Care Home: Elmbridge Residential Care Home

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What the care home does well The home completes a very comprehensive assessment of someone`s needs before they agree to an admission. This usually involves close communication with other health care professionals who may already be involved in the person`s care. The home aims to treat everyone as an individual and in doing so recognise the need to address people`s equality and diversity needs. Care is delivered in a manner that also maintains people`s privacy and dignity. It is important to the staff that each person has a good quality of life. Therefore emphasis is given to providing purposeful activities and people are supported well to make daily choices. What has improved since the last inspection? The home has always carried out many things that help it provide a service that benefits the people living in the home, but these efforts have not always been formally recorded. Improvements therefore have been made in the homes record keeping for example, pre admission assessments are now well recorded and the way people`s views and suggestions are collected has been improved. What the care home could do better: The home needs to consider how it could offer the choice of a bath or shower. Currently the only option is to have a bath. Although the homes audits demonstrate good levels of cleanliness and infection control. In order to demonstrate that all risks are being reduced, staff should wear protection over their uniforms whenever they enter the kitchen. Areas of record keeping that still require attention is following staff supervision/support sessions and after care plan auditing. Key inspection report Care homes for older people Name: Address: Elmbridge Residential Care Home 21 Elmbridge Road Gloucester Glos GL2 0NY     The quality rating for this care home is:   three star excellent 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: Janice Patrick1     Date: 2 2 0 4 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Elmbridge Residential Care Home 21 Elmbridge Road Gloucester Glos GL2 0NY 01452524147 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): elnres21@hotmail.com Ms Caroline Ann Margaret O`Grady Name of registered manager (if applicable) Ms Caroline Ann Margaret O`Grady Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 16. The registered person may provide the following category of service: Care home only Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum of 10 places Dementia (Code DE) - maximum of 4 places Mental Disorder, excluding learning disability or dementia, aged 65 years or over on admission (Code MD(E)) - maximum of 2 places Date of last inspection 2 1 0 8 2 0 0 9 4 0 0 Over 65 0 2 10 Care Homes for Older People Page 4 of 30 Brief description of the care home Elmbridge Residential Home provides personal care for sixteen older people. Within this number the home can accommodate two service users with specific mental health needs and up to four with dementia. The accommodation is a converted two-storey older style house, which has been adapted and extended for its current use. Service users rooms are provided on two floors, fourteen of which provide single accommodation, with one shared room. One single room provides an en-suite facility, though each room has its own hand washbasin. Communal areas consist of a lounge, dining room and a conservatory, all of which are situated on the ground floor. A stair lift provides easy access from the ground to the first floor. All areas have a call bell system. Information about the service to include the Commissions previous report and current fees can be obtained from the Registered Provider. Additional charges are made for hairdressing and chiropody. 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: three star excellent 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: Before we visited the service we considered all the information we had gathered since the last key inspection which was carried out on 30th April 2007. This included consideration of the last random inspection which took place on 21st August 2009. This service has no outstanding requirements. We also reviewed all notifications from the home. These inform us of any accidents, deaths and occurrences that have involved service users. We also considered any additional information we may have received from professionals, service users and members of the public. We read the most recent Annual Quality Assurance Assessment, AQAA. This document is completed by the registered manager/provider and tells us what the home feels it does well, how they evidence this, what improvements have been made and those that are planned. Prior to our visit we forwarded questionnaires to the people who live in the home and Care Homes for Older People Page 6 of 30 to the staff, so that they could give us their views on the services and care provided. We received eight questionnaires back from service users which had been completed with help from staff members. We received seven staff questionnaires back. One inspector then visited the home and spoke to the people who live there, the staff and manager. We spent one day in the home between the hours of 12 midday and 7.30pm. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 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 9 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to make the right decision about their future care by being provided with helpful and appropriate information, by being able to visit the home prior to moving in and by staff taking their time to make a thorough assessment of the persons actual needs. Evidence: The AQAA tells us that people are provided with appropriate information when they first consider moving in. It tells us that people are able to visit and spend time looking around, talking with staff and meeting the people who already live there. It tells us that great care is taken to make people feel welcome and that staff recognise that this can be a difficult and sensitive time for some. The AQAA explains that the homes pre admission process is designed to help people make a positive decision about their future care. The manager explained to us that she also encourages people to look at other care Care Homes for Older People Page 10 of 30 Evidence: homes as well as Elmbridge as part of this process. The AQAA explains that the manager will go and assess a person in their own home or in another place of care if they are unable to visit the home. On admission, the person is helped to settle and family are made welcome. If appropriate at this point the manager will go through the homes statement of purpose, service user guide, complaint procedure and terms and conditions. If it is not the best time on admission then this is done at a later point. During this inspection we saw that the homes last two inspection reports were available to read in the entrance hall, along with other useful information, which included a copy of the complaints procedure. The manager told us about one persons recent admission. This person had visited the home with their family and stayed for tea. In this case the pre admission assessment was carried out then. The person was then admitted on another day accompanied by their relatives. We saw records that demonstrated that a comprehensive assessment process had taken place. Other records told us that people are provided with the homes terms and conditions, irrespective of how someones care is being funded. All the returned questionnaires indicated that people felt they had received enough information about the home to help them make a decision about living there. Two specifically told us that they had visited the home twice before making their decision. This care home does not provide designated intermediate/rehabilitation care. Care Homes for Older People Page 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being cared for by staff who spend a lot of time getting to understand their personal needs and preferences. They also benefit from having their particular health care needs expertly identified and supported. Evidence: Once the person is admitted any immediate health care needs are identified and a care plan is devised. Staff work very closly with external health care professionals to ensure peoples needs are well identified and supported. Care plans then give guidance to the staff on how an individual persons needs are to be met. Some records demonstrated that the Community Nursing team, local General Practitioner (GP) and/or mental health team had been involved immediately after admission. Additional assessments carried out by the home within the first few days of admission include, an assessment of the persons safe moving and handling and their level of risk in developing pressure sores. The most recently admitted person had both these areas of risk assessed by the third day of their admission. Care Homes for Older People Page 12 of 30 Evidence: The manager explained that care plans for other needs were not always devised straight away because of the persons changing levels of support during the settling in period. We were therefore keen to know how staff, during this period of time, knew what support a person needed and how this was communicated amongst the care team. The manager explained that the team consisted predominantly of long standing and very experienced care staff. These staff cover all shifts throughout the week and no agency staff are used. The manager told us that she takes the lead in peoples assessments and in directing the care. It was explained that a persons changing needs may be discussed several times a day by the staff on duty. Therefore she is confident that any alterations in the required support are well known by all the staff who are able to be flexible. We spoke to one carer about the support staff had been giving the new person, up to this point. She was able to confirm that the persons needs were still changing and that these changes are discussed on a daily basis and each day is taken a day at a time. She discussed a specific example which helped to demonstrate that staff were changing their daily approach in order to try and establish a routine that met with the persons preferences. She also explained that in doing this staff still had to make sure that the persons actual care needs were being met or at least discussed with them. We looked at the care records of two more people who had been in the home for a longer time. Both these files demonstrated that very individualised care plans are eventually devised. In both cases, the care plans gave the reader a very concise picture of the individual and the kind of support they needed. They also gave clear guidance to staff in how to meet various needs. In one file there was a very comprehensive list of situations that could act as a trigger to some challenging behaviour that the person could and has exhibited. The staffs daily notes, which are completed at the end of each shift, demonstrated that staff were aware of these triggers and demonstrated that the action taken by them aimed to avoid these situations. The only exception to this was one care plan that referred to one specific element of one persons challenging behaviour. Again, the triggers were well recorded and the records demonstrated that physical aggression had been demonstrated by the individual. What the care plan did not go on to say was how this should be managed. The staff notes also just stopped at recording that aggression had taken place but did not go on to record what the possible trigger had been, what staff had done to manage this and the outcome. From the descriptions the manager gave us it sounds as if these situations were well managed. This was clearly helped by having good Care Homes for Older People Page 13 of 30 Evidence: continuity of staff and those staff knowing the people in the home well. However, a clear record must be maintained when any challenging behaviour has been exhibited. We also discussed with the manager, the homes policy on non restraint and recommended that clear protocols for this, either be incorporated within the associated care plan or sit alongside it. It is important for the home to be able to demonstrate that appropriate action is being considered and taken in such situations in order to protect people from inappropriate practices and abuse. The manager explained that she audits the care plans and their contents but does not record this. We recommended that she do this in order to be demonstrate future compliance (see Management and Administration outcome of this report). The medication administration records (MARs) and associated medicine records are audited and these audits are recorded. We inspected a selection of MARs which were consistently well maintained. The storage of medicines had been reviewed recently and a new medicine trolley purchased to accommodate correct storage requirements. Medicines seen in the trolley showed that packets and bottles are dated on opening to ensure use of the medicine within its correct shelf life. The MARs are preceded by a photograph of the individual so that there are no mistakes in identification. Peoples allergies had been identified and recorded at the top of each MAR. The MARs also demonstrated that topical applications, such as creams and ointments were being recorded. One member of staff explained that the MAR is signed by the carer that has applied these. On admission each person is registered with the local surgery and a check is carried out to ensure that what the person came in to the home with, corresponds with the GPs records. The surgery nurse will also visit at some point and carry out an initial health check. The home staff had picked up that one person had been taking medicines in the past for their blood pressure but had not come in with this medication.Some peoples medication is adjusted by the visiting Psychiatrist and we saw records of this taking place through the GP. Some medicines are only prescribed to be used when required and we saw associated care plans that gave clear guidance of when such medicines warranted use. The manager explained that she aims to have very few medicines prescribed like this to avoid any misappropriate use. The home was able to demonstrate that medicines are appropriately reviewed and adjusted as required. Only staff that have successfully attended accredited training in the safe administration of medicines, administer medicines within the home. Care Homes for Older People Page 14 of 30 Evidence: Returned questionnaires from the people living in the home and their representatives tell us that people feel well cared for and they agree that they receive appropriate medical support. We did not witness any situation that would make us feel that peoples privacy and dignity may be compromised. We observed staff speaking to and supervising people in a respectful and caring way. Any personal care is carried out behind closed doors as was evident when someone had a bath when we were in the home and when someone else was helped with their toilet needs. The AQAA tells us that peoples equality and diversity needs are explored and arrangements are made to accommodate these as needed. It also tells us that staff are made very aware of peoples rights to privacy and dignity. One member of staff told us that she and another staff member had attended a local conference/workshop on dignity and had found this to be a real eye opener. This member of staff is also attending the dementia link worker training and told us that equality and diversity, and privacy and dignity are frequently discussed in relation to the delivery of peoples care. 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. People benefit from living in a home where individuals are able to make choices and where purposeful social activities are seen as an integral part of peoples well being. Evidence: The homes AQAA tells us that peoples choices and preferences are acted upon. It also informs us of the many arrangements in place that help support people socially. Following admission the staff will attempt to find out what hobbies and interests people had before their illness/admission. This helps the home to provide activities that suit the particular individual. During the morning of our inspection we witnessed a group of people joining in one of the informal activities organised by the staff. The AQAA tells us that each member of staff organises a particular activity each week. This has been very successful in learning about peoples individual wishes. During the afternoon we witnessed people really enjoying the music of an outside entertainer. This person comes to the home on a regular basis as does another person at the weekends. We spoke to one carer who had been shopping with a person who lives in the home on the morning of our inspection. The person showed us what they had purchased and it was clear that they had really enjoyed this outing. A similar outing had taken place with another person Care Homes for Older People Page 16 of 30 Evidence: previously to this. The questionnaires returned to us from those living in the home confirm that people are happy living there. There were several comments about how staff help them to go out and to see their family and friends. There were several comments about how the staff make them laugh and as a result this makes them happy. One person also said they give me a hug when I need it. We did notice that there was frequent laughter and we saw one person indicate to a member of staff that they would like a hug, which was appropriately given and responded to very positively. The manager explained that many older people in care do not experience any physical contact apart from the physical delivery of personal care and she believes that for some, it was important to their well being. She was also aware that some people would not want this and that is respected. We were informed that the menus are devised according to the likes and dislikes of the people living in the home. Care staff are responsible for sharing the kitchen tasks on a daily basis. They were able to tells us about certain peoples likes and dislikes and explained that although one main meal is cooked for lunch, alternatives are available. One person has a specific diet for health reasons and this is provided. The AQAA tells us that peoples nutritional risk is monitored. We learnt during this inspection that although a formal nutritional assessment tool is not used, peoples appetites are monitored and monthly weights are recorded. Records demonstrate that where there have been concerns these are raised with the GP, which has sometimes led on to a referral to a dietitian. 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. There are processes in place for people to be able to voice their concerns or make a complaint and for people to be protected from abuse. Evidence: There are arrangements in place to both acknowledge and investigate peoples concerns/ complaints and to ensure people living in the home are protected against any form of abuse. The complaints procedure was seen in the entrance hall and the manager explained that this is discussed with people during the admission process. At this point people are also given their own copy. The manager explained that she operates an open door policy and would much rather be available to discuss peoples concerns before they become a complaint. The AQAA tells us that the home has not received any complaints in the last twelve months and we have not received any since the last key inspection in 2007. In a random inspection of the home in August 2009, we did discuss one concern that had been raised with the manager by a relative. This related to the closing mechanism of some of the fire doors. We subsequently followed this up with the fire safety officer who was satisfied that the home were taking the appropriate action required to safeguard people in the event of a fire. Care Homes for Older People Page 18 of 30 Evidence: The home has a policy which is linked in to the local County Councils safeguarding adults protocols. Staff receive training on safeguarding adults from the local County Council and the subject of abuse is discussed in staff hand overs and training sessions. In talking to the manager it was clear that she has a zero tolerance of any form of abuse and that she makes relatives very aware of the staffs limitations during care and peoples individual rights. All of the returned questionnaires from those living in the home confirmed that people knew who to talk to if they were unhappy. Some commented that they would speak to the staff and or their relative but two specifically said they would speak to the manager. All confirmed that they knew how to make a complaint and again some commented that they would speak to the manager. 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. This home provides comfortable and clean accommodation that is well maintained and which is altered and updated to meet peoples needs. Evidence: This care home provides a very domestic environment for people to live in. There is a choice of communal space and the majority of people have their own bedroom, which they can personalise. There are arrangements in place for the day to day maintenance and an ongoing plan of decoration and refurbishment. More recently, improvements have been made to the dining room. These include its redecoration, new pictures and improved lighting. Staff explained to us that the people who live in the home were involved in choosing the colour scheme. A new hand rail has been strategically placed in this room after staff observed people having difficulties in one part of the room. Some of the chairs in the lounge have been re upholstered and one new recliner chair purchased. Some new carpets have been laid and an ongoing programme of bedroom redecoration is in place. We were told that one person had requested anything blue with flowers on for her bedroom and this is what she got. One of the corridors is due to be redecorated and will also have a new carpet. This home does not have a manual hoist to move people. The manager explained that the people currently living in the home are mobile and able to move themselves safely. One persons care records suggested that staff had experienced times when Care Homes for Older People Page 20 of 30 Evidence: this person had been difficult to move safely. This persons care was discussed with the manager and the person is no longer cared for at Elmbridge. The manager explained that in the event of an emergency, for example a fall where the person could not get themselves independently back up, then the emergency services would be called. The home has enough bathrooms but no shower facility. The manager explained that the people living in the home prefer a bath but we would recommend that consideration be given to providing a shower in the future so as to be able to offer choice. The home has an infection control policy and the cleanliness of the home is audited on an annual basis, along with its health and safety, by an external company employed by the manager. The manager explained that there are no specific cleaning schedules but staff on duty are responsible for this on a daily basis. She explained that the external auditors are happy with this as the home is able to demonstrate good house keeping. The manager has completed an infection control course and staff are given training in house. We observed wipes and gloves in the home for staff use when needed. Toilets have hand washing facilities which have soap and towel dispensers. The kitchen has its own hand washing facilities. We noticed that two members of staff who were in the kitchen, were not wearing protective clothing over their uniforms. This was raised with the manager and staff when a similar situation was observed during our random inspection in August 2009. During that inspection a member of staff was in the middle of cooking and a tabbard was put on straight after we had pointed this out. During this inspection we were informed that protective tabbards were only required when staff were actually dealing with food. Although food preparation did not appear to be in progress at this point we would strongly recommend that for good practice reasons and for added precaution in reducing the risk of an infectious outbreak, staff automatically wear a tabbard over their uniform on entering the kitchen area. Radiators in the home are not covered but the temperature is regulated and peoples ability to recognise the difference between hot and cold is recorded. Where there have been concerns in the past about peoples safety, steps have been taken to reduce this. For example a radiator in one bedroom was covered. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being cared for by staff who are experienced and well trained and who have undergone robust recruitment processes designed to help protect vulnerable people. Evidence: Staff in this home share the tasks that need to be fulfilled such as the cooking, cleaning and provision of activities as well as caring for the people who live there. The numbers on duty therefore are planned accordingly by the manager. During this inspection there appeared enough staff on duty during the day time to meet the needs of the people living in the home. One member of staff had also been able to take a person shopping. The AQAA tells us that staffing levels are adjusted accordingly when people need extra care. This was discussed with the manager when talking about the recent care of one person. Staff receive all of the required basic training to ensure they can carry out their jobs safely and this is updated when required. They have also received additional training in dementia care and awareness and care of the person following a stroke. Four staff have completed the National Vocational Qualification (NVQ) in care and the home is committed to make sure other staff also achieve this award. The manager has Care Homes for Older People Page 22 of 30 Evidence: attended training on the Mental Capacity Act and the Deprivation of Liberty Safeguards (DOLs) and has cascaded this back to her staff. Further discussions on this and subjects such as equality and diversity and dignity are held so that staff are able to truly apply this to their work. We inspected the recruitment files of two staff employed since our last key inspection. Both started work in the home following satisfactory references and initial checks. One had started work before the home had received an updated clearance from the Criminal Records Bureau (CRB). The manager confirmed that she had checked the staff members previous clearance and that the person did not work alone in the home. In this case we were reassured that responsible recruitment procedures had been followed. There are fairly new guidelines pertaining to this which were discussed during this inspection and in the future a risk assessment must be completed in this scenario. There were no unexplained gaps in employment on either application form and both staff had been issued with the General Social Care Councils Codes of Practice. Both staff member files demonstrated that a comprehensive induction training is provided. Induction records demonstrated that this is a formal process that must be successfully completed and signed off before the carer is considered competent. The manager explained that irrespective of what qualifications the staff member has when they join the home, they all complete the homes induction training. Care Homes for Older People Page 23 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 run for the benefit of those that live in it and improved systems will help the home demonstrate this. Evidence: This care home has been owned and managed by the same person for twenty three years. The manager/owner is a qualified mental health nurse who maintains her registration with the Nursing and Midwifery Council (NMC). She is registered with the Commission and keeps herself updated by attending various trainings/seminars. She demonstrates strong leadership and is clear about her high expectations for those who live in the home. Care records and discussions held during this inspection tell us that she liaises well with local health care providers to ensure people in her care receive what they are entitled to. There is no formal management structure below the manager but there are key staff that have been within the team for many years. They all collectively help towards the Care Homes for Older People Page 24 of 30 Evidence: smooth running of the home but some also have specific areas of responsibility. Since the last Key Inspection improvements have been made in how peoples views and ideas are collected. Improvements have also been made in how the manager formally communicates to those living in the home and to those visiting. The latter has always been done but the home needed to better demonstrate how it did this. Questionnaires are still given out to people seeking their views on the services provided but people are now also encouraged to provide feedback/suggestions by completing a form that has been made available in the conservatory area. Asked if people were using this the manager explained that most feed back is still gathered through the open door policy and by the manager being present in the home most days. A newsletter now provides a more formal platform for the manager to communicate what is going on in the home, what has been achieved and what is planned. As discussed in the Health and Personal Care outcome of this report, the manager has always been very much in control of the services provided in the home and of the monitoring of standards. The improvements to the quality assurance system and the recording of various audits and processes will help the manager demonstrate how she monitors and improves the service. We spoke about this very fact in relation to staff supervision. Although the staff have been part of the same team for so long and the manager is therefore very aware of each staff members standard of work, strengths, weaknesses and training needs, the process has to be demonstrated and at the moment staff supervision records are not being maintained. With all of this in mind we discussed the need in the future, under the Health and Social Care Act 2008, of the service being able to demonstrate compliance against certain criteria. This therefore also means recording the checks that are carried out on the care planning system. The home makes sure that they are aware of who has Power of Attorney arrangements and who holds this in respect of each person. The manager is very aware of the issues that surround potential financial abuse of a vulnerable person. Small amounts of money can be kept safe for people and an invoicing system can be arranged for the payment of things like hairdressing and chiropody. We saw various records and certificates that demonstrate that appropriate checks and maintenance arrangements are in place for such things as the heating system, gas and electrical appliances and internal pieces of equipment. The fire fighting equipment and alarm system is checked and maintained by an external company. Regular fire training, including drills are carried out. The home has also completed a full evacuation which involved the people who live in the home, which the manager said Care Homes for Older People Page 25 of 30 Evidence: was extremely useful. The AQAA tells us that all utilities are serviced appropriately. We inspected a selection of accident forms. These corresponded with events within individual peoples care records. We have received appropriate notifications from the home in the event of a death, serious injury or adverse event within the home, which is a legal requirement. We discussed the need to clearly identify any shortfalls in peoples mental capacity within appropriate areas of the persons care planning as is now required as part of the Mental Capacity Act. 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 36 18 The registered person must 07/06/2010 be able to demonstrate that all staff are being appropriately supervised. This is so that staffs strengths, weaknesses and training needs are monitored and addressed. It is so that the people living in the home benefit from consistent good practice. 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 homes protocols on the use of restraint/non restraint should be incorporated in any associated care plan for challenging behaviour or sit alongside this care plan. This is so that staff are very clear on what is good practice and how any particular situation is to be managed. You should consider installing a shower facility so as to provide people with a choice of a bath or shower. Protective clothing (in this case the blue tabbards provided) 2 3 21 26 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 should be worn by all staff on entering the kitchen. 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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