Care Home: Ferndale House

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What the care home does well The home provides a homely and welcoming environment and all of the service users spoken to told us that the homes staff provide an excellent service and comments received include `there is nothing the home could do better`. `The main asset of Ferndale House is the staff all of whom are very friendly and extremely caring people`. `The home is kept spotlessly clean at all times`. `I do not think that there is anything that could make the home better`. `The staff support me when I need help and they give me choices of what I eat, wear and things I want to do`. `The home meets all my needs`. `The staff at this home are friendly, polite and professional and my family have good communications with the home who ensure all my needs are met`. Records show that the home liaises with health care professionals regarding residents` medical and health needs. Residents and their relatives are provided with a copy of the complaints procedure and are aware of what to do if they have a complaint. The home`s routines were flexible and it promotes the right of residents to make choices for themselves and exercise personal autonomy as far as was reasonably possible, including dealing with their own finances. Activities and leisure provided by the home to service users was based on service users individual choices and service users are encouraged and supported to participate in the day to day living arrangements. Residents said they were pleased with the range of activities provided but the management would like to provide a more extended activities programme in the future. Residents were positive about the food that the home provides. Staff were recruited properly ensuring that residents` safety and welfare was given proper consideration. There was a strong commitment to staff training and development to ensure that staff were able to fulfil their roles and responsibilities and meet residents` needs. There is a stable staff team who were observed to be interacting well with the service users and were noted to be good humoured and sensitive to the needs of confused people. The home is well maintained and kept to a high standard of cleanliness. All comments from all surveys returned were very positive about the care provided at Ferndale House. What has improved since the last inspection? Three requirements were made from the last report and these have been complied with.Initial needs assessments for potential new services users has been improved by ensuring all care needs are identified at the assessment and are clearly recorded so that the home and service user can establish if the home can meet their assessed needs. New admission packs have been provided to service users new to the home that clearly outlines what is included in the service and encourages residents and relatives to share knowledge about the person`s past life and social history to enable the home to enhance their recreational activities and support those with dementia. Care plans are more detailed and are reviewed at appropriate intervals. A protocol has been introduced for all service users who are prescribed medication on an `as needed` basis (PRN) to ensure it is used as intended and to provide consistency and remove as much individual interpretation as possible. All staff are regularly supervised and training opportunities are made available to them to meet their needs. What the care home could do better: Risk assessments for those choosing to manage their own prescribed medications must be undertaken and must document the necessity for the storage of such medication to be in a locked environment at all times. Reviews of the assessments must be undertaken at regular intervals. Hand washing facilities should be installed in the laundry area for the purpose of infection control. The management of the home must consider and review the numbers of staff on duty when the dependancy of service users become greater. Key inspection report Care homes for older people Name: Address: Ferndale House 38-40 Grove Road Hardway Gosport Hampshire PO12 4JL     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: Janette Everitt     Date: 1 5 0 9 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 32 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 32 Information about the care home Name of care home: Address: Ferndale House 38-40 Grove Road Hardway Gosport Hampshire PO12 4JL 02392524918 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ferndalecares@tiscali.co.uk Mr Andrew Sidney Bowles,Mr Sidney Ernest Bowles,Mrs Jacqueline Amelia Bowles,Mrs Theresa Jane Bowles care home 20 Type of registration: Number of places registered: 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 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Ferndale House is set in a residential area close to local amenities on the outskirts of the town of Gosport. It provides residential care for up to 20 elderly residents, some of who have mild dementia. The home is on ground and first floors and there is a stair lift between these. There are a variety of aids and adaptations to allow residents to move Care Homes for Older People Page 4 of 32 Over 65 0 20 20 0 Brief description of the care home about more independently. Sixteen of the bedrooms are single and two are doubles. All of the bedrooms have en-suite toilets, and the two double bedrooms are provided with screening for privacy. There is a communal bathroom and toilet on the ground floor and a further communal bathroom and toilet on the first floor. There is a large garden with a small number of car parking spaces to the rear of the property. The fees for the home are on equiries to the home and do not include toiletries, hairdressing, chiropody and items of a personal or luxury nature. Care Homes for Older People Page 5 of 32 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 site inspection visit to Ferndale House which was unannounced, took place over a one-day period on the 15th September 2009. The two deputy managers, who are also two of the four registered providers, assisted us throughout the visit. For the purpose of this report the person undertaking the inspection visit and being a representative of CQC, will be referred to as we throughout this report. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The manager had returned the Annual Quality Assurance Assessment (AQAA) to the CQC. The content provided evidence of how well the service is performing and achieving outcomes for the people using your service. The focus of this visit to the home was to support the information stated in the AQAA Care Homes for Older People Page 6 of 32 and other information received by the CQC since the last fieldwork visit, which was 2nd October 2007. The process for this visit included a tour of the premises, discussions with the deputy managers. Staff on duty were spoken with and most of the residents were spoken to during the visit. CQC survey forms were distributed for comments prior to the visit. 5 of 10 service users surveys were returned to CQC. The comments made were very positive. Other surveys distributed to visiting health professionals and staff were not received by CQC. Staff were observed interacting with the residents well. Polices and procedures were examined. Records, including residents care plans were also looked at as part of the inspection process. The home is registered to provide support for 20 service users and at the time of the inspection there were 19 service users living at the home. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Three requirements were made from the last report and these have been complied with. Care Homes for Older People Page 8 of 32 Initial needs assessments for potential new services users has been improved by ensuring all care needs are identified at the assessment and are clearly recorded so that the home and service user can establish if the home can meet their assessed needs. New admission packs have been provided to service users new to the home that clearly outlines what is included in the service and encourages residents and relatives to share knowledge about the persons past life and social history to enable the home to enhance their recreational activities and support those with dementia. Care plans are more detailed and are reviewed at appropriate intervals. A protocol has been introduced for all service users who are prescribed medication on an as needed basis (PRN) to ensure it is used as intended and to provide consistency and remove as much individual interpretation as possible. All staff are regularly supervised and training opportunities are made available to them to meet their needs. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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. Potential service users are assessed prior to moving into the home to ensure the home can meet their needs. Evidence: The AQAA told us that the home has continued to adapt the admission documents to include information about issues of equality. Race, gender identity, disability, age, religion and beliefs are documented to ensure that the staff are fully aware of not just service users personal and physical care needs but also of all their diverse needs. The home has improved their admission pack to include terms and conditions of what the fees include. Also the home wants to capture more of a persons social history and be able to offer adivce to potential service users and their family about the practical side to moving into the home. A sample of three care plans and pre-admission assessments were seen to be Care Homes for Older People Page 11 of 32 Evidence: completed. The deputy manager, who is also one of registered providers, told us that she or a senior carer will visit the service user prior to them moving into the home to carry out an assessment. This is undertaken at their home or in the clinical area. The assessment form used includes information on mobility, washing, dressing and undressing, diet, sight, hearing, communication, recreation and hobbies, likes, dislikes, extent of family involvement, independence and any particular needs. The home also obtains the care managers assessment if appropriate and with this information the home and service user can make an informed decision on whether the home can meet the persons needs. The deputy manager told us that she would expect to receive the information from the care needs assessment if the social worker had undertaken one. A care needs assessment was seen for one service user case tracked. Surveys returned from service users indicated that they felt they had received sufficient information about the home before they made to the decision to move in. Care Homes for Older People Page 12 of 32 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, personal and social care needs of service users are set out in an individual plans of care. Service users have access to all relevant health care professionals and the health care needs of service users are met. Generally medication procedures in the home are satisfactory, however, records are not consistently maintained and service users are put at risk from medication not being secured in a locked environment at all times. Evidence: The AQAA says care plans are kept up to date and are full working documents which are referred to and used daily with the service user and professionals. The home has a key worker system in place that gives each carer the responsibility for a number of residents care and their care plans. The deputy told us this is working well and carers have taken ownership of this role. One carer spoken to said she enjoyed the key worker role and felt involved with specific peoples care. A sample of care plans were viewed. These demonstrated a comprehensive admission Care Homes for Older People Page 13 of 32 Evidence: assessment that included all aspects of a persons health and well being and also included a mental assessment to identify emotional or psychological needs. Risk assessments are undertaken with care plans written to manage any risks identified. The care plans documented information about the service user and provided information for staff on how they wished to undertake their activities of daily living and the level of support they would like and need. Each resident is checked hourly throughout the night and this monitoring is recorded on the report sheet, which describes each service users activity throughout the night. Care plans were seen to be reviewed monthly and daily notes are recorded for every service user. These were detailed and describe how service users have spent their day. Nutritional assessments are not being undertaken regularly and the deputy manager told us that she is researching a more detailed assessment to use to ensure service users nutritional status is monitored. It was observed that service users weights are recorded monthly and it is from this monitoring that any problems of weight loss is identified and referred to the GP for advice. Health care needs are met by a variety of visiting professionals. The AQAA says that the home has good relationships with the primary health team that serve the home. At the time of this visit the home was caring for a resident who was very unwell and this was being supported by the district nurse who was calling regularly and who visited at the time of this visit. Charts were seen to being recorded for this person of all their fluid and food intake and output and how often they were moving position. Service users at the home are registered with local GP surgeries and have a number of different GPs. Service users may keep their own GP if they wish. Records of visits by GPs, district nurses, chiropodist, opticians, other health professionals and hospital appointments were seen in separate records in the care plans. Other health care professionals are accessed through GP referral. The GP will visit the home on request and at the time of this visit called at the home to monitor some of his patients. The deputy manage told us the home has good relationships with the GP who is very supportive. The home has commenced recording all falls and this has involved the community matron supplying the home with appropriate documentation to record the falls accurately and the reason for falls. This then can be considered when trying to risk Care Homes for Older People Page 14 of 32 Evidence: assess a person and formulate a care plan to manage or eliminate any risk. Service users spoken to and surveys returned from service users told us that they consider their needs are met and that they receive all the support they need and say staff are friendly and polite. One survey said that the home supports me when I need medical appointments and any changes regarding my health are dealt with immediately and my family informed. The home uses a monitored dose system from a local chemist and the home has a policy and procedure for administering medication. Medication is delivered to the home by the pharmacy and there is appropriate storage available. The inspector examined medication administration record (MAR) sheets and noted that photographs for each of the service users were on the front of their charts, to ensure correct identification. Gaps were identified where some carers had omitted to sign the chart that they had administered the medication. This was discussed with the deputy manager, who told us that she does audit these sheets regularly and has identified the people who have not signed the MAR sheets with no reason as to why not and she has sent a memo to all staff emphasizing the importance of signing this document or recording reasons why prescribed medication had not be administered. She also told us that this issue is discussed at the regular supervision meetings. It was also observed that when visiting one service users room some of their prescribed topical creams and another oral medication was left on a shelf in an unlocked environment. This was discussed with the deputy manager, who took the medication and locked it in a secure cupboard immediately. There was no risk assessment recorded for this person managing their own medications and this together with the medication not being stored in a locked environment, puts service users at risk and demonstrates poor practice. All staff at the home who are authorised to administer medication have received appropriate training. The AQAA states that the home has developed a protocol for the administration of PRN (as required) medication to ensure that this is only administered when needed and that there is consistency when staff are interpreting if a service user requires this medication. This protocol is kept with each of the service users MAR charts. Service users spoken to were very positive about the care received at the home, they said that staff were very caring, helpful, and friendly and stated that they were always Care Homes for Older People Page 15 of 32 Evidence: treated with dignity and respect. Observations made throughout the visit confirmed that service users and staff get on well together and staff were observed to be interacting with service users and were seen to treat service users with dignity and respect. Staff were observed to knock on service users doors before entering and used service users preferred form of address when talking to them. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of activities for service users, which meets their expectations. The religious and recreational interests of service users at the home are provided for. Service users are able to maintain contact with family and friends and visitors are welcome at any time. Service users are supported to exercise choice and control over their lives and are provided with choices within a wholesome and balanced menu. Evidence: The AQAA received said that the home ensures that service users have the benefit of as much community contact as possible. There are regular visits by the clergy and other visitors come to the home to entertain. The home also has a lovely garden for the service users to enjoy. It said that in the coming year they hope to work on a variety of activities in conjunction with service users. The care plans evidenced that a social history is documented as much as possible and much of the information is obtained from relatives and service users over time. An activities programme was observed on the notice board in the hallway. This indicated that activities take place later in the mornings and as the home has no Care Homes for Older People Page 17 of 32 Evidence: designated activities organiser, the carers undertake this role. The AQAA has stated that one of the improvements over the last year is that an activity rota has been created that specifies a carer to take responsibility to carry out daily activities in accordance with service users wishes. The programme advertised various activities such as quizzes, games, films, puzzles and armchair aerobics. A person attends the home once a week to do slide shows, reminiscence, sing-a-longs, crafts and gardening. Some service users undertake their own hobbies in their room and one gentleman spoken to was delighted to show us his drawings. Five surveys returned from the service users indicated that the home always arranges activities that they can take part in. Some service users spoken to said they preferred to stay in their rooms, other said they liked to join in the activities at times but sometimes enjoyed just watching other people do the activities. The AQAA told us that the home has received feedback from their quality assurance questionnaires that service users enjoy the activities provided. The deputy said that she and the other deputy manager would like to provide a more variable activities programme in the coming year and to invite more local community groups to the home to entertain the residents. The AQAA said that the service users have the benefit of as much community contact as possible. The home has a visiting policy and there are no restrictions on visitors. Service users spoken to said that their visitors were always made welcome by the staff. The home does have visits from the clergy if this is specifically requested by the service user. Religious beliefs and denominations are recorded on the assessment and these are respected. Service users do go out into the community with relatives.The deputy manager told us that she has tried to organise outings for the service users but they are reluctant to go out. Service users spoken with said they were quite happy in the home and that they did not want to venture far. Service users spoken to confirmed that they are able to make informed choices and were able to control their own lives as much as possible. Service users are consulted on a one to one basis and these are used to plan menus, discuss activities and outings and to make suggestions about the day to day running of the home. Surveys returned to the CQC indicated that the service users can make Care Homes for Older People Page 18 of 32 Evidence: choices within their everyday life. One comment said The staff give me choices in what I eat, wear and things I want to do. Care plans document service users likes and dislikes and their preferences on food and daily routines. The home operates a planned menu, which is changed regularly with input from service users. The lunchtime meal was observed. It looked wholesome and well presented. The cook was spoken with and she told us that there is always a choice to two main meals and that she is very aware of the service users likes and dislikes having been at the home for some years. Staff at the home were observed asking service users what they would like for lunch. All service users spoken to were happy with the food provided and confirmed that they had choice and said the food was good. Meals are served in the dining room at the home, although service users can eat elsewhere if they wish. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a simple, clear and accessible complaints procedure, which includes timescales for the process. The homes policies and procedures protect service users from any form of abuse. Evidence: The AQAA told us that the home ensures that everyone knows how to complain and to whom and staff are aware of what to do if they receive a complaint. The AQAA said that the home has not received any complaints in the past year. Questionnaires are sent out to service users and families asking them if they know what to do if they are not happy with everything in the home and all replied yes. The home has a complaints policy and procedure that is documented in the Statement of Purpose and also in the new admission pack that all service users and their families receive. The AQAA told us that the home has not received any complaints in the last year and CQC have not received any complaints. The surveys received by CQC said that service users would know who to talk to if they have any issues to discuss or want to complain. One survey said the home could do no better and meets all my need. The registered provider included in the AQAA a collection of responses from questionnaires the home had given out to relatives, those returned documented Care Homes for Older People Page 20 of 32 Evidence: compliments about the home and on the kindness and care shown to their relatives. All staff at the home have received training on safeguarding vulnerable adults and abuse and the home has a whistle blowing policy and also a copy of the Hampshire Adult Protection procedure. Providers and staff spoken to know what to do should they suspect any form of abuse or observe poor practice. Newly recruited staff are made aware of abuse and the safeguarding procedures at the time of induction which is based on the Skills for Care induction standards. The two deputy managers told us that abuse and protection is permanently on each of the staffs supervision agendas, to ensure staff understand the procedures. The record of this was seen by us. The home has had no safeguarding issue investigated in the past year. Care Homes for Older People Page 21 of 32 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. Service users live in a safe environment and have access to comfortable indoor and outdoor facilities. The home is clean, pleasant and hygienic and free from offensive odours. Evidence: The AQAA states that the home has made good progress over the last year with taking the environment forward and making improvements. Window restrictors have been fitted and smoke detectors fitted in the loft area on the advice of an outside specialist company. The home has purchased an evacuation mattress and have provided training to all staff. Trees and scrubs that were blocking service users light from their windows have been cut down or cut back. The garden is well maintained by staff in their spare time. The AQAA told us that outside the front door the area is untidy and the provider anticipates laying a new pathway soon. We looked around all areas of the home. The home was clean and tidy and furniture was in a good state of repair. The home comprises of 2 floors, and access to the upper floor is via stairs or chair lift. The home has sixteen single and two double rooms all of which have en-suite facilities.There are 2 lounge areas, one is a conservatory that leads off of the main lounge and provides a quiet relaxing area for service users. The main lounge area is larger and most of the service users sit in this room which Care Homes for Older People Page 22 of 32 Evidence: contains a TV and music system. There is a separate dining area. The home has a rear garden, which is secure and is accessible to all service users. The deputy manager told us that the gardens are a work in progress as he is cutting down lots of the overgrown trees and hedging to allow more light into some of the rooms. The home has a defects book where any problems are recorded and there is a programme of maintenance and decoration. All radiators and hot water pipes have been covered and all hot water outlets were thermostatically controlled and window restrictors were in place in upstairs rooms to ensure service users safety. It was observed that there was a free standing heater in some bedrooms which, the deputy manager told us, if they are used, are risk assessed. Service users rooms that were visited had been personalised with pieces of personal furniture and their own belongings and were therefore very individual. It was observed that in the upstairs bathroom there was no hand washing soap dispenser or hand towels available, the deputy manager acknowledged this and said it would be put in place within the next day. The laundry was visited and the machines were fit for purpose, with sluicing facilities. There is a procedure in place for dealing with foul linen but there was no hand washing facility in this room. The deputy manager provider undertakes all the maintenance and repair works for the home but also has contracts with professionals in case of emergency for gas, electricity and other specialist equipment. The home does have one hoist, and one pressure relieving mattress, supplied by the Primary Care Trust for one lady who is very unwell. The kitchen was clean and very well organized with all the appropriate documentation in place to evidence that equipment is tested regularly and cleaned on a daily basis. The cook has been employed at the home for seven years and reports that there have been many improvements to the home since the current owners have been in place. Service users spoken to in their rooms told us that they are very happy with their rooms, some saying they prefer to stay in their rooms for most of the day but come to join the other residents for meals. Service users surveys returned to CQC indicated that the home is always fresh and clean. The AQAA told us that the hours allocated to the cleaning of the home had been Care Homes for Older People Page 23 of 32 Evidence: greatly increased in recent months to ensure that the cleanliness of the home is maintained to a high standard. The AQAA stated that twelve of the staff have undertaken infection control training and the deputy told us this is ongoing and updated yearly for all staff. The training matrix evidenced that this does take place and staff spoken to were aware of the principles of cross infection and how to prevent it. Care Homes for Older People Page 24 of 32 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. The home generally has sufficient staff on duty to ensure service users receive the support they require, however, there are some circumstances when there are not sufficient staff to meet the needs of the service users. Service users are protected by the homes recruitment procedures. Staff are competent and the home provides training to enable them to carry out their roles effectively. Evidence: The deputy manager told us and the staff rota evidenced that usually there are two staff on duty in the morning and afternoon with two waking staff at night. On the day of this visit the staffing levels were such with the two deputy managers in the home. The deputy manager told us that most days she and the other deputy manager are in the home during the day.These numbers are complemented by a cook and cleaner with the care staff undertaking the laundry duties. The cook told us that staff on duty in the afternoon prepare the tea time meal and serve it and clean up afterwards. Numbers of staff on duty was discussed with the deputy managers. It was felt that currently there was one resident who was very unwell and being nursed in bed and who was being monitored hourly. This together with just two staff on duty in the afternoon to care for residents, prepare tea and monitor the person who was unwell, was expecting the staff to manage and be responsible for many duties. Although the staff spoken to said they managed, the deputy managers agreed to review the Care Homes for Older People Page 25 of 32 Evidence: afternoon staffing arrangement, whilst there is a resident who continues to need a high level of care. All service users spoken to said that they felt that staffing levels were adequate and said staff are caring people and are always available when they need them. A sample of three recruitment records was seen and these contained all of the required information including application form, Criminal Record Bureau (CRB) and the Protection of Vulnerable Adults (POVA) checks received before the person commenced employment. Two references were also evidenced the files. Files also contained training records and supervision notes. The AQAA says that the deputy managers see staff very regularly for supervision. The AQAA states that the management have good relationships with the staff group. The homes aim is to have 100 staff trained at least at NVQ level 2. The providers are committed to providing staff with training. Staff are given self assessment questionnaires to complete and this is followed by supervision, at which time their strengths and weaknesses are discussed and training needs are decided on. All supervisions for staff take place on a one to one basis and time is given to this process. Records of this were evidenced in staff files. The AQQA tells us that there are seven carers with the National Vocational Qualification (NVQ) level 2, one with NVQ level 3 and currently two have commenced their NVQ level 2. The two deputy managers have also achieved their NVQ level 4 in care and are undertaking their Leadership and Management in Care award. The home has an induction programme in place based on the Skills for Care induction standards but the deputy manager told us that if a person is employed who has already achieved their NVQ level 2, they then undertake a local induction programme, which includes health and safety, moving and handling, infection control and fire safety along with a general introduction to the home. Staff files evidenced that a variety of training has taken place and there was evidence that staff had received mandatory training in health and safety, fire, first aid, moving and handling, infection control and safeguarding vulnerable adults. The members of staff spoken to said they have good training opportunities and consider they are well supported and valued by the management team. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and has an ethos of a family environment. Service users are consulted about the running of the home. The health, safety and welfare of service users and staff are promoted and protected. Evidence: There are four registered providers named on the registration certificate. The current registered manager of the home is one of the named providers and does not visit the home often. The registered managers role was discussed with the two providers who have been acting in the deputy managers role for the past four years. The two deputy managers, who are man and wife and are both registered providers of the home, are in the home daily. One of the deputies is about to apply to CQC to register as manager of this home, to replace his father who is the existing registered manager. The deputy managers have both has previous management experience and are currently undertaking the Leadership and Management in Care Award. Care Homes for Older People Page 27 of 32 Evidence: The home has a quality assurance system in place. The home does distribute service users questionnaires to gain the views of the people who use the service. Questionnaires are also given to relatives and visiting professionals. The AQAA said the results of these questionnaires have told the management that the home is going in the right direction and know where the service needs to improve and this contributes to the homes development plan. The deputy manager told us that the management welcome any suggestions about the home to improve it. Staff meetings are held and staffs views are sought through regular supervision. Staff spoken to told us they are very happy with their jobs and have plenty of training and get the training they ask for. The home does not manage any service users finances. These are managed by relatives or by service users themselves. The home has an accident book and accidents were recorded appropriately. There is a fire risk assessment for the building and the fire log was inspected and all required recording and testing had been carried out at the recommended intervals. Certificates were seen for annual tests of equipment and these were all in date. Fire equipment was last tested in July 2009, Private electrical equipment in Feb 2009. A new boiler was fitted in October 2008. The training matrix evidenced that staff have undertaken appropriate health and safety training, moving and handling, food hygiene, first aid, infection control and fire training. A risk assessment for the environment was seen and this evidenced risk assessments for the free standing heaters in some service users rooms. Two service users are prescribed oxygen when needed. Signs that oxygen is in use, are placed on doors of the service users when using it. Care Homes for Older People Page 28 of 32 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 32 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 is 30/10/2009 required to ensure that all prescribed medications that service users choose to keep in their rooms is kept in a locked environment at all times. Prescribed medication that is kept by the service user in their room must be stored in a locked environment to ensure other service users are not put at risk. 2 9 13 The registered person must 30/10/2009 ensure that all records of prescribed medication is maintained and that reasons for non-administration is documented on the medication record chart. Prescribed medication records must be kept for all service users and the date of which they were administered to ensure Care Homes for Older People Page 30 of 32 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 correct records are maintained. 3 9 12 The registered person must ensure that service users who manage their own medication do so within a risk assessment framework. You must undertaken risk assessments for service users who wish to manage their own medications to ensure they are safe to do so and are compliant with the prescribed regimen. 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 30/10/2009 1 26 It is recommended that hand washing facilities be installed in the laundry room. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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