the daily list, an example was early morning tea. We suggested a daily total and also that the information should be shared with the visiting District Nurses who visit on two defined days each week. We found that people were generally weighed monthly and this is good practice. This person is now being weighed weekly. We found evidence of good working relationships with the GP and other health care professionals, including a close working relationship with the team of community psychiatric nurses from the Health Trust. Advice and training has been provided by this team and any concerns can be directly discussed with them. We saw examples of this. We spoke with two visiting District Nurses who confirmed they visited 2 days each week (or additionally if urgent). They had no concerns about the home, were well received and staff readily available to give any information they needed. They said that staff followed advice and instructions carefully and there was a very positive working relationship. The home acted swiftly when there was a recent diahorrea and vomiting outbreak and worked closely with the Health Protection Team. We looked at risk assessments and found that they were generally well recorded. One exception was a person who smokes - there was a generic risk assessment and a short and dated individual risk assessment for this. We felt that this should be more detailed, reviewed regularly and should clearly outline the actions taken that would reduce the risks. A recommendation of the last report to audit falls/accidents has been addressed. The service have computed all accidents to identify any underlying trends. We saw that there were no identified trends and that the audit was ongoing. We looked at the medication system in place. The providers have recently completely revised their medication policy and procedures for all their Local Authority Services. The policy is very detailed giving precise instructions for staff to follow, covering all areas of recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. We found that there were lots of handwritten additions to MAR (Medication Administration Records) sheets, mainly due to people arriving for short stay during the medication cycle and this being entered upon the MAR sheets by a member of staff. It is important that this is checked and Care Homes for Older People Page 14 of 28 Evidence: countersigned by another staff member to ensure the entries accurately reflect the prescribers instructions. - This is, in fact, included as a procedure in the new medication policy mentioned above and is a further check on the safety of medication administered. This procedure should be followed. We found that a safe system of medication was in use in the home. Care Homes for Older People Page 15 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. Improvements in daily activities and participation of the people using the service have improved the quality of life here. Evidence: At the time of the last inspection two recommendations were made to improve daily life and social activities. There were no meetings for people using the service, activities were minimal and needed improvement. The recommendations have been acted upon. There are now regular meetings for people using the service. there are individual lounge meetings. We saw minutes of those meetings where people had raised important issues about daily life in the home, and they had been acted upon. Life Story Books for each person have been introduced as a means of identifying personal, social and recreational interests that can be built upon. A daily record of activities for each person has been established, there were examples of more internal activities such as reminiscence material from the library service being used to promote discussion and stimulation. We saw movement towards external visits for people, an example was a person taken by her key worker to see her sons new apartment (he was unable to visit her). There are obvious staffing implications for external visits but these have commenced and there are plans for Care Homes for Older People Page 16 of 28 Evidence: further community involvement with external groups including local schools. We saw some positive changes to routines in the home, some arising from suggestions made by people in meetings. It was pleasing to see that people were being given greater choices - we noticed that there are now tea/coffee/milk/sugar trays on each dining table - drinks were previously served to people from a trolley - a small but very important change to extend choice and maximise practical and social skills. We were satisfied that positive efforts had been made in improving social activities and quality of life - based upon input from people using the service. The AQAA stated in relation to improvements over the past year A programme of activities has been brought into the home, including reminiscence boxes from local library services. There is now a full record of all activities, including which service users have participated. Daily living routines are now recorded on care reports. In relation to improvements in the next year the AQAA stated Continue to improve facilities both in and outside the home by planning a series of events with the Outreach Team of Stoke on Trent Museums including individual museum passports for all service users. People told us that they were happy with life at Eardley House and spoke positively about staff support and commitment. Throughout the day we observed positive engagement between staff and the people they were supporting. We spoke with several people who said that the food provided was good, choice was varied and they had no complaints about any aspect of food provision. We spoke with 5 visiting relatives who confirmed that they were pleased with the care provided for their relatives. Comments included I cannot fault the staff here, they do all they possibly can to make life easier and pleasant for my mother One relative visiting prior to leaving for Australia the same day for 5 weeks said If I was not entirely satisfied with the care my father has here, I can assure you that I would not be going away for five weeks. Care Homes for Older People Page 17 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 can be sure that they are listened to and concerns are acted upon. Staff training, procedures and actions ensure they they are protected from potential harm or abuse. Evidence: There is a copy of the Local Authority complaints procedures readily available in the home for people using the service and visitors. The home have not received any complaints since the last inspection and no complaints have been received by us. Advocacy services are available and referrals made where appropriate or necessary. Staff have all had training in Safeguarding Vulnerable Adults. The AQAA states We have further improved staff awareness of adult protection issues in the past year, through training courses, staff briefings, departmental bulletins and the placing of information leaflets on notice boards. The home have made 4 Safeguarding referrals since the last inspection. These relate mostly to one person where aggresive behaviour has been exhibited. Staff have attended Safeguarding strategy meetings, but no action taken other than staff vigilance in observing triggers of potential difficult situations. Appropriate referrals have been made and managed well by the home. The AQAA states in relation to Safeguarding in the next 12 months We will establish a Care Homes for Older People Page 18 of 28 Evidence: closer working relationship with the older peoples mental health assessment and care management team, this will facilitate earlier identification of vulnerable adult issues. This aim will be achieved with managers attending monthly meetings with social work Team Managers where safeguarding will be a standing agenda item. Care Homes for Older People Page 19 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. The well maintained environment and good facilities enables people to live in a safe, comfortable home promoting independence. Evidence: Improvements to the environment have been made since the last inspection when some areas still looked tired and in need of redecoration. Significant improvements to the environment have been made with some quality littleused lounge and bedroom furniture being brought by the Acting Manager from a recent home closure where she was the Manager. Very comfortable and well presented furniture including lounge chairs have been provided. All four lounges have been redecorated improving the previous tired look of those areas. The large dining area central to the home that is used by people in the two large lounge areas on the ground floor, is scheduled for redecoration. This area has lots of natural light with hexagonal ceiling windows. This will provide a bright, spacious dining facility when those changes are made. The changes in the past 12 months are summarised in the AQAA There has been redecoration of all four of the homes lounges and one corridor. Redecoration of a number of bedrooms. Furniture and equipment improvements have been made including the replacement of easy chairs and a number of beds. New signage has been Care Homes for Older People Page 20 of 28 Evidence: provided to support people as they move around the home improving orientation The Local Authority have a future planned refurbishment programme for this and other homes they operate. We saw a sample of bedrooms. Although some were small they were adequate and all were well furnished and personalised reflecting individuality and a homely room. There are no en-suite facilities in this home, the majority of people use commodes. There are adequate numbers of assisted bathing facilities and toilets located throughout the building. There has been a recent outbreak of vomiting and diarrhoea. The Health Protection Agency were swiftly contacted and the outbreak now clear. As a result the Health Protection Agency carried out an inspection of the environment last week and a positive report (not seen) provided, outlining good infection control practices in place. The AQAA confirmed to us that regular Health & Safety Audits are carried out and a fire risk assessment in place and regularly reviewed. There are individual fire risk assessments and we were able to confirm that a person with a hearing impairment was nevertheless able to respond when the fire alarm sounds. Care Homes for Older People Page 21 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. People receive a service from staff who are well trained and safely recruited. Staffing levels are reviewed to ensure the needs of people can be met. Evidence: At the time of the last inspection there had been no regular staff meetings or supervision of staff. A recommendation was made to establish a training matrix for staff to enable training to be monitored. During the year there have been 3 staff meetings in addition to separate staff meetings for night staff and anciliary staff - minutes were seen. All staff now have regular supervision every 2 months - records seen and wall chart confirmed this. Bank staff are also included in the supervision plan. We were able to see that training had taken place in the following areas: Infection control, Health and Safety, Dementia Care, COSHH, moving and handling, Food Hygiene , Equal Opportunities/Diversity and we saw that 15 staff have had certificated training in Safeguarding Vulnerable Adults. NVQ training continues and the home exceed the required 50 of care staff trained to NVQ standard. The AQAA states in relation to training for the next year, that The Department has agreed a dementia training strategy that the homes staff will access over the next year - this is a 2 day Dementia Care course provided by the Outreach Team of the Care Homes for Older People Page 22 of 28 Evidence: PCT (Primary Care Trust). Staff are allocated throughout the day to each of the 4 separate units in the home. The two larger units on the ground floor have 2 staff allocated for 18 people, the other two units each have 1 member of staff allocated to each. Additionally there is 1 floater - staff member who moves to assist between the 4 units - on the day of the inspection 2 floaters had been rostered. The Manager works additional to the above numbers. At night time there are 3 waking night care assistants and a Manager sleeping-in and on call. There is an Assistant Manager on duty throughout the 24 hour period. The AQAA states that in the past year A Deputy Care Manager post has been established to increase the management staffing compliment. This person has a wide experience of managing similar care services, has been a Registered Manager and holds NVQ4. It was evident that the overall dependency levels of people using the service had reduced since the last inspection due in part to people being transferred to nursing care or hospital. We looked at a sample of 2 staff files and found evidence of pre admission procedures being followed - this included required written references, police and health checks to ensure people using the service are protected. Pre admission interviews and records showed attention to Equality and Diversity. Care Homes for Older People Page 23 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. Changes made in areas of practice, routine and management have further improved quality of life for people in this home. Evidence: At the time of the last inspection in January 2009 the former Manager had left the home and a new Acting Manager just commenced. We felt that improvements could be made in some areas and made recommendations. These related to an absence of regular staff or supervision meetings. Quality assurance had not been undertaken in 2008 in the form of annual questionnaires as a basis for seeking the views of people using the service. We also asked for an audit of all accidents in the home to monitor any particular trends. These matters have all been addressed. Staff meetings are now held regularly and supervision for all staff planned on a bi-monthly basis. Residents meetings are now held and provide opportunity for people to express their views and influence daily Care Homes for Older People Page 24 of 28 Evidence: routines. An annual questionnaire was circulated to all people using the service, their relatives and professionals involved in providing a service to the home, in May 2009. The results have been summarised and changes made where necessary. The Acting Manager has considerable experience in similar settings, having been a Registered Manager in two homes formerly owned by the Local Authority. She has the required Registered Managers Award. She has made further application to become the Registered Manager of this service and due to be interviewed by us on 7th January 2010. The home is well supported by Service Managers from Social Care & Health who were seen during the inspection. One arrived at the start of the inspection to carry out a periodic review of the service - she decided to return on another day and later another Service Manager was present during the greater part of the inspection and we were able to usefully discuss many issues with him and the Acting Manager. We saw that regular monthly visits are made by representatives of the provider under Regulation 26 of the Care Home Regulations with written reports left in the home. The Acting Manager felt that she was well supported by the Service Managers. She told us that she has regular meetings with the Assistant Managers working in the home also. Previous recommendations have been addressed and we have seen positive changes and progress made in areas of practice, environment, training and record keeping. People using the service and their relatives tell us that they are happy with the care provided at Eardley House and we are satisfied with the interim management arrangements in place. Care Homes for Older People Page 25 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 26 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 2 A contract/statement of terms and conditions should be provided for all people using the service. This will ensure their rights are known and protected. It is important to quantify the amount of fluid recorded on fluid intake charts as a means of ensuring people have the required daily intake to sustain good hydration. Handwritten entries on MAR sheets should be countersigned by a second member of staff to ensure the prescribers instructions are accurate and people have the correct medication to ensure good health. 2 8 3 8 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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