Care Home: Emily Jackson Care Home

What the care home does well The new registered manager was open, honest and receptive to advice given and demonstrated a commitment to put right any matters needed addressing to improve the service. Staff spoke enthusiastically about their roles and enjoy working at the home. Residents like living at the home and feel comfortable and safe. The provider is committed to ensuring the environment is comfortable and homely. The home has a good local reputation. There is an extensive range of activities which should meet the diverse preferences and abilities of residents currently living at the home. Compliments about the service included "The home provides a good standard of personal care"; "I have met the new general manager and believe her to have a very positive and open approach, which I find very refreshing"; "The home considers the needs of individual patients and makes use of the available resources"; "They provide person centred care"; "I feel the standard of care to people with Parkinson`s disease has been good. The home is always clean and tidy"; "They are very good with dementia patients. Emily Jackson has a warm, friendly and inviting atmosphere". "There is a good nursing team"; "Staff are always kind and friendly"; "It`s great to be part of Emily Jackson because the manager, clinical managers, housekeeping staff, kitchen staff and carers are all lovely, courteous and very kind. And above all there`s team work"; "Emily Jackson is generally a well run friendly home"; "My contract was very clear and easily understood"; "The home generally provides good standards throughout"; "I am well looked after and happy living here"; "The care home manager is very approachable. I receive a high standard of medical support"; "The cleanliness of the home is much better since the current home manager was appointed"; "Our present chef is doing well and is open to suggestions"; "The recent arrival of a new activities coordinator has seen significant improvements in the range of activities. In more recent months there has been evidence that there has been a sustained effort to improve meals. However past experiences in this area has proved that there have been many false dawns"; "The staff are always calm with residents despite the behaviour of some residents which can be challenging to say the least. Jo Bown has only been the General Manager since June of last year but she has tremendous energy, is very caring and works long hours. She is always looking to improve things for the residents and their families". What has improved since the last inspection? A new manager has been appointed and is now registered with us. New dining room furniture has been provided. Almost all unregistered care staff are now trained to NVQ level 2 care or equivalent. A bathroom has been refurbished. The rear gardens have had a make over and provide a peaceful, secluded and safe place for residents to enjoy in good weather. The home`s statement of purposes and service user guide have been updated. A second clinical manager is in post. And another activities coordinator has been appointed. What the care home could do better: More formal supervision of care assistants should be carried out at least six times a year. For auditing and reference purposes the supervision should be recorded. Only approved mechanisms must be used to prop open doors which for fire safety purposes must remain closed. This is for the safety of all people living, working and visiting the home. For equality purposes, meal choices should be extended to meet the needs and preferences of all the residents living at the home, including vegetarians. Registered nurses must ensure they work to the guidance issued by their professional body with particular regard to medicine administration and recording. Survey respondents` comments included ""Provide more staff so we can give the best quality care to the service users"; "Some members of staff need training and guidance on working as part of a team and not as individuals"; "The carers could possibly spend more time with individual residents"; "The first floor has been converted into an Alzheimer`s unit. This has a large part of the attention and has reduced the more homely atmosphere we had previously enjoyed. However we can see how necessary it all is"; "The turnover of staff can give some problems. At weekends the home appears short staffed"; "The staff are very busy so this makes their job a difficult one which they do very well"; "The rooms are a little on the small size. Quite a lot of time is spent on waiting for things to happen. It takes a while to get people to and from and the dining room"; "The food in general is varied and well prepared. Sometimes the pleasure is marred by a long delay in starting serving. A reason for any delay would be appreciated"; "Some residents find some members of staff more difficult to interact with. The home could do with more staff, and more one to one support in the dementia unit" and "Staff who know the resident are not always available to speak to". No requirements have been made, but a number of good practice recommendations have been made throughout the body of the report. Key inspection report Care homes for older people Name: Address: Emily Jackson Care Home Emily Jackson House 34 Eardley Road Sevenoaks Kent TN13 1XH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Baker     Date: 2 1 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Emily Jackson Care Home Emily Jackson House 34 Eardley Road Sevenoaks Kent TN13 1XT 01732743824 01732465703 emilyjackson@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Joanne Bown Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 60. The registered person may provide the following category/ies of service only: Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) (31) Dementia (DE) (29) Date of last inspection Brief description of the care home Emily Jackson House is a care home for older people with nursing needs and includes a Dementia Care Unit. The home is situated in a quiet residential area but in close proximity to the main town centre of Sevenoaks. Bedroom accommodation is provided on two floors. There are 53 single and three double bedrooms. With the exception of Care Homes for Older People Page 4 of 31 Over 65 0 60 60 0 Brief description of the care home two singles and one double, bedrooms have ensuite WC facilities. Day rooms consist of three lounges, a conservatory and large separate dining room. The home has two passenger lifts accessing all areas used by residents. Parking is available. The home has well maintained secluded gardens. Sevenoaks is served by public transport, including train connections to London and Kent and Sussex Coasts. The home is approximately one mile from the A25. Current fees range from £577.06 to £1,103 per week. Additional charges are payable for chiropody, hairdressing, newspapers and physiotherapy. There is an extensive range of activities including armchair exercises, lunchtime recitals and piano playing, film afternoons, cooking, arts and crafts, garden club, bowling, skittles, crossword and word searches. There is one mini bus for residents use. Religious services take place at the home regularly. Care Homes for Older People Page 5 of 31 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: Link inspector Elizabeth Baker carried out the key unannounced visit to the service on 21 April 2009. The visit lasted just over nine hours. As well as briefly touring the home, the visit consisted of talking with some residents and staff. Five residents, two carers and one visitor were interviewed. Verbal feedback of the visit was provided to the new registered manager and clinical managers during and at the end of the visit. At the time of compiling the report, in support of the visit we, the Commission, received survey forms about the service from 16 residents, seven health professionals and four members of staff. At our request the home was required to complete and return an Annual Quality Assurance Assessment (AQAA). Some of the information gathered from these sources has been incorporated into the report. Care Homes for Older People Page 6 of 31 Since the last visit there have been no safeguarding investigations. The home has just made one safeguarding referral. There have been no referrals to the Protection of Vulnerable Adults list. We have not received any complaints about the service. The last site visit to the home was carried out on 3 May 2007. An annual service review of the service was carried out on 25 June 2008. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: More formal supervision of care assistants should be carried out at least six times a year. For auditing and reference purposes the supervision should be recorded. Only approved mechanisms must be used to prop open doors which for fire safety purposes must remain closed. This is for the safety of all people living, working and Care Homes for Older People Page 8 of 31 visiting the home. For equality purposes, meal choices should be extended to meet the needs and preferences of all the residents living at the home, including vegetarians. Registered nurses must ensure they work to the guidance issued by their professional body with particular regard to medicine administration and recording. Survey respondents comments included Provide more staff so we can give the best quality care to the service users; Some members of staff need training and guidance on working as part of a team and not as individuals; The carers could possibly spend more time with individual residents; The first floor has been converted into an Alzheimers unit. This has a large part of the attention and has reduced the more homely atmosphere we had previously enjoyed. However we can see how necessary it all is; The turnover of staff can give some problems. At weekends the home appears short staffed; The staff are very busy so this makes their job a difficult one which they do very well; The rooms are a little on the small size. Quite a lot of time is spent on waiting for things to happen. It takes a while to get people to and from and the dining room; The food in general is varied and well prepared. Sometimes the pleasure is marred by a long delay in starting serving. A reason for any delay would be appreciated; Some residents find some members of staff more difficult to interact with. The home could do with more staff, and more one to one support in the dementia unit and Staff who know the resident are not always available to speak to. No requirements have been made, but a number of good practice recommendations have been made throughout the body of the report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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. Information about the home is good and provides prospective residents with the information they need to make a decision about moving into the home or not. Evidence: The home has a statement of purpose and service user guide. These are supplemented by a colour brochure and inserts covering other useful information prospective residents may need. The documents are in normal size print and formats and do not indicate whether or not other versions are available. On admission new residents are provided with a Welcome to Emily Jackson House information folder. This has been printed in larger print, which some residents may prefer for easy reading. To minimise any anxieties new residents may have a welcome card and fresh flowers are put into their rooms. This is good practice. All 16 survey responses from residents indicated they had received enough information about the home before they moved in so they could decide if it was the right place for them. Care Homes for Older People Page 11 of 31 Evidence: Indeed two respondents added I had a good reception, full explanation how the home was run and inspected the rooms and Everybody was very informative. Not all prospective residents are able to visit the home prior to admission. If this is the case, their relatives or advocates do so on their behalf. Where possible prospective residents are assessed in their current environment by one of the homes clinical managers. Information gathered during this process is recorded and helps to inform the resulting care plan. The home does not provide intermediate care. Standard 6 is not applicable. Care Homes for Older People Page 12 of 31 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. The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. Evidence: For case tracking purposes the care records of five residents were inspected. Records contained pre admission assessments, care plans and a range of supporting clinical and health and safety risk assessments to inform, support and review the care plans. These related to needs such as nutrition and hydration, risk of skin breakdown and moving and handling. Records evidenced that residents are referred to and receive treatments from other health professionals when there is an assessed need. This includes Consultant Neurologist, Parkinsons Disease Nurse, Community Psychiatric Nurse and Physiotherapist. Residents also receive treatment from allied health professionals such as chiropodists, dentists and opticians. All residents are registered with a GP, although arrangements are currently in hand for a change to the Visiting Medical Officer arrangements. The local Primary Care Trust is dealing with this situation. Daily progress notes are maintained for all residents and provided a mix of the residents condition and quality of day experiences. Care Homes for Older People Page 13 of 31 Evidence: The home has two small rooms in which medicines and some nursing sundries and aids are safely and hygienically stored. No residents are currently self-medicating, so registered nurses administer the medicines. During an interview with a resident in their room, a person handed the resident two tablets in a pot. The person withdrew. The resident then took the tablets, which they had been expecting. The tablets are important in order to control their condition. The time was 12.15. A review of the residents Medication Administration Record (MAR) chart recorded the two tablets had been administered at 11.45. This is the time the medicines are prescribed to be administered and should have been administered. A review of another MAR chart indicated the prescriber had made some changes to a particular medication. The prescriber had recorded this in the care records. However although the MAR chart indicated the new instructions were being followed, details of the changes had been recorded on a post-it note stuck to the chart. For residents protection registered nurses must comply with their professional bodys guidance with regards to the recording and administering of medicines. Other MAR charts inspected were appropriately completed. Most residents were seen appropriately dressed for the time of day and season, with particular attention to detail where this is important to them. In one of the care records seen there was very good information on the residents needs to maintain her personal preference of wearing make up. This was actually reflected in her appearance during our interview. However in another case where the care plan clearly stated the resident was to be offered choice of clothes, our interview identified this is not actually happening. Some residents need support and encouragement to maintain their privacy and dignity as they would prefer. Residents spoken with said staff support them with their personal hygiene in a way that does this. However some residents require even more support to achieve this. Sadly a particular resident was seen on two occasions in a state of dress which may not have their preference. Although staff did eventually intervene, if there is a known problem then a review of how to maintain and maximise the residents dignity and self-esteem should be undertaken. Most of the residents living at the home will do so for the rest of their lives. Care records seen contained minimal information in that only the residents religion and preference of burial or cremation had been recorded. To ensure residents wishes and preferences are readily available to staff, more information should be sought and recorded about residents spiritual, cultural and care wishes during death and dying. Care Homes for Older People Page 14 of 31 Evidence: Some records provided information as to whether the resident wished to be resuscitated or not. The organisation has issued a leaflet which helps explain why this delicate but vital information needs to be established and recorded. This is good practice. Care Homes for Older People Page 15 of 31 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. Activities in the home are excellent offering both choice and variety. Although meals and nutrition are good, not all residents receive the same level of choice and variety of meals as the majority do. Evidence: Residents said they choose when to get up and go to bed and how to spend their time. Some residents like to stay in their own rooms to watch or listen to their favourite programmes, read or just for quiet contemplation. Other residents like to join in communal activities. Indeed this visit coincided with a religious service and an old fashioned sweet shop sale. Both events were well supported. The home employs two activity coordinators who between them provide 45 hours activity time per week. Residents are provided with a weekly activities programme. Current activities include skittles, film afternoons, crossword or word search, garden club, painting, bowling, arts and crafts, armchair exercises, cooking with a chef, lunchtime recital and piano playing. The home has one mini bus to take residents out and about. A resident spoken with said they enjoyed these trips in that they had been shopping, went to a pub for a drink, and visited garden centres and stately homes. The 16 returned surveys from residents indicated there are activities arranged by the Care Homes for Older People Page 16 of 31 Evidence: home that they can take part in. The home puts on functions to celebrate special occasions and anniversaries. Recent events have included an Easter Egg Hunt, Tea at the Ritz, St Patricks Day and Red Nose Day. Notices were displayed in the home advertising the forthcoming St Georges day evening quiz. A number of survey respondents added Activities are highly commended. There are usually about 10 activities per week and I could participate in eight of these if I wished. I enjoy the activities, like the scrabble with school students, church services, craft activities and big crossword. I like the bowling activity and the regular piano and singing concerts are very good and quite frequent. However one resident said the evenings can be long and boring and a survey respondent added Very rarely are there any weekend activities. Efforts are made to assist residents in maintaining links with clubs and societies they were connected with prior to admission. Indeed arrangements were made for a particular group to have a lunch meeting at the home so a member could participate. Staff should be commended on this. Visitors were seen coming and going throughout the visit. Residents said their visitors are always made welcome and offered refreshments. Residents can choose to eat their meals in the dining room or in the privacy of their bedrooms. Meals were not sampled on this visit but the lunchtime meal seen was presented and smelt appetising. Tables had been nicely laid with appropriate cutlery and crockery and gave the impression of a restaurant setting. Records showed that residents are regularly weighed and their nutritional needs assessed. Where the assessment identifies a specific need, then action is taken to address the problem. Arrangements were in hand for residents to toast the Queens birthday with a glass of champagne at lunchtime, if they wished to. And residents spoken with said they enjoy their meals. Fresh fruit is available to all residents and is prepared and presented in a way for residents to easily access and enjoy. This is good practice. The menus seen include choices, one of which is a vegetarian dish. However following on from a conversation with a resident who is vegetarian, it was identified that there are no vegetarian choices. For equality purposes menus should offer choices for all residents, including vegetarians. Chair scales are used to monitor residents weights. To make sure they are maintained at an accurate level, the home has a contract for them to be regularly serviced and Care Homes for Older People Page 17 of 31 Evidence: calibrated. Bedrooms visited had been individualised with personal effects. To assist residents in the Memory Lane Unit recognising their own rooms new identity memory boxes are being put on bedroom doors. Families have been involved in the process. Care Homes for Older People Page 18 of 31 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. Residents can be confident their concerns are listened to and acted upon Evidence: For the publics ease of access, a copy of homes complaints procedure is displayed in the entrance vestibule. The procedure is also included in the Statement of Purpose and a larger print version is included in the homes Welcome to Emily Jackson information folder. The procedures include our contact details, as well as those of the provider. However it has not been the homes practice to include contact details of the local authority. For ease of reference this should be added. The displayed complaints procedure is printed in normal size print and does not inform the reader whether it is available in other versions, formats or languages. For equality purposes this should also be considered. Residents spoken with knew what to do if they had a concern or were unhappy about their care. Two of the 16 returned surveys from residents indicated they did not know how to make a complaint. All respondents indicated they knew who to speak to if they were not happy. The home has a safeguarding policy and procedure which interlinks with the countys multi agency safeguarding procedures. Staff receive safeguarding training which is facilitated by an approved Kent County Council trainer. The trainer has informed us the sessions are always well attended. Staff interviewed described appropriately the Care Homes for Older People Page 19 of 31 Evidence: action they would take if they suspected abuse had taken place. The registered manager said arrangements would be made for residents to exercise their right to vote in forthcoming elections if they so wished. This would include postal votes or indeed taking residents to the polling station if they preferred. The returned AQAA records that the home has received ten complaints. All the complaints were resolved within 28 days. They were all upheld. We have not received any complaints about the service. Care Homes for Older People Page 20 of 31 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. Residents live in a comfortable, attractive, homely and clean environment Evidence: Areas of the home visited were warm, clean and generally fresh and clean. Twelve of the 16 returned surveys from residents indicated the home is always fresh and clean. The others indicated it is usually fresh and clean. Survey respondents additional comments included Good standards of cleanliness are maintained; The cleaning is good but subject to staff as ever. Much better since current home manager appointed. An environmental health inspection of the main kitchen and satellite kitchens was carried out in February 2009. No requirements were made. The kitchens were not reinspected on our visit. Rooms used by residents are nicely decorated, furnished and maintained in good order. New dining room furniture has been acquired for the main dining room. The ground floor corridor carpets are about to be replaced and the reception refurbished. And window sashes have been replaced throughout the home, making them easier to open and shut. Although compact, bedrooms have been individualised with personal affects, making Care Homes for Older People Page 21 of 31 Evidence: the rooms homely and inviting. As expected of homes providing nursing care, the home has dedicated sluice rooms for the safe storage and disposal of clinical waste. The doors are lockable to prevent unauthorised access and minimise risks. The home has a range of moving and handling equipment for the safe transferring of residents. Since the last visit the home has acquired more hoist slings. However a survey respondent added The home needs to get the right equipment needed per person, for example more hoists and slings, to enable the staff to do their job better. The homes grounds are well maintained and residents enjoy using the facilities in good weather. Since the last visit, a bathroom has been refurbished and there are plans to change and upgrade the shower facility. The homes laundry is appropriately staffed and equipped. Although there were no discussions with laundry staff on this visit, other staff spoken with indicated they have sufficient resources and equipment to undertake their duties, including protective clothing. Care Homes for Older People Page 22 of 31 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. Residents receive care and support from an enthusiastic and caring workforce. Evidence: As well as care staff, staff are employed for cooking, cleaning, laundry, activities, administration and maintenance. Staff were seen carrying out their duties in an unhurried and attentive manner. Rotas are maintained and show the home is staffed 24 hours a day. Residents spoken with said staff generally respond to their call alarms quite quickly. Four of the 16 returned surveys from residents indicated staff are always available when needed. The other 12 respondents indicated staff are usually available when needed. Survey respondents additional comments included Nurse attention is good, service staff are always available but carers are generally too busy at suppertime. Can be a little short staffed on occasions for the workload but generally good. Staff are usually available within a short space of time. If staff do not attend promptly they occasionally make comments that they are short staffed. Sometimes a slow response, to say toilet requirements, but do I do appreciate that carers are sometimes hard pressed. Two of the returned surveys from staff indicated there is usually enough staff to meet the individual needs of the residents. The other two indicated there are sometimes enough staff to meet the needs of residents. Additional comments included The majority of time we have enough staff within the home to care for residents properly Care Homes for Older People Page 23 of 31 Evidence: and Nine times out of ten we do not have enough staff. Ninety percent of unregistered care staff are now trained to NVQ level 2 or equivalent. This is excellent and should provide care assistants with the skills and knowledge required to perform their roles. New staff are required to complete an initial induction programme followed by a 12 week induction programme. This programme has been devised by the organisation and follows the Skills for Care common induction standards. Staff said they had received or were doing their induction programme. All four staff survey respondents indicated their induction mostly covered everything they needed to know to do the job. Two staff files were inspected. Files contained evidence that two references had been sought, Criminal Bureau (CRB) and POVA checks carried. Although two references had been received for one member of staff, only one reference could be found for the other member of staff. Staff are also required to provide evidence of their identification and complete an application form. The home has contact details of the Border and Immigration Agency. This is good practice as it allows the home to quickly check out documents of overseas applicants, for authenticity purposes. A member of staff has recently taken over the role of training coordinator at the home. The staff member has been given supernumerary time for this important role. The registered manager was open and honest about some training not being completely up to date and hopes the new arrangements will quickly address the deficits. Training details supplied in support of the visit identified some staff have received training in subjects including fire, first aid, Mental Capacity Act awareness, moving and handling, safeguarding vulnerable adults and customer care. A number of registered nurses have received clinical training for verification of death, palliative care and immunisation. Staff interviewed said they had received safeguarding training and one said she had received Parkinsons disease training. Following some changes to homes main purpose, the first floor now accommodates residents with dementia. Although the training matrix did not include details of staff having received dementia care training, some staff already have and others are now undertaking the organisations Yesterday, Today and Tomorrow course. This course is based on and recognised by the Alzheimers Society. Despite staff having received Mental Capacity Act awareness training they have not yet received training in respect of the Deprivation of Liberty Safeguards which came Care Homes for Older People Page 24 of 31 Evidence: into affect on 1 April 2009 and could have implications on the homes current and future residents. The home is continuing its attempts to source this training. In the meantime the home has acquired the Department of Healths guidance for staff reference purposes. It is the providers responsibility to ensure this training is sourced and provided. Care Homes for Older People Page 25 of 31 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. Residents benefit living in a well run home. The new registered manager is aware of further improvements that need to be made and planning is in place to achieve this. Evidence: Since the last visit there has been a change in the management structure of the home. A permanent general manager was appointed to the position in June 2008 and registered with us in December 2008. The registered manager is not a registered nurse but is supported by two clinical registered nurse managers. Although the registered manager has extensive experience in management and marketing in both the retail and care sector, she does not have a formal management qualification. The registered manager is now undertaking a management and leadership course equivalent to NVQ 4 and hopes to complete this by the end of this year. Residents and staff spoke openly throughout the inspection visit. Comments about the homes management team included management are very nice and easy to talk to. The managers door is always open. A survey respondent added I have a good Care Homes for Older People Page 26 of 31 Evidence: professional working relationship with management and staff and am always made to feel very welcome. To seek views and opinions of the service being provided, the organisation surveys residents, relatives, advocates and professionals. The last survey was carried out in October 2008 and identified that in most areas customer satisfaction has improved. Where areas for improvements remain an action plan is in place. Regular meetings for staff, residents and relatives are facilitated and minutes are taken for record purposes. The home does not maintain monies on behalf of residents. Neither does the home or its staff act as appointee for any resident. Where services are provided or items purchased on behalf of residents, the home invoices the resident or their advocate for settlement. Registered nurses receive formal clinical supervision on a regular basis. This is good practice. However this is not the same for unregistered care staff. Whilst acknowledging that unregistered care staff have their practice observed, are able to freely access their managers and have appraisals, there is currently no formal supervision structure of one to one meetings. This situation could prove problematic if an under performance matter resulted in disciplinary action needing to be taken. The organisation and home are aware of and use the professional website our predecessors set up to support providers and home managers. This allows easy access to our professional guidance and other relevant documents. The returned AQAA indicates the homes equipment is serviced and maintained as the manufacturer or other regulatory body recommend. The home has undertaken a fire risk assessment of the home and reviews this annually. Since the last visit the home has purchased and fitted a number of magnetic self closures. These are fitted to doors, which must be kept shut for fire safety purposes, but can be left open as the mechanism automatically shuts the door in the event of the fire alarm sounding. This includes some bedroom doors. However during the visit a particular bedroom door was propped open by a Zimmer frame. This was at the residents request. The door does not have a magnetic closure. Whilst not wishing to deny the resident this choice, it is an unsafe practice. It is the providers responsible to ensure the premises are safely maintained at all times. As stated previously the registered manager was open and honest about training not Care Homes for Older People Page 27 of 31 Evidence: always being as up to date as it should be. This includes moving and handling. To rectify the problem two members of staff have recently attended moving and handling train the trainers course. This is timely as a staff respondent added to their survey that Sometimes even without moving and handling training management will allow you to start the tour of duty whereas you must have the training first. And another respondent added We have not had a trainer for the last few months and most people are out of date on their moving and handling training. It is the providers responsibility to make sure staff receive training relevant to their roles and this is kept up to date. Care Homes for Older People Page 28 of 31 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 29 of 31 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 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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