Care Home: Eastrise

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What the care home does well The home provides a warm and clean environment for residents. People spoken with were happy with their home. One person commented, `I like the home - I have my own room and toilet and its kept clean and tidy`, whilst another said, `its a very nice and clean home`. The staff were described as caring and friendly and people were happy with their care. They also told us that the home had a relaxed atmosphere and visitors were welcomed at any time. People were also encouraged to make decisions about aspects of their lives and how their home is run. People had their needs assessed prior to entering the home so the staff could be sure they were able to look after them properly. The care plans contained the information staff needed to support people and health professionals visiting the home said that staff followed their instructions and contacted them when required. People generally liked the meals provided and said they had plenty to eat and drink. One relative suggested there be more variety for the tea-time meal but residents spoken with confirmed they could have alternatives to the menu if they wished. Residents really enjoyed the slide shows and discussions of days gone by in Hull that were regularly organised. The home monitored the quality of the service it provided and treated complaints seriously. The manager tried to look into things quickly and resolve them. The staff are progressing well with national vocational qualifications in care and 46% of care staff have achieved this so far with three additional staff progressing through the course. The home is well managed and the proprietors are always on hand to support and advise staff. They have made their direct telephone numbers available to relatives so they can be contacted quickly should there be any concerns. What has improved since the last inspection? There have been major changes to the environment since the new owners took over and there are more environmental changes planned to improve the home even further. The home is now light and bright and is nicely decorated and furnished. The lounge has been made larger by knocking through into a spare bedroom next door. This provides the residents with much more space and is nicely decorated and refurbished. Residents helped to choose the carpets. Several bedrooms have been refurbished. One of the bathrooms has been refurbished into a walk in shower room and is almost complete. The home has more space for storage such as the medicines trolley and laundry.The central heating system and electrical circuits have been replaced and the nurse call and fire alarm system have been integrated. The care plans have improved and care staff write monthly summaries about each residents care. There is a range of daily recording, which means that care staff are writing about the care they provide to people. This could be made clearer though so that staff know exactly where they should be recording information. See below. A training plan for the coming year has been produced. What the care home could do better: The range of social stimulation could be broadened so that all residents are happy with this aspect of their care. Staff must have up to date training in first aid and moving and handling and the training plan could also be expanded to include conditions affecting older people. This will help staff to have a full range of skills and be confident when supporting people with diverse needs. New care staff must receive moving and handling training and instruction prior to their support of residents requiring specific moving techniques.This will ensure the safety of the resident and provide staff with the confidence they are completing the support correctly. Care staff should receive a minimum of six, formal supervision sessions per year. This will provide the supervisor with frequent opportunities to monitor and discuss their practice and provide the supervisee with the opportunity to discuss their work and any issues they may have. Gaps in employment should be recorded. This will show that the subject has been addressed and the employer satisfied that gaps are accounted for. The way that staff record information and update risk assessments could be improved to ensure staff all know what and where they should be recording information and to make using the information easier. Changes or stoppages to medication dosages mid-cycle should have a witness signature. This will help to avoid mistakes being made. Key inspection report Care homes for older people Name: Address: Eastrise 851 - 853 Holderness Road Kingston upon Hull East Yorkshire HU8 9BA     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: Beverly Hill     Date: 0 7 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Eastrise 851 - 853 Holderness Road Kingston upon Hull East Yorkshire HU8 9BA 01482794270 01482794270 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Redstacks Residential Home Limited care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 21 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 Dementia - Code DE Date of last inspection Brief description of the care home Eastrise was registered with new proprietors in July 2008. The home is situated on a main road, which leads to the centre of Hull. It is close to East Park and other local facilities such as shops, pubs, health services and public transport. Eastrise is registered to provide care and support to twenty-one older people, some of whom may have needs associated with dementia. The home is made up of two houses separated by a driveway but connected by a Care Homes for Older People Page 4 of 30 Over 65 0 21 21 0 0 9 0 1 2 0 0 9 Brief description of the care home corridor at the rear of the buildings. It has two floors serviced by a passenger lift in one building and a chair lift in the other. Communal areas consist of a main lounge and a dining area near the kitchen in one of the houses, a small conservatory in each house and a further small sitting/dining area in the second house. The home has nine single and six shared bedrooms. Four bedrooms have en-suite facilities. There are three bathrooms, two of which have bath hoists. The new proprietors have almost completed a conversion of one of the bathrooms into a walk-in shower room. There is a large garden to the rear of the property and a covered area for people wishing to smoke at one of the rear exits. Visitors can park their cars in the driveway or there is extra parking on the street at the front of the home. Information about the home and its services can be found in the statement of purpose and service user guide. The home also has a pack to give out to prospective residents with additional information. The weekly fee for the home is 350.50 pounds. The home does not charge any top ups. The proprietors provide items such as basic toiletries, soap, shaving foam, talc and hair care products. There is additional charges for optional extras such as hairdressing, chiropody, personal toiletries, newspapers and magazines. Care Homes for Older People Page 5 of 30 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 2 stars. This means that the people that use this service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 9th January 2009 and a site visit to the home, which lasted approximately nine hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Eastrise. We also had discussions with the manager, the proprietor, some staff members and two health professionals. Comments have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living Care Homes for Older People Page 6 of 30 there. Also examined were, medication practices, risk management, activities, nutrition, complaints, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked to see how residents were consulted with in how the home was run and how privacy and dignity was maintained. We also wanted to be sure that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. The provider had returned their annual quality assurance assessment (AQAA) within the required timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Eastrise, the staff team and management for their hospitality during the visit, and also thank the people who had discussions with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? There have been major changes to the environment since the new owners took over and there are more environmental changes planned to improve the home even further. The home is now light and bright and is nicely decorated and furnished. The lounge has been made larger by knocking through into a spare bedroom next door. This provides the residents with much more space and is nicely decorated and refurbished. Residents helped to choose the carpets. Several bedrooms have been refurbished. One of the bathrooms has been refurbished into a walk in shower room and is almost complete. The home has more space for storage such as the medicines trolley and laundry. Care Homes for Older People Page 8 of 30 The central heating system and electrical circuits have been replaced and the nurse call and fire alarm system have been integrated. The care plans have improved and care staff write monthly summaries about each residents care. There is a range of daily recording, which means that care staff are writing about the care they provide to people. This could be made clearer though so that staff know exactly where they should be recording information. See below. A training plan for the coming year has been produced. 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 30 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 30 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 had their needs assessed prior to admission. This enabled staff to be sure that residents needs could be met in the home. Evidence: We looked at three care files during the visit, one of which was for a person recently admitted to the home. We wanted to assess the admissions process and check that the home obtained all the relevant information about people prior to admission. Although the person was admitted as an emergency, the home had obtained the assessment completed by the local authority. The other care files evidenced that this was routine practice. The home also had documentation that staff completed when they visited potential residents. This in-house assessment was in a tick box format but had scope for comments in each section. The one seen could have been completed with more information about what the person could do for themselves but on the whole it Care Homes for Older People Page 11 of 30 Evidence: contained sufficient information to enable the home to decide whether their needs could be met. The manager confirmed that following the assessment, people were notified in writing that their needs can be met in the home. The home does not provide intermediate care services so standard 6 does not apply. Care Homes for Older People Page 12 of 30 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 had their personal and health care needs planned for and met. Keeping risk assessments under review would ensure staff have full and up to date information about peoples needs. Evidence: During the day we looked at three care plans that had been produced from assessments of need. Improvements were noted in care plans and on the whole they covered the assessed needs well and gave clear tasks for staff in how to care for people. The care plans stated what the resident could do for themselves and indicated preferences, for example, on the times they liked to rise or retire to bed. Surveys from people and discussions with residents indicated that they were happy with the care they received. Comments were, the standard of care is very good, they keep me informed about everything relating to her, excellent since being taken over, they do everything well, I manage most things myself but the satff look after us and they are all good and would do anything for me. When asked if staff respected privacy and dignity one person said, oh yes they definately do. Care Homes for Older People Page 13 of 30 Evidence: Staff completed monthly evaluations that gave a brief summary of how the person had been and updates in care plans were seen when the needs changed significantly. Risk assessments were completed for areas of concern and generally these linked to the care plans. To improve, the care plans should be signed by staff when they formulate them and by the resident or their representative to evidence they have seen them and agree with what is written. In one care plan is was noted that the resident did not have many teeth and declined to let staff clean them. The care plan should be clear in what alternative ways the staff support the resident in this area. One risk assessment could also be expanded on to show exactly the steps the staff are taking to minimise the risks. When checked this was actually happening in practice. The risk assessments could also be checked and commented on in the monthly summaries. This would evidence that staff are keeping them under review. Daily recording was completed in a number of different ways which can be confusing for staff. These included daily charts that corresponded with care plan sections for personal care, bathing, nutrition, mobility, toileting, keyworker activity, sleep, GP and hospital visits and social visits, and which were initialled when tasks completed. There were separate daily records that staff recorded intermittently not daily, and keyworker records that were completed after each shift. The recording systems could be reviewed to simplify them and ensure staff all know what and where they should be recording information and to make using the information easier. Staff also recorded on monitoring charts, for example pressure relief. Staff could comment on the condition of the persons skin at each check. There was evidence that people had access to health care professionals. One health professional we saw during the day told us that staff followed their instructions and referred people to the district nursing services in the correct way. They found the staff helpful and the home in general much improved. The company also employs a physiotherapist to spend time in each of their homes. We spoke to him during the visit and he advised he visited Eastrise fortnightly to support individual residents with specific exercises and provide advice and guidance to staff. The management of medication was good. All medication was signed into the home and on administration, and was stored appropriately. There were some occasions when changes in dosage had been completed by the prescriber. Staff had signed these but for good practice, there should also be a witness signature. There were also some pain-killing medicines that were prescribed to be taken throughout the day but Care Homes for Older People Page 14 of 30 Evidence: residents were recorded as not requiring them or only requiring them intermittently. A discussion should take place with the prescriber regarding the medicines being written, as required. They could then be dispensed in their original package to avoid the waste of dispensing in monitored dosage systems that are returned to the pharmacy unused. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents had a good quality of life although social stimulation could be improved upon so that all residents were happy with this aspect of their care. Evidence: Personal profiles were completed and staff had gathered some information about past hobbies and interests. There was evidence that the home provided some stimulation for residents such as games and quizzes, dominoes, cards, nail care and massages, individual one to one activities and outings to local shops. There was also a trip to Hornsea recently. A physiotherapist and aromatherapist visited fortnightly to treat residents and there was a slide show and discussion of Hull in days gone by during the visit. People watched television and listened to the radio and CD player and some people preferred to do their own thing. One resident had some chickens and ducks in the garden and spent time looking after them, which he thoroughly enjoyed. Some residents told us that they would like to have more activities and when asked in a survey what the home could do better, one relative wrote, more stimulation for residents like bingo. People could make choices about aspects of their lives and residents spoken with told us there were no set times for rising or retiring and relatives could visit at any time. Care Homes for Older People Page 16 of 30 Evidence: Staff said they tried to ensure that people made decisions for themselves, we ask people if they want to do things and we respect their choices and we read care plans so we know how people want to be cared for. Two residents had their own phones in their bedrooms to help them to keep in touch with relatives. People generally liked the meals provided. Some comments were, the food is pretty good and we get drinks whenever, the food is great, it really is, the food is great, no problem at all - there are choices and we get plenty to eat and drink and the food is not bad at all really - the cook comes around and I remind them I cant have pie and they give me the filling. There were at least two choices for the main meals of the day but staff confirmed that residents often made requests that were not on the main menu, especially at teatime, and these were provided were possible. This was confirmed in a discussion with a resident who told us they had asked for beans on toast for tea on the day of the site visit and they knew this had been arranged. Five surveys stated that people liked the meals either, always or usually whilst one person stated this was, sometimes. One relative did state in a survey that there could be more choice at tea-time. This comment and the survey results were mentioned to the manager to see if any changes are required. Catering staff received information about special dietary needs and checked with residents each day regarding their choices for the following days meals. Care Homes for Older People Page 17 of 30 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. The home protected people from abuse by staff training and the use of policies and procedures. Evidence: The home had a complaints procedure, and complaints forms for people to complete, on display in the entrance. Staff spoken with and surveys received from them indicated they were aware of what steps to take should people raise concerns with them. The home had not received any complaints since the last inspection and one complaint received by the local authority was dealt with quickly and resolved. Residents spoken with stated they would tell people should they have any concerns or complaints. Comments were, Id tell Jeff or Yvette (the proprietors), Jeff would sort it out and I dont have any complaints, we have key workers and we tell them. The home used the multi-agency policy and procedure for safeguarding vulnerable adults from abuse. The proprietors had demonstrated their knowledge of the procedures by making appropriate referrals to the local authority for two particular financial issues they had become aware of. There had also been four incidents between residents, of which the local authority were notified by the home. Using the procedures to keep the local authority aware of issues means that care management staff can visit the residents and check out the management systems in place to Care Homes for Older People Page 18 of 30 Evidence: protect people. All staff, apart from one very new staff member, have received training in how to safeguard people from abuse. The manager, who is also one of the proprietors, has received more in depth training facilitated by the local authority regarding their referral and investigation role. Care Homes for Older People Page 19 of 30 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 quality of life for residents has been improved by the recent environmental updates and changes to the home. Evidence: There have been significant improvements in the environment since the new proprietors took over the home eighteen months ago. The home consists of two houses, 851 and 853 Holderness Road, Hull. They are joined together by a walkway across the shared drive. The proprietors have decided to reduce the numbers of bedrooms in the current build so that the environment can improved for people. The main lounge is situated in house number 853 and has recently been extended by knocking through into one of the bedrooms. This has made the area much larger and has been decorated in a light and airy fashion. There are two sets of dining tables and chairs at one end. Other communal space consists of a small dining area near the kitchen, two small conservatories, large enough for two chairs in each and used for people to see relatives in private, and a further small seating area in house number 851. This area also has a dining table and chairs. The entrance, stairway and landing have been redecorated and carpeted. In addition several bedrooms and the small the dining area have also been recarpeted and redecorated. One of the bathrooms is in the process of being refurbished into a walkCare Homes for Older People Page 20 of 30 Evidence: in shower room and there are further plans to knock the second upstairs bathroom and toilet together to make another shower room. A new boiler has been fitted, storage space extended, laundry equipment purchased, the fire and nurse call systems linked to both sides of the building and various other essential work completed. The proprietors advised that the project for 2010 was a complete refurbishment of the kitchen. The refurbishment so far evidences the proprietors commitment to improving the home for the residents that live there and the staff that work there. People spoken with were very happy with their home and the improvements that had taken place. The home was much cleaner and tidier and comments in surveys and from discussions were, very comfortable place, the cleanliness has changed immensely and it is clean, friendly and well run. The laundry was suitable for the size of the home and number of residents. Peoples clothes were well looked after and hung up in wardrobes. One person did comment in a survey that sometimes their relatives clothes got mixed up despite them being labelled. This was mentioned to the proprietors to address. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient staff members on duty to meet the personal and health care needs of the residents. Expanding the training for staff on the conditions affecting older people and ensuring first aid and moving and handling updates are completed will upgrade their existing skills and enable them to confidently care for residents with a range of diverse needs. Evidence: The home currently supported fifteen residents. There were two carers and a senior on shift during the day and two carers at night. In addition, the assistant manager worked during the day and the manager was supernumerary. The provider also spent large sections of the week working in the home. There were sufficient catering, domestic, administration and maintenance staff to support the service. Surveys received from people and discussions with them on the day highlighted that they were happy with the care they received. Some comments were, friendly, caring staff, the staff are all good, they listen and do what I ask, the staff are marvellous and they are very helpful - you can have a laugh and a joke and they help the best they can. One person did tell us that the nurse call was answered quickly if staff were in the Care Homes for Older People Page 22 of 30 Evidence: same side of building as the resident but this took longer if staff were at the other side. The two houses are joined together on the ground floor and it can take staff some time to get from one side to the other. However, the provider advised that they had plans to join the two houses together at another point upstairs, which will make it easier for residents and staff. Five surveys stated staff were available and provided the right care and support either always or usually. One person said this was, sometimes. However, all six surveys stated there was always someone to speak with informally should the need arise. In discussions and surveys it was clear that staff enjoyed working at the home and were pleased that improvements had been made in the environment but also with the philosophy of the home. One staff member stated, its a positive home and the residents seem happy to be here. There have been staff changes and the atmosphere is positive - this has affected the residents. Other comments were, we have a good team now, we can sit and talk to the residents, personal care of the residents is the utmost importance plus their dietary needs and its a good atmosphere. The home had a training plan and there was evidence that service specific training was included. For example, dementia care, nutrition, diabetes, record keeping, catheter and sheath care, values and attitudes, care of the dying and mental capacity legislation. Mandatory training such as fire safety, health and safety and basic food hygiene were planned and the manager was awaiting dates for infection control and medication. It was noted that night staff did not have first aid training and practical moving and handling updates were required. The training plan could be expanded to include conditions affecting older people, such as, strokes, arthritis, Parkinsons disease and sensory loss. Two staff members were observed moving and handling a resident and the technique was questionable. When checked out, one of the care staff was new and had not received any moving and handling training. It was important that new staff did not support in moving and handling techniques prior to their training. This was mentioned to the manager to address. Six out of thirteen care staff had gained a national vocational qualification (NVQ) in care at level 2 or 3. This equated to 46 and was a good achievement. When the three care staff have completed their course the home will have exceeded the standard, which expects 50 of care staff to be trained to this level. Care Homes for Older People Page 23 of 30 Evidence: The recruitment system was generally sound with application forms completed, references checked and formal interviews. One staff member had a gap in their employment record and although the manager was aware of the reasons for this, it should be recorded to evidence a discussion has taken place. Checks were made to ensure that new staff were not excluded from working with vulnerable people and criminal record bureau checks were completed. One staff member started work just prior to the return of the final check but the time spent was in induction. The criminal record bureau check had still not been received for a second staff member but the manager confirmed they would not be working alone with residents until it was returned. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was managed well, which helped to promote residents safety and wellbeing. Evidence: The home is managed well. The manager is also one of the proprietors and was previously the registered manager at one of the sister homes in the company. As such, she has been through the registration process with us before and is currently in the process of collating information together to complete an application to be the registered manager for Eastrise. The manager has many years experience in the care sector and has an NVQ level 4 in care and Management. Staff spoken with told us the manager and proprietor were always present in the home and could be approached at any time if they had any problems to sort out. Comments were, they are brilliant managers and very supportive, they come around and ask us if we have any concerns, they are very hands-on, their door is always open and they are always there, management is very Care Homes for Older People Page 25 of 30 Evidence: approachable and will listen to any concerns and issues - they will correct things, we have regular staff meetings to air our views, and they look after the residents and staff really well. Residents spoken with knew the manager and the proprietors first names and said they would speak to them if they had any concerns. One relative wrote in a survey, clean, friendly and well run. The proprietors have given relatives their home phone number and mobile number so that they can be contacted by them at any time should they have any concerns. The home had a good quality monitoring system that included audits and questionnaires. These were carried out throughout the year and all staff took some part in ensuring that the residents continued to receive a quality service and if shortfalls occurred they were addressed quickly. The home completed the annual quality assurance assessment required by the Care Quality Commission and this evidenced that the manager and staff team listened to the views of people living in the home and encouraged their participation in decisions. For example, in the redecoration of the home. There was evidence that care staff received some one to one supervision but the amounts varied between one and five sessions in the last year. This should be organised more effectively so that staff have a minimum of six sessions a year. However, in discussions and surveys staff told us they felt well supported and could talk to the manager and proprietor at any time. The supervision records that were checked showed that a range of topics were discussed covering training and development, care planning, the key worker role, medication, time keeping, any disciplinary issues or follow up, staff rotas, recording and feedback on the workers progress. The management of finances was touched upon during the site visit. Individual records were maintained for any monies held in safekeeping for chiropody, hairdressing and minor purchases, and receipts were obtained. Families generally managed peoples monies and the administrator oversees the finances for the home. The home was a safe place for people to live in and staff to work in. Fire equipment was checked routinely and gas and electrical equipment serviced. Staff participated in mandatory training and had policies and procedures to guide their practice. Care Homes for Older People Page 26 of 30 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 27 of 30 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 30 18 Staff must have up to date skills in first aid and moving and handling. This will ensure the safety of the residents and provide staff with the confidence to support people correctly. 31/03/2010 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 7 The recording systems could be reviewed to simplify them and ensure staff all know what and where they should be recording information and to make using the information easier. Risk assessments should be kept under review and updated when needs change significantly. This will ensure staff have up to date information. Changes or stoppages to medication dosages mid-cycle should have a witness signature. This will help to avoid mistakes being made. The range of social stimulation could be be broadened so that all residents were happy with this aspect of their care. 2 8 3 9 4 12 Care Homes for Older People Page 28 of 30 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 5 6 28 29 The home should continue to work towards 50 of care staff trained to NVQ level 2 or 3. Gaps in employment should be recorded to enable an audit trail of discussions and decisions. This will show that the subject has been addressed and the employer satisfied that gaps are accounted for. The training plan should include first aid and moving and handling updates and be expanded to include conditions affecting older people. This will help staff to have a full range of skills and be confident when supporting people with diverse needs. The manager should apply for registration with the Care Quality Commission. This will ensure stability for the home and enable their fitness to be tested. Care staff should receive a minimum of six, formal supervision sessions per year. This will provide the supervisor with frequent opportunities to monitor and discuss their practice and provide the supervisee with the opportunity to discuss their work and any issues they may have. 7 30 8 31 9 36 Care Homes for Older People Page 29 of 30 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). 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