Care Home: Eclipse Lodge

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What the care home does well Most of the care plans at the home give good information about the person being cared for, both with their current needs and also their past lives and lifestyles. This helps staff understand the whole person they are caring for. The home is a large period building and offers people a variety of areas to sit and wander. The garden is enclosed. The home offers day and respite care and well as long term care for people. People have opportunities to visit at any time and get to know the home and staff well before making a transition to move in on a permanent basis. There are activities offered to people each morning and afternoon, aimed at people who need 1:1 activity as well as people who enjoy group based activities. There is an active relative support group and "Friends of Eclipse Lodge" group, which helps people to feel more involved in the home and the care of their relatives. Staff or relatives can have access to a counselling service provided by the home. This helps to support people who are having difficulties understanding or coping with people`s illness. The home produces a newsletter for relatives and other stakeholders giving them news about developments at the home. This helps people keep in touch with the home. People told us: "They provide a very good respite service for clients in crises. I have no concerns about this service" "Looks after their clients with care and dignity.....In my opinion Eclipse lodge do a very good job" "When I visit my mother on a very regular basis all the staff make me very welcome" "Respect patients individuality with personalised care" "Eclipse Lodge is excellent. The staff are wonderful" "Puts the needs of the residents first and does everything it can to ensure that they feel happy and safe. Staff are able to approach the manager at any time with concerns they may have" "Provides exceptionally focused person centred care to residents and day care. Family members are encouraged to participate in routine and special activities. Ethos of home ensures residents well cared for in this dementia specialist home". What has improved since the last inspection? The home`s management have made considerable investment in upgrading areas of the home and improving odour control so that the home is an attractive place to live and work in. Training for care staff has been increased and now staff receive a high level of training to help them care for people. This in particular relates to Dementia and their understanding of best practice in this area. The home`s staff have worked on developing memory boxes for people which contain prompts and objects of reference for each person to help keep their individual memories alive. The home have improved their quality assurance systems which help to ensure the management understand what is working well at the home and what could be improved. Male carers have been employed so that people can have a choice of the gender of carer. The support group offers free monthly parties, and every Wednesday people can enjoy a trip out. All social functions are free of charge. A quick guide into moving into a home has been provided, and the home have updated their brochure, statement of purpose and website. Information has been provided by existing friends and family about living with Dementia. Medication systems have been improved. Staffing levels have increased, and there are more staff meetings. What the care home could do better: The home should try to gather at the pre-admission stage as much information about the effects of the person`s medical or psychiatric condition on the individual. Medical advice should always be sought after a head injury. The home should ensure that on days there are larger numbers of day care clients the people who live at the home are not disadvantaged in any way. The home should consider best practice in environmental adaptation when carrying out work on the premises. This is to ensure that the home provides an environment that is supportive to people with dementia. For example people should be able to find their way around the home just by visual clues without having to rely on their memory. The home should continue with the refurbishment of the premises, so that all areas of the home are a comfortable place to live and work in. The home should provide an Infection control risk assessment, to assess and reduce the risks of cross infection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Eclipse Lodge Rawlyn Road Torquay Devon TQ2 6PQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Finniear     Date: 0 1 1 0 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2010) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Eclipse Lodge Rawlyn Road Torquay Devon TQ2 6PQ 01803607604 01803607604 clare@crocuscare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Crocus Care Limited Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Eclipse Lodge is a detached building in a residential part of Chelston, fairly close to local shops and Torquay sea front. It is registered to accommodate people aged 65 and over and principally cares for people with dementia. All but two of the bedrooms are single rooms and some have en suite facilities. There are several spacious communal areas, including three lounge areas and a dining room. Disability equipment includes stair lifts, assisted baths, Care Homes for Older People Page 4 of 30 Over 65 27 27 0 0 2 0 1 1 2 0 0 8 Brief description of the care home mobile hoists, raised toilet seats, toilet frames and grab rails. There is a sophisticated call system. Residents are accommodated on three floors, and a new stair lift has been fitted to the top floor . There are a few steps down into the lower floor communal areas. There is a pleasant secluded garden and a sizeable car parking area, and residents are able to access outside areas fairly securely. Fees range between 380 to 480 pounds per week dependant on needs. Information on the homes previous inspection reports is available on request within the home. 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: To complete this inspection we asked the home to complete an Annual Quality Assurance Assessment. This is a self assessment tool used by the home, and gives us information about how the home is run and what changes they have made since their last Inspection. We also visited the home on two occasions without telling them when we were coming; we spoke to the managers, staff, visitors and people living at the home; we spent time observing the care and activities available to people for a period of two hours in the homes lounge; we looked at the records the home keeps about the care they give and also how they make sure the home is well maintained and kept safe; we sent questionnaires to people living at the home, staff who work there are other stakeholders, including community medical and psychiatric services, to gain their views of the service; and we looked at all the information we have received during the last Care Homes for Older People Page 6 of 30 year about the home. This approach helps to give us a rounded view of what the home offers to people. What the care home does well: What has improved since the last inspection? The homes management have made considerable investment in upgrading areas of Care Homes for Older People Page 8 of 30 the home and improving odour control so that the home is an attractive place to live and work in. Training for care staff has been increased and now staff receive a high level of training to help them care for people. This in particular relates to Dementia and their understanding of best practice in this area. The homes staff have worked on developing memory boxes for people which contain prompts and objects of reference for each person to help keep their individual memories alive. The home have improved their quality assurance systems which help to ensure the management understand what is working well at the home and what could be improved. Male carers have been employed so that people can have a choice of the gender of carer. The support group offers free monthly parties, and every Wednesday people can enjoy a trip out. All social functions are free of charge. A quick guide into moving into a home has been provided, and the home have updated their brochure, statement of purpose and website. Information has been provided by existing friends and family about living with Dementia. Medication systems have been improved. Staffing levels have increased, and there are more staff meetings. What they could do better: The home should try to gather at the pre-admission stage as much information about the effects of the persons medical or psychiatric condition on the individual. Medical advice should always be sought after a head injury. The home should ensure that on days there are larger numbers of day care clients the people who live at the home are not disadvantaged in any way. The home should consider best practice in environmental adaptation when carrying out work on the premises. This is to ensure that the home provides an environment that is supportive to people with dementia. For example people should be able to find their way around the home just by visual clues without having to rely on their memory. The home should continue with the refurbishment of the premises, so that all areas of the home are a comfortable place to live and work in. The home should provide an Infection control risk assessment, to assess and reduce the risks of cross infection. Care Homes for Older People Page 9 of 30 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 set out 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 10 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 11 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. The home makes sure they can meet peoples needs before they are offered a place. People can visit and get information about the home before they make a decision to move in. Evidence: Eclipse Lodge has a statement of purpose and a service user guide available. These give information to people thinking about moving into the home about the services, facilities and philosophy of the home. This may help people decide if Eclipse Lodge is the right place for them. People living at the home or families of people living there who completed questionnaires said that they had received enough information about the home before a decision was made to move in. Several people we spoke to or who completed questionnaires had been coming to the home for a while beforehand for day care and respite care so they were familiar with the home and what was offered. An assessment is completed before a decision is made that the home can meet a Care Homes for Older People Page 12 of 30 Evidence: persons needs. This assessment would be carried out by senior people at the home, looking at the support needed, any behavioural issues that may arise and the accommodation available. People are encouraged to visit the home and to ask questions about the care provided. We looked at the file for the most recently admitted person. They had been a day care client for some months, so were well known to the service. However a pre-admission assessment was also undertaken to make sure that areas not seen during day care sessions were also covered. This includes for example sleeping patterns. Further development of the assessments to include more detail on peoples mental health and support needed would help to provide a more person centred approach, as the current assessment focuses mainly on physical needs and support. People who completed questionnaires who live at the home or their supporters indicated that they had received contracts. These indicate the terms and conditions of residency and what people can expect to receive for their fees. They explain peoples rights while living at the home. Eclipse Lodge does not provide Intermediate care, which is a specialised service intended to return people to their own home after an intensive programme of rehabilitation. The home does however provide day care and respite care. This is sometimes planned and sometimes as a response to a crises in the persons life, for example the sudden illness of their main carer. Care Homes for Older People Page 13 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. Peoples health care needs are being met. Evidence: On the first site visit we looked at the care plans and files for five people living at the home. These people were chosen to reflect a range of need, from people who were reasonably able to some people who were very frail both physically and mentally. We then talked to or spent time with some of the people whose files we had seen and on the second visit we discussed the care given to one person in detail with a staff member. We also had other discussions concerning the care given with staff, management and a relative who visited while we were at the home. We also sat in on a staff handover so that we could see how information is passed from shift to shift. The files seen contained copies of assessments undertaken and plans to identify support the person needed. These care plans also included specific assessments including risk assessments for falls and the development of pressure areas where appropriate. These help to ensure that risks are minimised. Some files also contained good information from the person or their relatives about their lives before moving Care Homes for Older People Page 14 of 30 Evidence: into the home. This information is important as it helps staff understand the whole person they are caring for in the context of their individual circumstances. Some files did not have this information and staff said this was in some cases because there was no-one who could supply it. Discussion was held with the Responsible individual from the company about possible strategies for improvement and standardisation of the care plans. Some of the plans seen needed reviewing, but in the main they had been updated to reflect peoples changing needs. In particular updating had occurred where there had been incidents. As an example one person had recently fallen and their falls risk assessment had been amended as a result. This helps to make sure that all staff are aware of changing needs and possibly increased risks so that they can work consistently to reduce them. In each persons file there was also information about the health care needs and how these were being met. This included information about occasions when medical staff or district nurses were contacted. One persons file we looked at showed that they had recently had a fall and suffered a head injury, however the general practitioner had not been called as a routine response. Files also contained information about peoples needs for specific moving and handling equipment or risk assessments, specialist beds or pressure relieving mattresses. The new manager, appointed recently is a qualified nurse. The home told us they have taken account of the Mental Capacity Act and Deprivation of liberty safeguards when compiling their policies. Most people living at the home or their relatives have signed the care plans to agree with the actions in them. The home have told us they have worked with the local Speech and language therapy services to ensure people with swallowing difficulties are assessed and nutritional assessments have been undertaken with supplements provided as indicated. Staff files seen showed that they have attended training in Nutritional support and a staff member spoken to was clear about one persons poor appetite and how they work with this to try and encourage them to eat. On the first visit we looked at the medication systems at the home. This staff on duty told us that the home had recently been inspected by the supplying pharmacist and that no significant concern had been identified. Only senior staff deal with medication at the home, and many of the staff currently working there are registered nurses from abroad. All staff who deal with medication Care Homes for Older People Page 15 of 30 Evidence: have received training in the system in use from the supplying pharmacist. There is an administration policy and procedure for medication and lockable storage available to ensure medications can be kept safe. Medication is supplied from the pharmacist in a series of blister packs. These are colour-coded and help to ensure that the risk of errors is reduced and that staff can easily check that medication has been given. This ensures that a full audit trail can be carried out. The home provides a councillor to support staff or relatives who have found difficulties in caring for people with a degenerative illness. In addition the home runs carers groups and provides daycare opportunities for people living outside of the home with relatives. Care plans are also compiled for these people, however these were not examined on this inspection. Staff at the home had recently attended training in end of life care, and additional training is to be provided. This helps to ensure that at the end of peoples lives the home can meet their needs and wherever possible they can stay at the home. Care Homes for Older People Page 16 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to take part in activities. Resources to support people with memory loss are being used well. The food is good. Evidence: Eclipse Lodge provides a home for up to 27 people over the age of 65 with or without a Dementia. They also provide day care for a number of people which varies from day to day but may be up to an additional 9 people, and respite services when there is an empty bed. The day care clients are cared for amongst the people who live there, and discussion was held with the manager and staff on some of the challenges this presents. On the day of the first site visit we spent a period of two hours in the main lounge of the home observing the care and activities provided. We also looked at the way the staff interacted with the people in the lounge and how the people were interacting and engaging with their environment. This approach helps us to try to get an insight into what it is like to live at the home from the perspective of the people who live there who may not be able to communicate freely with us about their experiences. The observation showed that people were being supported well by the staff and were Care Homes for Older People Page 17 of 30 Evidence: generally content in the environment. There was a good level of interaction between staff and people receiving care services, and a lot of activity going on. Staff were able to communicate and support people well, and their communication was respectful. On some occasions staff spoke over people receiving care or referred to them in the third person. Visitors are welcomed to the home and some were spoken to on the first visit. Discussion was also held with the manager on ways of keeping people involved in their relatives care. The meals being served on the days of both visits were a good quality and attractively presented. Some people have swallowing difficulties so have pureed or softened food, and some others have very small appetites so receive supplementation. Staff spoken to were clear about the nutritional needs of people they were caring for and of how they had to encourage at least one person to eat. People are weighed regularly and any concerns over their nutrition is raised. Staff have received training in the nutritional needs of older people and to assess poor nutrition. The home has a number of communal spaces available for people to sit. This includes quiet areas and areas of activity, and people can wander freely unless their care plans identify they would be at risk, when they may need supervision. The lower ground floor lounge is used mainly for people who are more frail. There are plans to increase and improve this area. Dedicated staff are available to support the people who come in for day care, and they provide bathing services and activities throughout the day. Time was spent talking to one of these staff, who had completed specialist training programmes in activities and gentle exercises for older people and people with Dementia. During the day activities were provided in both lounges so that everyone had opportunities to take part. The activities organiser was also committed to providing individual and more person centred activities for people living at the home Files seen contained some information on peoples life histories which included some information on hobbies and activities people have enjoyed during their lives. The homes staff are also working on developing individual memory boxes. These contain information, prompts and objects or photographs of significance to people. They are a useful tool for working with individuals with memory loss, and can provide opportunities to open communication and allow people to re-connect with their past. Care Homes for Older People Page 18 of 30 Evidence: The home also has exhibitions and resources of period items of every day use, including an exhibition of dolls. These items can be used for reminiscence sessions and to provide an interest or comfort to people. Care Homes for Older People Page 19 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. People should be protected by the homes policies on complaints management and prevention of abuse. Evidence: Eclipse Lodge has a complaints procedure that is available in the homes hallway in the entrance hall and also in the service users guide. The procedure tells people how and to whom to make a complaint, and what will happen when they do. The home keeps records of all complaints and compliments received and their response. They told us that in the last year they have received two complaints and information on the investigation of these was looked at during the first visit. This showed that the home respond appropriately to investigate concerns and address them with action as needed. On the first visit we also looked at how well the home protects people from abuse or abusive practices. The staff files seen showed that people working at the home had received training in safeguarding and the home has policies to support staff in reporting concerns about poor practice. Staff spoken to or observed were clear about how some people may not be able to verbalise any concerns and could say how an individual might express displeasure or concern. Information is available in the home on The Mental capacity Act and deprivation of Care Homes for Older People Page 20 of 30 Evidence: liberty safeguards which are recent pieces of legislation which support peoples rights and ensure that they are not being unduly restricted. The home has locked external doors. People who completed questionnaires for us or their families said that they knew how to make a complaint, apart from the relative of a person who attended for day care. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation offered to people varies and not all areas reflect the quality of care being delivered. However the home owner is investing in improving the environment. Evidence: During the site visit a tour was made of the accommodation available to people, including laundry and service areas. The home is a large converted building on several levels. Rooms vary considerably in size and facilities. There are communal areas on the ground and lower ground floors, and two quiet room areas on the ground floor. On the first visit the communal areas on the ground floor were very busy with day care clients also being accommodated in this area. Since the last inspection the home have told us they have invested heavily in the accommodation, and have provided quiet areas for people, increased lighting in darker areas of the home; improved fire detection and fighting equipment; improved the gardens and worked on improving odour and Infection control. They have upgraded many rooms and improved many areas of decor. The tour of the home showed improvements in several areas, with new carpets and Care Homes for Older People Page 22 of 30 Evidence: decor. Some areas still require attention, including to odour control, furnishings and fittings to ensure rooms are attractive and comfortable for people. A relative wrote: I am sure that the owners and managers would wish to make certain improvements to the building, however improvements are constantly being made and I suspect even more would be made. However the funding is limited and the emphasis of the home is related to Direct care which I personally believe is the correct emphasis. I have visited other homes on many occasions.... and whilst I have visited many nicer buildings I have concluded that spending choices in favour of the environment have resulted in poorer care in almost all instances. The home has been granted planning permission to extend the accommodation to increase day care space, toilet numbers and the number of en suite rooms which will help with some of the current issues. Minor areas requiring attention were discussed with the senior staff on duty. These included a light fitting not working, some loose toilet seats, a torn counterpane and two bedrooms where there was a significant odour problem. Several plugs were missing from wash hand basins. The home has a laundry on the lower ground floor. This is capable of achieving sluicing standards according to the staff on duty. These help to control the risk of infection. Staff have access to hand gels and washes, paper towels, aprons and gloves as appropriate. Contracts are available for the safe disposal of clinical waste. During both visits we discussed appropriate environmental adaptation for people with dementia and some ways in which this can help to orientate people with memory loss. Ideally people should be able to find their way around the home without having to rely on their memory, just through the use of visual clues. Care Homes for Older People Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs, trains and supports staff well. Evidence: On both visits to the home we spoke to staff and management about the staffing arrangements; we looked at how the home recruits, trains and supports the people that work there and we looked at a sample of staff files. The staff rota showed appropriate levels of staff on duty, and additional staff are available to cater for the needs of the day care clients. The home have told us they have increased the numbers of staff on duty in the last year, and have recruited male as well as female carers so that people can have a choice of carer gender. The home has a good level of support staff, such as domestics, cooks, kitchen assistants and drivers. The staff files seen showed staff are recruited appropriately, with references and criminal records bureau checks taken up. The home have told us they take account of equality and diversity issues when employing staff. Staff at the home are well trained. The files seen showed staff receive regular core training and a high level of training that is specific to the client group. The owner has told us that nearly all the staff have completed an advanced Dementia care training Care Homes for Older People Page 24 of 30 Evidence: package from a national provider. Some specialist training has also been provided locally for staff, for example in the management of enteral feeding systems. Staff are also to do additional training in end of life care. The staff spoken to on this visit were positive and knowledgeable about the people they were caring for. They had a good understanding of the homes philosophy of care and had received a high level of training to help them do their job. People told us: Family members are encouraged to participate in routine and special activities; the ethos of the home ensures residents are well cared for in a dementia specialist home where staff are directly employed unlike others who use agency staff regularly. This ensures as far as possible consistency for residents. I have observed care given to residents approaching end of life and have been most impressed by the gentle focused care provided to all concerned.....residents are well supported to achieve as much Independence as possible and are not hurried for the benefit of routines or staff Provides good staffing ratios The owner has also told us that families and people living at the home are encouraged to be involved in staff recruitment, which is commendable. Care Homes for Older People Page 25 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 is being well managed, however no registered manager has been in post for several years. Evidence: Since the last Inspection the home had recruited a manager, who was in post, although not registered, for some time. However they left just before this Inspection started. A new manager has been appointed, who has experience of running homes and the second site visit was delayed slightly to allow for an opportunity for her to spend a week at the home before the Inspection was completed. The home has unfortunately not had a registered manager in post for several years, however systems for managing the home appear to be well maintained and in place, and the home has had consistent ownership and senior staff for several years. The home needs to have a registered manager as it is run by a company. This means there needs to be someone accountable in day to day control. Since the last inspection the home have told us that they are working to try to reduce Care Homes for Older People Page 26 of 30 Evidence: the level of stress in the manager role. As an example an administrator has been provided to assist the manager with records management. The home has quality assurance systems in place, and is about to commence another cycle. The system in use allows for a series of questionnaires to stakeholders and the inclusion of information from internal and external audits to gather information about how the home is operating. The home then use the information to produce an annual development plan, looking at what is working well and what can be improved. We looked at the way the home handles small amounts of money for day to day expenses for people. An individual account is maintained for each person with receipts kept for expenditure made on behalf of each person. This might for example be for toiletries, hairdressing or podiatry services. We checked the balances of two accounts at random and found them to balance correctly. We also looked at the health and safety arrangements the home makes to ensure people can live and work at the home safely. The manager could demonstrate risk assessments having been completed for activities undertaken and for the environment of the home. Risk assessments help to evaluate and reduce risks wherever possible. We discussed the provision of an Infection control risk assessment, and the home told us they have an emergency plan for staffing in the event of a flu outbreak. Evidence was not seen of an Asbestos or legionella risk assessment but the deputy manager was sure one had been completed. Cleaning materials were kept locked away during the visit, and information was available to demonstrate the servicing of gas and electrical appliances. The deputy manager confirmed that all hot surfaces were guarded and hot water regulated. The water tested at random on the visit was at an acceptable temperature.Windows appeared to have restricted openings which help to ensure people cannot accidentally fall from the windows. We looked at the ways that staff are supported through a process of supervision. This is a system including elements of workload management and personal development and helps to ensure staff are working consistently and to the best of their abilities. The system in use showed staff receive 1:1 sessions every 6-8 weeks. Discussion was held on ways to keep this fresh, varied and interesting for people. We were not able to locate the Regulation 26 visit reports on this visit, but the manager agreed to send the last 3 months reports to us. These are reports completed by the Responsible individual of the company, who is required to visit the home at least monthly and compile a report about the operation of the home. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 19 23 (2) (c) (d) The registered person shall, 28/02/2009 (f)(p) having regard to the number and needs of the service users ensure thatAll parts of the home are kept clean and reasonably decorated. This applies in particular to areas where there is poor odour control. Care Homes for Older People Page 28 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 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 People may benefit from additional information being gathered at the pre-admission stage about peoples mental health needs and lifestyle choices. Medical advice should always be sought after a head injury. The manager must make sure that the numbers of people attending for day care do not disadvantage the people who live at the home. The home may find best practice guidance on environmental adaptation useful, in particular if they are planning building works. Work should continue on areas of the home that still require attention to refurbishment and odour control. 2 3 7 12 4 19 5 38 The home is recommended to provide an Infection control risk assessment and associated planning. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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 © (2010) Commission for Social Care Inspection (CSCI). 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. 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