Care Home: Ernest Dene Residential Care Home

What the care home does well Many of the residents and relatives were positive about the care they received at the home. One relative had said in a survey, "my relative always seems very happy". Another resident said during the inspection, "the staff are all very kind". The atmosphere in the home was friendly, with the residents enjoying each others company and chatting with the staff. The residents were all well presented and appeared to be supported adequately with their personal care. The staff were very positive about their work and when they spoke to the residents they demonstrated a caring approach. Many of the staff were the same as those who had been working at the last inspection and this shows the staff team is continuing to become more stable. Several residents commented on how willing and helpful the staff are if they ask for any support. The home was comfortable, tidy and clean. A resident said during the inspection, "I am comfortable in my room with a TV and I like sitting in the garden if the weather is good". What has improved since the last inspection? The home has worked hard to complete most of the requirements and recommendations from the last inspection. This has included providing staff with training on dementia so they have the skills to meet the needs of the residents in the home. They have also taken the necessary steps to ensure medication is administered safely in the home. Whilst activities are being provided regularly in the home, further work is needed to ensure these meet the needs of all the residents, especially those with dementia. In addition the home has prepared a two week menu although changes are still needed to provide meals that are healthy and nutritious at all times. The owners of the home have continued to make improvements in the environment. This has included replacing all the windows at the front and rear of the house, ensuring all the bathrooms are in working order, providing new bedding, having screens in the shared bedrooms to preserve the privacy of the residents and providing disposable handtowels in all shared bathrooms to maintain standards of health and safety. Staff recruitment has continued and all the new staff have the necessary recruitment checks in place. All the staff have started and some completed the Skills for Care induction standards. The staff have all benefited from a training programme and feel that communication has improved since the acting manager came into post. They are also being paid on time each month. The staff have all received fire training and know how to respond in the event of a fire. An accurate rota is in place that includes a record of the hours worked by the manager. The owners of the home have carried out a quality assurance exercise to seek the views of the residents, staff, relatives and other care professionals. Further work is needed to collate the responses and ensure any suggestions are followed through. What the care home could do better: A number of requirements were made at this inspection. Firstly the home needs toprovide a range of activities that meet the needs of all the residents including those who are harder to engage. They also need to ensure that the cook always has the appropriate food hygiene training and that the food provided relies less on convenience food and is healthy and nutritious. The home also needs to use the responses from the quality assurance exercise to produce an improvement plan to ensure the views of the residents and their representatives are properly taken into account. There also needs to be clear written guidance on when to administer medication that is given "as required" to ensure staff are clear on when it should be used. It is also recommended that residents are supported to have an annual review meeting with their care manager. It is suggested that resident meetings and staff meetings take place regularly to maintain good communication in the home. It is also recommended that the outcomes of complaints are recorded so it is clear when they are resolved and what action has been taken. Staffing levels in the home need to be kept under review and increased if the numbers or needs of the residents increase. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ernest Dene Residential Care Home 8-12 Donovan Avenue Muswell Hill London N10 2JX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Ray     Date: 1 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Ernest Dene Residential Care Home 8-12 Donovan Avenue Muswell Hill London N10 2JX 02088834901 02088834531 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Brownlow Properties Limited care home 33 Number of places (if applicable): Under 65 Over 65 0 0 33 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 33 33 0 The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose pimary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE Mental Disorder, excluding Learning Disability or Dementia - Code MD The maximum number of service users who can be accommodated is: 33 Date of last inspection Brief description of the care home Ernest Dene is made up of 3 double fronted houses that have been adapted for use as a residential home by being linked together. The registered provider responsible for the home is called Brownlow Properties Ltd. Ernest Dene is registered to provide care and support for 33 older people with dementia. On the day of the inspection there were 26 residents living in the home. Care Homes for Older People Page 4 of 31 1 9 1 1 2 0 0 8 Brief description of the care home The home is situated in a quiet residential area of Muswell Hill. There are bedrooms on all floors and a lift to all floors. Ernest Dene is not a purpose built establishment and as such there are limitations on the number of people with mobility problems that the home can support. There are 15 single rooms and 9 double rooms. The aims of the service are to provide a safe and homely environment where the unique needs of each individual are recognised and skilled staff are available to provide care and support in a way that encourages self determination and enables each person to achieve their best possible quality of life. The current weekly fees are between 441 and 598 pounds for each placement and people are expected to pay separately for items such as hairdressing and private chiropody. 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 Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place on the 14 and 15 May 2009 and was unannounced. The inspection lasted for twelve hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to the current residents and also spend time talking to them. The inspector was also able to spend time talking to the acting manager, head of care, one senior carer and one carer as well as the two night care staff who were working during the inspection. The inspector did a tour of the premises and also looked at a range of records including Care Homes for Older People Page 6 of 31 resident records, staff files and health and safety documentation. Prior to the inspection the home provided the inspector with a written self assessment (AQAA). The inspector also received 17 completed surveys, 10 from residents usually completed with their relatives, 6 from staff and 1 from a healthcare professional. The inspector would like to thank the residents and staff for their assistance with the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: A number of requirements were made at this inspection. Firstly the home needs to Care Homes for Older People Page 8 of 31 provide a range of activities that meet the needs of all the residents including those who are harder to engage. They also need to ensure that the cook always has the appropriate food hygiene training and that the food provided relies less on convenience food and is healthy and nutritious. The home also needs to use the responses from the quality assurance exercise to produce an improvement plan to ensure the views of the residents and their representatives are properly taken into account. There also needs to be clear written guidance on when to administer medication that is given as required to ensure staff are clear on when it should be used. It is also recommended that residents are supported to have an annual review meeting with their care manager. It is suggested that resident meetings and staff meetings take place regularly to maintain good communication in the home. It is also recommended that the outcomes of complaints are recorded so it is clear when they are resolved and what action has been taken. Staffing levels in the home need to be kept under review and increased if the numbers or needs of the residents increase. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 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. People living in the home can be assured that their individual needs will be assessed. New people moving to the service will be able to visit the home and have access to information in an appropriate format to tell them about the home. Contracts between the home and the resident are available and so there is clarity about what the home will provide. The staff have received the training to meet the specific needs of the residents including training on caring for people with dementia. Evidence: My mother is happy to stay and has had no complaints. (Comment from a relative) The home has a comprehensive pre-admission assessment form which is completed prior to acceptance to the home. Through this we are able to confirm and demonstrate whether the home has the capacity to meet the assessed needs of the individuals admitted to the home. (Extract from the information completed by the home) Care Homes for Older People Page 11 of 31 Evidence: The Ernestdene statement of purpose which is written in plain English and is also available in large print, contains the terms and conditions, complaint procedure, the aims and objectives of the home as well as our philosophy of care. The statement of purpose is given to each service user upon moving to the home and generic copies are available in both the general office and next to the front door for all interested parties to consider. (Extract from the information completed by the home) Four case notes for people who have moved to the home since the last inspection were inspected. All four had completed assessments. One had a social service assessment as well as an assessment completed by the manager. The three other residents who were privately placed only had an assessment prepared by the manager. The assessments contained all the necessary information in sufficient detail to act as a good basis for the care plan. The manager explained that in most cases the relatives visit the home before the resident moves in. This is because many of the residents move to the home from hospital and are unable to make visits. Residents are offered a six-week trial period to enable them to decide about their long-term admission to the home. The four people who moved most recently to the home all had either family, friends or a care professional who visited on their behalf. The inspectors discussed the current needs of the people living in the home with the care staff and manager as well as observing the care they were receiving. The staff felt confident that they were meeting the needs of the residents and this was reflected in the care that was observed. The staff records show that most of the staff have received training on caring for people with dementia and further training is booked as needed for staff who still need the training. The staff who were interviewed during the inspection said they had found the training very useful. The manager explained that the contracts for the four people who have moved to the home since the last inspection are being addressed. Two residents had a completed contract in their records. One had a contract that had been sent to a solicitor to agree and sign on her behalf and one person was still having the fees finalised with the placing authority. 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 people living in the home are supported to access healthcare professionals when they need this input. Their plans of care are very person centred and reflect their individual needs. The system of medication administration has improved although clear administration guidance is not always available for people who take their medication as required. Evidence: The staff refer the patients with long term conditions such as diabetes to the district nursing team for help with management and this shows a good response to the care needs of the individuals. (Comment from a healthcare professional in a survey) Mum is always clean and well presented. She is seen by the hairdresser, chiropodist and optician. (Comment from a relative in a survey) The homes care plan, the end point of the assessment of the individual, is a comprehensive, simple to navigate and easily understandable document. Each resident Care Homes for Older People Page 13 of 31 Evidence: has one, a dynamic document drawn up with their assistance, that is reviewed and updated on an ongoing basis, by their key worker to reflect the changing needs of the service user. Each month they are formally reviewed and reprinted, and daily log notes archived to prevent the document becoming confused. (Extract from the information completed by the home) The care plans for four people living in the home were inspected. These documents covered all the areas where care and support were needed. They provided guidance to staff on what action they needed to take to meet each persons needs. The care plans were all up to date and were very person centred, recognising the importance of relationships and personal preferences. We could see that care plans are being reviewed regularly and reflect the residents changing needs. Two of the four people who case notes were inspected had a record of a review meeting with a social worker in the last year. One person had not had a review for over a year and the manager said this was not arranged and the final person was privately placed and had relatives abroad and so the home provided them with updates through the use of e-mails. As recommended at the last inspection the home needs to contact some placing authorities to request an annual review. The case notes that we inspected showed that areas of risk were assessed very thoroughly. These recognised not only physical risks but also emotional risk and areas of potential abuse. These records were a very high standard. At the last inspection we identified that restrictions are placed on some residents, such as holding their cigarettes on their behalf. The care plans now include details of how this arrangement should be implemented and how many cigarettes should be provided each day, with the agreement of the relatives and other appropriate care professionals. The manager explained that at the time of the inspection none of the residents had pressure sores. Two residents are using pressure relieving equipment as a preventative measure. The case notes showed that the home has a separate record of healthcare appointments for each resident. These showed that the residents were receiving primary healthcare input and being referred for specialist input as needed. A private chiropodist comes to the home every month and treats residents as needed. The case notes also show that residents are receiving a dental, optical and where needed continence service. Referrals are also made where needed for input from the dietician, speech and language therapist and physiotherapist. Throughout the inspection the staff were observed supporting the people living in the home with their personal care, meals and moving around the home. This was done in Care Homes for Older People Page 14 of 31 Evidence: a manner that respected the residents privacy and dignity. It was observed that the staff were very aware of the mood and comfort of the residents and responded to any sign of distress, including non verbal indications. One resident said, if I ring my bell the staff come as quickly as they can. Another resident said, if I ask the staff for anything they will help. It was observed that the residents appeared well presented. One relative in a survey said, mums clothes are clean and she is well presented. Two surveys commented that personal clothing can end up in other peoples bedrooms, although it was observed that all the clothing was labelled. Residents are supported to follow a routine of their choice. One resident said I like to go to bed later, last night I went to bed at 11.30pm as I was watching my TV. Another resident explained that the supper is too early for her so later in the evening the staff prepare her some soup and a sandwich. On the second day of the inspection we arrived at 7.30am and some residents were up but others were in bed and able to get up later if they chose to do so. The home keeps a record of when people have a bath, although staff said that residents can have a bath whenever they want or if this is necessary. The record showed that unless baths had been refused most residents were having baths. Individual preferences about bathing are also recorded in each persons care plan. Since the last inspection the home has notified the Commission of one incident where a resident fell out of bed. When we checked this person had been provided with bedrails. The appropriate assessment and care plan was in place. The medication was inspected. The medication is stored in two trolleys in separate lounges. The medication is dispensed using a blister pack system. The medication storage temperature is recorded daily in the trolleys and in the cupboard in the office. The medicines administration record (MAR) chart was inspected and had been completed correctly. Medication arriving in the home is recorded on the MAR sheet and medication being returned to the pharmacist is separately recorded. Some residents have some medication that is taken as required. This is mostly pain relief and the residents can ask for the medication but there is guidance on when it should be given for people who cannot ask. One resident was prescribed as required medication to help him relax and no guidance was in place for when this should be administered. Two residents were prescribed Controlled Drugs (CD) within schedules 2 or 3 in the home. These are securely stored and a separate record is kept monitoring the number of items administered with two staff signatures when the medication is given. This had been completed correctly. Residents all have a record on their MAR sheet, about Care Homes for Older People Page 15 of 31 Evidence: whether they have an allergy. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to make choices in their daily lives. People who use the service do not have opportunities to go out other than with relatives. Regular activities are offered in the home but do not meet the needs of all the residents. The meals are enjoyed by most of the residents but would benefit from being more nutritious. Evidence: They say in their brochure that they take you out but they do not. (Comment from a resident) More structured activities are needed that will include everyone. (Comment from a relative in a survey) I really enjoy the food. (Comment from a resident) The food is really awful, although they have improved its visual appearance. (Comment from a resident) We believe that life is for living, and we truly believe in this motto. We therefore Care Homes for Older People Page 17 of 31 Evidence: assist service users to lead a life of their choosing, a stimulating life, a comfortable life, a life where leisure and social activities, mealtimes, daily living routines and social interaction are enjoyable and fulfilling. Autonomy and choice are encouraged and promoted. (Extract from the information completed by the home) The staff were observed supporting the people living in the home throughout the inspection and actively offering choices about meals, drinks, what they wanted to do and activities. The staff showed a good understanding of each persons communication needs. A residents meeting has not taken place since December 2008 and seen in the records and confirmed by the acting manager. It is recommended that these take place regularly as a means of seeking the views of the residents. The home arranges for an entertainer to visit the home on a fortnightly basis. The staff also have some games, puzzles and craft equipment available and they were observed sitting with the residents doing these activities. The staff also do an exercise class in the morning and this was enjoyed by the residents. Since the last inspection the drama-therapy class that was taking place in the home has finished. It was however observed that most of the activities do not engage people who are less able to participate due to their dementia. This was discussed with the owners who acknowledged this was an area for improvement. They explained that they are recruiting an activity co-ordinator to work across all their homes to develop appropriate activities. The acting manager and staff explained that a number of the residents have close contact with their relatives. The sign giving visiting times has been removed, although the statement of purpose still includes visiting times. From talking to residents it was apparent that relatives and friends are welcome to visit at any time and made welcome by the staff in the home. One resident said, my relative visits whenever he wants and they make him a cup of tea. It is recommended that the statement of purpose is revised to include the open visiting times. The home has a cook available seven days a week and during the inspection breakfast and lunch was prepared. The cook did explain that she was normally employed as a senior carer and was just undertaking this role whilst a new permanent cook was being appointed. The owners confirmed that this recruitment process was underway. The senior carer who was doing the cooking said she had only completed the half-day food hygiene course provided to all the care staff. This is not adequate training for the member of staff preparing all the main meals. The home has a two week menu, although the senior carer said this was only being followed a bit. On the day of the Care Homes for Older People Page 18 of 31 Evidence: inspection there was porridge, cereals and bread and butter for breakfast and residents who asked were offered toast. At lunch there is a choice of two hot meals and the cook asks everyone what they want in the morning before the food is prepared. It was observed that there were some fresh fruit and vegetables. From looking at the record of food consumed it could be seen that there is a daily use of convenience food including frozen burgers, sausages, fish in bread crumbs, pies and tinned meatballs. It is required that the cook has completed an appropriate food hygiene training course and the food provided is fresh, healthy and nutritious. Throughout the inspection it was observed that the residents were offered hot and cold drinks. The acting manager explained that where the residents could safely manage they were offered a cup and saucer rather than a plastic mug. Care Homes for Older People Page 19 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. The people living in the home have access to an appropriate complaints procedure and feel able to raise any concerns. Staff demonstrate an understanding of how to safeguard vulnerable adults. Evidence: We want the service we provide to match your needs and your expectations, and we welcome any comments you may wish to make. (Extract from the homes complaints procedure) The home has designed and keeps on permanent display at the main door a simple and effective form for the communication of any written complaint by residents or any other interested parties. The same form also provides guidance on making a verbal complaint. Thankfully there has been little recourse to either. Information regarding the procedure for making complaints is also available in the Statement of Purpose. The making of suggestions about how things might be improved helps create co-operative relationships within the home and prevents situations where complaints can develop. (Extract from the information completed by the home) If I had a problem I would speak to the manager and they would deal with me, I know they would. (Comment from a resident) Care Homes for Older People Page 20 of 31 Evidence: I would speak to the owner if I needed to. (Comment from a relative in a survey) The complaints procedure is available in the welcome to Ernest Dene guide and includes details of who complainants can contact. We looked at the record of complaints and two complaints had been recorded since the last inspection. For one of the complaints there was no record of whether the matter had been resolved and the timescale. It is recommended that the outcomes of completed complaints are recorded to ensure they are appropriately addressed. The staff were asked about how they would recognise abuse and what steps they would take if they felt abuse had possibly taken place. They all demonstrated a good knowledge in this area. There have been no safeguarding issues since the last inspection. The staff training records showed that almost all the staff had received safeguarding training and further training was booked. Care Homes for Older People Page 21 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. People who live in the home have access to an environment that is clean and homely. Considerable work has taken place to improve the building. Evidence: The home is sited across three professionally refurbished and extended houses, designed and fitted out to provide residential care to the elderly. The houses retain their homely feel and this is appreciated by the service users, who like the fact that it is not clinical, cold and austere in feel. The building and grounds are subject to a rolling maintenance programme of work, organised and executed by the service provider, that ensures the fabric and appearance of the building and grounds in addition to its fixture and fittings are kept in best condition. The homes interior is decorated in Victorian style in keeping with the era of the houses, built in 1905. The garden is accessible and loved by the service users who in good weather will spend large parts of the day enjoying it. (Extract from the information completed by the home) Ernest Dene consists of three Victorian terraced houses that have been joined together. The home is on three floors, a basement, ground floor and first floor. Bedrooms are available on all of these floors and there are nine double and fifteen single rooms. The building has a lift. The homes interior is decorated in a Victorian Care Homes for Older People Page 22 of 31 Evidence: style, which creates a homely atmosphere. The house does however have lots of stairs, including some bedrooms that are accessible by small flight of stairs. This makes the building very difficult to move around for people with limited mobility. The bedrooms are all different. Some residents have brought personal items with them into the home and other rooms were rather bare. Shared bedrooms have a screen to maintain the privacy of the residents. The home has an attractive garden at the rear and several residents said they enjoyed sitting in the garden where seats are available. The garden is accessed through the basement dining room and a small exit next to the managers office. Smoking is only permitted in the garden and a covered shelter has been built by the managers office. There are three lounges on the ground floor and they each have a television and music systems. The main dining area is in the basement and some people also eat in the middle lounge on the ground floor. The staff have a room in the basement, where there are lockers available to leave their belongings and where there is a fridge, microwave and kettle to prepare snacks, although there are no seats available for them to sit and relax during their breaks. Since the previous inspection the new provider has upgraded two of the bathrooms, replaced windows at the front of the house, moved the boilers to a building accessible from the garden, decorated the front of the house, provided a room for hairdressing, replaced some laundry equipment and replaced old bedding. On the day of the inspection ongoing garden maintenance was in progress. It was observed during the inspection that the home was very clean and free from offensive odours. Hand sanitising gel is available throughout the building to prevent the spread of infection. In addition disposable hand towels have been provided in all the shared bathrooms. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported by a caring and committed team of staff who are getting to know the residents well. The staff have been supported to receive training and supervision, which helps to give them the skills they need to do their work. Evidence: The home has a core of staff working the rota, both old and new, providing continuous excellent care to the service users who appreciate it and view the staff as much as friends as well as carers. All the staff have continuing training and supervision. (Extract from the information completed by the home) The staff are all very kind. (Comment from a resident) The staff are grand. (Comment from a resident) The staff spend time with me when they can. (Comment from a resident) The acting manager explained that the staffing structure now consists of four senior carers and a team of eleven carers. Two of the three senior carers have just been recruited and have not yet started working fully. The staff rota was inspected. This Care Homes for Older People Page 24 of 31 Evidence: showed that during the day there are three care staff working in the home from 8am to 2pm and four care staff from 2pm to 8pm. The acting manager explained that he also helps provide care in the morning. There are also two waking care staff at night. Some of the staff felt that the staffing levels in the morning were low and they couldnt support the residents as quickly as they wanted. It was however observed that the residents needs were being met at present, although most are mobile and quite a number able to wash and dress themselves. If the resident numbers or needs change then staffing levels will need to increase and it is recommended that staffing levels are kept under review. The acting manager explained that all the staff have either completed or are enrolled to study for an NVQ in health and social care. Six staff records were inspected for the new staff who had come into post since the last inspection. They had all completed the necessary recruitment checks including a CRB disclosure (criminal record bureau) two references and a copy of photo identification with permission to work in the country where needed. The staff all had contracts in their records. The staff spoken to now said that they are paid regularly into their bank accounts. The staff who were interviewed were asked about their induction training. They explained that they were introduced to the home and the residents by the senior carers and completed an induction checklist. They then worked for five days shadowing an existing staff member. The home is using the Skills for Care induction format although it could be seen that some staff were taking longer to complete the induction. It is recommended that the home sets clear timescales for the inductions to be completed. The home now has a clear profile of the training the staff have received and when this took place. This allows future training to be planned. The record of staff meetings showed that there had been no meetings between December 2008 and April 2009 as confirmed by the acting manager. It is recommended that regular staff team meetings take place as a means of ensuring effective communication between the team. 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. The people living in this home benefit from having the home run by a manager who has the necessary skills and experience and who is applying to be the registered manager. Residents are protected by the home making arrangements to protect their health and safety. Whilst residents views are sought on the running of the home their opinions need to be actively reflected in improvements at the home. Evidence: The management retains control and responsibility for the health, safety and welfare of the service users and staff, ensuring risk assessments are completed, reviewing and updating policies and procedures, complying with legislation and importantly ensuring safe working practices throughout the home. (Extract from the information completed by the home) The manager is very organised and has good attention to detail. (Comment from a member of staff) Care Homes for Older People Page 26 of 31 Evidence: At the time of the inspection the owner had decided to no longer be the manager and had appointed Christopher Tranquille into this role. Christopher had started the process of applying to be the registered manager. Throughout the inspection he demonstrated a good understanding of the regulatory process and was very organised in all the work he had completed. The home was much improved from the last inspection and the staff had a clear sense of direction. Since the previous key inspection the owners explained that the annual quality assurance exercise has been completed and questionnaires returned from relatives and care professionals. These need to be collated and an action plan prepared and this requirement is restated from the previous inspection. The staff supervision records were inspected for four staff and these showed that they had all had one or two supervision sessions. The staff who were interviewed explained that they had been supervised by the acting manager, although senior carers are being trained to carry out this role. The owner explained that they are still not holding money for residents and will send out invoices instead. They will provide a receipt if this is requested. The staff explained that since the last inspection more in depth health and safety training has been provided including moving and handling, fire safety and infection control. The staff training records showed that staff had received nearly all the mandatory training and further training was booked. The staff when asked all demonstrated a good understanding of how to respond to a fire including the night staff. During the inspection the fire alarm went off and staff followed the correct procedure. The record of fire drills show these have been taking place regularly. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 33 24 The registered person must collate the results of the quality assurance excercise and prepare an action plan. . 31/12/2008 Care Homes for Older People Page 28 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 1 9 13 The registered person should ensure there are clear guidelines in place for when as required medication can be administered. This is to ensure residents receive their medication correctly. 30/06/2009 2 12 16 The registered person must ensure that there are activities in place that meet the needs of all the residents in the home. This is to ensure all the residents are offered appropriate stimulation. 30/06/2009 3 15 13 The registered person must 30/06/2009 ensure that the staff member preparing meals in the home has an appropriate food hygiene qualification. They must also ensure that the food that is provided is healthy and nutritious. Care Homes for Older People Page 29 of 31 This is to ensure the residents eat a good diet at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 16 The registered person should amend the statement of purpose to reflect the open visiting hours. The registered person should ensure that the outcome of complaints are recorded so that it is clear when they have been resolved and what action was taken. The registered person should arrange regular staff team meetings to ensure there is effective communication between the team members. The registered person should keep staffing levels under review and ensure that staffing levels increase if the numbers or needs of the residents increases. The registered person should set timescales for the completion of the staff inductions to ensure they are completed in a timely manner. 3 27 4 27 5 29 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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