Care Home: Field View

What the care home does well When we arrived the atmosphere of this home was friendly and congenial and we were made to feel welcome, the residents were interested about our visit and happily talked to us, they said that they were happy living in the home and that the staff looked after them well. People thinking of moving into Field View are encouraged visit and discuss the home with the people living there and their families. Before a new resident is admitted, the manager makes sure that their needs were understood and could be met by the service. We observed that staff approached residents in a friendly and respectful manner. Residents told us that the carers were polite and gave them privacy when they were in their rooms. Field View is a comfortable and well maintained home. We were told that if anything went wrong they could report it and it would be fixed, the home has a maintenance person who is available to carryout small repairers. The home was clean and free from unpleasant odours. On the day of the inspection there was enough staff on duty to meet the resident`s needs. Staff we spoke to said they worked hard to give the residents a good quality service and residents told us they were happy with the staff team. One person told us, "I am happy to live here, staff are like friends to me." In the AQAA the director told us, "We thrive to ensure our team provides a high standard of care to the service users at all times. We do this by monitoring the staff closely and making changes where we feel it is appropriate and arranging different training. A majority of staff have completed their NVQ`s and I have received excellent feedback from the healthcare professionals that have visited service users at the home." What has improved since the last inspection? The statement of purpose has been reviewed and updated and the new version is sent to anyone who makes an enquiry about moving into the home. We are told in the AQAA that, "In the last year we have identified specific training that would benefit the team and have arranged this such as oral hygiene, continence care and dementia awareness." Staff have received fire safety training and regular updates will be offered to all the staff. People have their nutritional needs checked against the MUST(Malnutrition Universal Screening Tool) to enable the home to determine if they have any special needs in this ares. MUST is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition or are obese. It also includes management guidelines which can be used to develop a care plan. What the care home could do better: The acting manager has been post for over two years without having undertaken our registration process, which tests that a person is fit to manage a home for vulnerable people. The previous inspection report required that she should apply for registration and during this inspection we have found that she still hasn`t applied. The director explained that it was mutually felt that that acting manager still lacked the knowledge and skill to manage the home and that she had been supported by the director, who has been spending a lot of time at the home. It is not acceptable that a home should be without a registered manager for so long and the managing director has since applied to become the registered manager at Field View. While we found that there were some improvements to the care plans since we last inspected in May 2009, there is still room for improvement and the home has acknowledged in their AQAA that, "Some of the care plans did not give staff enough instructions to help them to meet resident`s individual health and personal care needs. Staff must make sure that risks to resident`s health and safety are assessed and plans are put into place to monitor and where possible, reduce the risks." We were told that they are in the process of reviewing and making improvements to the care plans. We noticed that the care plans were stored in a cupboard at the carers station, which is in an area just off the main corridor. The cupboard didn`t have a key and was left open, this gave anyone in the building access to people`s private information and didn`t protect their privacy. While we were at the home the maintenance person put a lock on the door and we were assured that all staff would be reminded to keep the cupboard locked whenever they were away from the station. In the previous inspection we had told the home should seek advice from the fire officer with regard to their use of door wedges to keep fire doors open, this was considered particularly important as there are several residents who prefer to have their bedroom doors open at night. We found that the fire officer had not been approached and the home was still using the door stops. Immediately the inspection was over the director obtained mechanical door stops that release the door if the fire alarm is sounded so that it can close and stop the fire spreading into that room. We also identified other fire risks and the home will still need to contact the fire officer to seek advice. Key inspection report Care homes for older people Name: Address: Field View Hayes Lane Fakenham Norfolk NR21 9EP     The quality rating for this care home is:   one star adequate 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: Ann Wiseman     Date: 3 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Field View Hayes Lane Fakenham Norfolk NR21 9EP 01328856037 01263713222 fieldview66@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Imperial Care Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Field View provides personal care and accommodation for 17 older people. The service is owned by Imperial Care Home Limited. The home is located on the western outskirts of the market town of Fakenham. It is pleasantly situated and close to all local amenities. The home provides accommodation on the ground and first floor with flats for staff being situated on the second floor. There are two shared bedrooms and thirteen single bedrooms with all bedrooms having en suite facilities. There is a five person lift to the first floor. There is adequate inside communal space. Outside there is a patio area and large, lawned, garden, which residents can enjoy in the summer months. Information about the home, including the latest inspection report is available from the manager. The weekly fees rang from £386 to £450 pounds, please contact the manager for current fees. There were extra charges for hairdressing, chiropody, toiletries and therapy sessions. Care Homes for Older People Page 4 of 30 1 8 0 5 2 0 0 9 0 Over 65 17 Brief description of the care home Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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: This was an unannounced inspection; we arrived at 9.30am in the morning and stayed for seven hours. The acting manager was at the home when we arrived and facilitated the inspection, which she did in an open and helpful manner. Shortly after our arrival one of the homes managing directors arrived and she also stayed for the duration of the inspection. Whatever files and documents we asked to see were quickly produced. During the day we had a look around the home and observed interaction between the staff and people living there. We also had opportunities to talk with some of the residents to get their opinion of the care they get. They all gave positive responses about the home and told us that they liked living there. We looked at information belonging to five people and some of the of the staff files. We also assessed some of the homes policies and procedures and sampled a random selection of the health and safety files and records. Care Homes for Older People Page 6 of 30 The managing director had sent us the Annual Quality Assurance Assessment (AQAA) she had completed prior to the inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. The detail given to us in the AQAA was detailed and it gave examples to reinforce the information given to us in it. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The acting manager has been post for over two years without having undertaken our registration process, which tests that a person is fit to manage a home for vulnerable people. The previous inspection report required that she should apply for registration Care Homes for Older People Page 8 of 30 and during this inspection we have found that she still hasnt applied. The director explained that it was mutually felt that that acting manager still lacked the knowledge and skill to manage the home and that she had been supported by the director, who has been spending a lot of time at the home. It is not acceptable that a home should be without a registered manager for so long and the managing director has since applied to become the registered manager at Field View. While we found that there were some improvements to the care plans since we last inspected in May 2009, there is still room for improvement and the home has acknowledged in their AQAA that, Some of the care plans did not give staff enough instructions to help them to meet residents individual health and personal care needs. Staff must make sure that risks to residents health and safety are assessed and plans are put into place to monitor and where possible, reduce the risks. We were told that they are in the process of reviewing and making improvements to the care plans. We noticed that the care plans were stored in a cupboard at the carers station, which is in an area just off the main corridor. The cupboard didnt have a key and was left open, this gave anyone in the building access to peoples private information and didnt protect their privacy. While we were at the home the maintenance person put a lock on the door and we were assured that all staff would be reminded to keep the cupboard locked whenever they were away from the station. In the previous inspection we had told the home should seek advice from the fire officer with regard to their use of door wedges to keep fire doors open, this was considered particularly important as there are several residents who prefer to have their bedroom doors open at night. We found that the fire officer had not been approached and the home was still using the door stops. Immediately the inspection was over the director obtained mechanical door stops that release the door if the fire alarm is sounded so that it can close and stop the fire spreading into that room. We also identified other fire risks and the home will still need to contact the fire officer to seek advice. 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information given to people of thinking of moving into Field View is detailed enough to allow people to make an informed choice about whether the home would suit them and everyones needs are assessed before they move in. Evidence: Field View has recently undated their statement of purpose, which is given to people thinking of moving into the home. The residents guide contains details of all aspects of life in the home, the AQAA tells us that it has also been reviewed and updated this year. The manager told us that people could see the last inspection report on request. We examined the files of three people during this inspection and saw that they each contained pre-admission assessments completed by the home as well as their local authoritys community care assessment, where available. The assessments contained good information and covered the persons care needs. Details of their preferred leisure and social activities were also recorded, this information is used to develop Care Homes for Older People Page 11 of 30 Evidence: peoples care plans. The director told us in the AQAA that, An initial trial period of four weeks is offered to all new service users with the option of this being extended if necessary. I or the acting manager carries out an initial assessment at the persons own home or in another residence to gather information regarding their needs and to make sure these could be met at the home. We always try to encourage potential service users to have a look at the premises initially wherever possible so they can visualise the outlay of the home and whether they feel it is the right setting for them. Recently a potential service user joined us for lunch and spent the afternoon with us to get a feel for the home. This is something that we offer all prospective service users. Field View doesnt offer an intermediate care service. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have care plans in place and have access to the health care they need. Evidence: We examined three care plans during our visit to the home, they reflected the needs of the person involved and they have been updated since the last inspection and have been reviewed regularly throughout the year. However they would benefit if they were written in a more person centred way that reflected the person as a whole, also people moving into the home or their representative should be asked to indicate that they have read and agreed with the care plan by signing and dating them. This helps people feel that they are still in control of their lives and encourages them to make more choices by including them in drawing up the care plan and gives then them the opportunity to tell staff how they want to be helped. In the AQAA the director acknowledges that improvements are needed in their care planning and we were informed that they are in the process of updating them and making changes to better reflect peoples needs and how they should be met. Care Homes for Older People Page 13 of 30 Evidence: The care plans contained risk assessments that are developed to minimise the risk of harm in peoples every day activities, which enable them to live a full and active life without being restricted unreasonably. One person who is diabetic and does their own insulin injections had a risk assessment on file, which shows that their ability to self medicate and whether it is safe for them to do so had been tested. The assessment has recently been reviewed to show that the staff now check the dose setting on the injection pen before handing it over for the resident to use. We saw evidence that peoples health care needs are met, doctors and other health care professional visits are recorded along with any treatment given so that staff can be made aware and can monitor any changes. We discussed the medication and the way it was managed and stored with the acting manager. We also witnessed staff administering medication and viewed the records and found that all the medication, including the controlled drugs were stored as required, the home was waiting for a controlled medication book to arrive, which has been on order for some time. The lack of a book has meant that the controlled medication was not being recorded as it should be. We have been reassured that since the inspection a book has now been obtained and is being used, action to obtain the book should have been taken as soon as the resident taking the controlled drug moved in, records show that they have been staying at the home for several months before it was bought. The AQAA told us that, We have identified specific training that would benefit the team and have arranged this such as oral hygiene, continence care and dementia awareness. We encourage different therapists, hairdressers and chiropodists to visit the home to allow the service user choice. We also Invite different clothing companies to allow the service users to choose new clothing frequently. We keep families and advocates informed if new clothing or toiletries are required. The acting manager has built up a very good relationship with everyone that visits the home. The importance of staff protecting the residents confidentiality is included in the induction training, but we noticed that the care plans were stored in a cupboard at the carers station, which is in an area just off the main corridor, but was secluded enough to allow unauthorised people to have access to them. The cupboard didnt have a lock and the door was left open, this gave anyone in the building access to peoples private information and didnt protect their privacy. While we were at the home the maintenance person put a lock on the door and we were assured that all staff would be reminded to keep the cupboard locked whenever they were away from the station. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home are offered a well balanced diet in pleasant surroundings and can take part in meaningful activities. Evidence: People we spoke to said they were happy with the activities they were offered and we saw photographs of people taking part in outings and activities round the home. The home doesnt have a dedicated activities coordinator, the acting manager has a special interest in supporting people to keep busy and entertained and arranges activities and outings for the residents. We were told that regular entertainers come to the home and local religious organisations also visit the home monthly.. Records are kept of the activities offered to evidence that they are provided on a regular basis and show that they are varied and appropriate to the people living in the home. In the AQAA we were told that, The activity plan has improved immensely following discussions with the service users about what they would like, we encourage the service users to spend time in the grounds weather permitting and staff will walk with service users if they prefer this. We arrange outings for the service users to places of interest and have taken part in sponsored walks with some of them. The local vicar attends monthly for communion, we have a weekly lottery bonus ball, and raffle and Care Homes for Older People Page 15 of 30 Evidence: we encourage the service users to assist with fund raising for their amenity fund and by doing this we have been able to buy more activities of their choice. People we talked to told us that visitors are welcomed into the home and family and friends are invited to parties and BBQs that are held to celebrate special days. The garden is well kept and is a pleasant and relaxing place to sit in fine weather. The home has one open plan dinning and sitting room, with the dinning tables placed together close to the kitchen and those who can get to the table eat there together. Other people are supported to eat in the lounge area or in their bedroom if they prefer. The tables were attractively set and each table had condiments and fresh drinks, the mealtime was a social occasion with people chatting congenially. The menus showed that residents were offered a varied and nutritionally balanced diet but there is little day to day choice. The main meal is set and residents have to ask if they want something different. There is a notice, which is displayed in the sitting area, that invites people to ask for an alternative meal if they dont like what is on offer. The teatime meal usually comprised of sandwiches. People should be given more opportunity to choose what they eat and the home should consider finding a way to enrich peoples mealtime experience by giving them an alternative meal to chose from. The people we spoke to said the food was well cooked and that they enjoyed their meals. One person told us, I enjoy my food, I get enough to eat as well. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that complaints and concerns would be taken seriously and that the home would investigate any complaints. Staff training and procedures help to protect people from abuse. Evidence: We examined training files at the home and found that staff continue to receive safeguarding training and that the staff are aware of what action would be needed if they felt that one of the people living in the home was being abused. One staff member, who we asked if it would be difficult to report their colleagues said, I wouldnt hesitate to report anyone who abused the residents here. The homes complaints procedure is on display around the home and when we examined it we found that it provided the necessary information on how to raise any concerns or complaints about the service. We havent had any complaints made directly to us since the last inspection and the information given to us in the AQAA tells us that the home hasnt had any complaints made to them either. We were also told that the complaints and safeguarding policies and procedures have both been updated in the last year. The acting manager told us that she makes herself available and prefers people to speak to her about their worries and concerns so that they can be sorted out before they escalate to become a complaint. Care Homes for Older People Page 17 of 30 Evidence: If people want to take part in the political process and vote, we were assured that arrangements are made to enable them to go to the polling station or to have a postal vote. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home offers comfortable communal facilities designed to maintain independence, but fire safety within the home needs to be reassessed. Evidence: Field View is a relatively modern building that has been converted into a care home , during a tour of the building we noted that the home was clean, well maintained and furnished comfortably. While we had a look around the house we checked for any health and safety infringements and noticed that the home is still using door stops to keep doors open as they were during the last inspection. This is a dangerous practise as it stops the fire door acting as a defence against the progression of a fire. We also noted that when the windows and doors were replaced the fire doors were fitted with keys. The keys were in the locks, but they can be removed and potentially lost, this infringes fire safety guidance and must be addressed. People must have free, unhindered access to leave the building quickly in the event of a fire. In the last report we had required that the provider must seek advice from the Fire Officer about a safer way to keep doors open if the residents prefer their door to be left open. They failed to approach the Fire Officer and so we have contacted him and have asked him to visit the service to have a comprehensive look at the fire safety arrangements at the home. Care Homes for Older People Page 19 of 30 Evidence: Since this inspection the provider has obtained mechanical fire stops that will allow the fire door to close if the fire alarm sounds, we were assured that they have been fitted to the doors of those people who prefer to have their door open at night. The door to the room where cleaning products are stored was left unlocked despite having a notice on the door to keep it locked, this is to protect people from gaining access to the chemicals and the possibility of harming themselves. There is a Yale type lock fitted to the door, which doesnt always catch when it swings closed. Staff must be reminded to pull the door to, ensuring it is locked every time they leave the room. The kitchen is a reasonable size and is appropriately appointed for a home of this size. The cook is responsible for maintaining hygiene standards in the kitchen and has a cleaning schedule, they have recently undergone an environmental visit and we were informed that no issues were raised. The bedrooms we saw all have en suite facilities and contained items of personal furniture and possessions that made them individual to the occupant. A rolling programme is in place of replacing carpets and decorating the rooms as they become vacant. Those rooms we saw were nicely decorated, clean and tidy. There is an attractive conservatory that has blinds fitted to shade it from the sun and to keep the room within a comfortable temperature range. The home has a well kept garden that is accessible to everyone and one of the residents said they liked to sit out on the large patio area in good weather. The bathrooms and toilets are sufficient in number and were clean. Some of the bathrooms and toilets have specialist equipment and adaptations to meet the needs of the people living in the home and to prolong their independence. Personal protective equipment was available for staff use to enable them to maintain good infection control, we saw staff use the equipment appropriately, which protects people from cross contamination. We carried out random checks of health and safety records and found them to be in order. PAT testing has taken place to make sure portable electrical equipment is safe to use and we saw that the hoists and the fire safety equipment is serviced regularly. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that staff are aware of their roles and responsibilities and are qualified. The home has recruitment policies and procedures in place but their recruitment practise do not always follow the procedures and residents could be placed at risk. Evidence: When we arrived at the home we found that sufficient staff were on duty to meet the needs of the people living in the home, however the rota was not sufficiently detailed to enable us to check that the staff on duty corresponded to those on the rota. The director told us that she spends a lot of time at the home to support the acting manager, but we were unable to verify this as she does not enter the time she spends at the home on the rota. We discussed the rota and the benefits of making sure that it is detailed, up to date and properly recording all staff that are on duty in the home at any one time. The director undertook to consider implementing our recommendations. In regard of staffing at the home the director told us in the AQAA that, We all have a positive working approach, which the service users recognise and appreciate. We encourage the staff to try and identify their own training needs and I shadow the staff to allow me to identify their training needs also. All new staff shadow several different shifts during the induction period to allow them to learn the service users needs. We offer an open door policy to allow the staff to talk anytime and feel that I am a very Care Homes for Older People Page 21 of 30 Evidence: supportive manager and the acting manager has a great deal of respect from the staff, she holds frequent supervision of staff including one to one, shadowing and group sessions. We have arranged different training as well as the mandatory sessions to include subjects such as Tena Care and Oral Health and almost all the staff are trained to at least NVQ level 2 in care. All staff have a training portfolio and are given in excess of 3 days paid training a year. Staff personnel files are kept at the home and we examined three of them in detail. They held all the information and documents that are required to be kept as set out in schedule 2 and 4 of the care home regulations. Staff members we spoke to confirmed that all the checks that safeguard people are carried out and that they took part in induction training when they first joined the workforce. The starting dates on the files indicated that not all the safeguarding checks are received before new staff start working at the home. The acting manager told us that it is usual for staff to start work unsupervised before their CRBs were returned and thought that this acceptable. In our guidance we do allow that staff can work before a criminal record bureau (CRB) check is received in exceptional circumstances. Care must be taken that our guidance is followed if staff do work before the CRB is obtained. This issue was highlighted in the previous report. The care staff we spoke with displayed a good knowledge of the people in the home and understood their needs. Information given to us in the AQAA tells us that the majority of carers in the home have obtained an NVQ in care, which means that they have met the minimum of 50 of its staff having this qualification. The staff records show evidence that the home offers the mandatory training, and staff have access to specialist training suitable for the assessed needs of the people living in the home. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is run with the best interests of the residents in mind, but stronger leadership is needed and action on requirements needs to be taken in a more timely manner, we expect that this will be rectified once the new registered manager is properly in place. Evidence: The acting manager has been in post for over two years but has not made an application for registration with us, part of the registration process is that the applicant is judged whether they are a fit person to manage a home for vulnerable people, in as much as they are of good character and that they are qualified and experienced enough to do the job properly. Her failure to make that application means that we havent had the opportunity to make that judgement. She has many years experience of caring for older people but had little management experience before taking up this post, nor has she any management training, it was required in our previous report that she undertakes the management training and apply for registration by 31st July 2009. Care Homes for Older People Page 23 of 30 Evidence: She has complied with neither part of the requirement. We were told that over the last year the acting manager has be receiving extra support from the managing director to build up her confidence and management skills but both have come to the conclusion that she is a skilled carer, she has worked at the home for many years, but finds the management part of the role difficult and has decided that she doesnt want to continue as the homes manager. Since the inspection the director has applied to become the registered manager of Field View, she is an experienced manager and is already registered with us as the manager of another home in the group. Although they have complied with four of the requirements made at the previous inspection, the service has been slow to respond to two which could potentially have a serious effect on the welfare of the people living in the home, one in regard of the acting manager receiving training appropriate to her position and taking steps to gain registration and the other in regard to obtaining advice on fire safety in the home. Steps have been taken to comply with the outstanding requirements since this inspection and action has been taken on some of the concerns identified during this visit. However we are not confident that the service is able to identify areas that need improvement and that they will act in a timely manner. This inspection would have been expected, as our guidance says that we will carry out an inspection of an adequate service within a year of the service becoming adequate, so therefore it would have been good practice to have complied with the requirements before the expected second visit if they hoped to regain their good quality rating. Because of the lack of action meaning that requirements have been left outstanding and the identification of other areas that need improvement, we have been unable to change our view that this service offers adequate outcomes for the people who live in this home on this occasion. Regular resident meetings are held and the director has listed some of the changes they have made in the home because they have listened to what people have said, The menus are revised on a 3 monthly basis to incorporate the service users choices that may have been raised at their meetings. The dining room has been laid out differently at the service users request and we now have a local sweet shop that visits the home weekly. Staffing hours have recently been increased to ensure that the changing needs of the service users are met. We have increased the amount of planned activities for the service users and because the staffing hours have been increased this allows staff to spend more quality time with the service users. The acting manager says that they have an open door policy and that she is always happy to talk to people and is open to suggestions and constructive criticism. Regular Care Homes for Older People Page 24 of 30 Evidence: regulation 26 visits are held, which are visits to the home by the director who then carries out their own inspection, which includes checking documentation, compliance to regulations and speaking to staff, visitors and residents to canvass their opinion on quality of care offered by the home. A report is made and discussed with the acting manager and a copy is kept at the home, which we were able to see. We noted from the staff files that there is evidence that people get supervision, although recently they have been getting only group supervisions Incorporated into the regular staff meetings. Staff we spoke to confirmed that they received supervision, but said they would prefer more one to one sessions. The home has a quality assurance procedure in place that involves them sending annual surveys to staff, residents and their relatives. The information collected is collated and action is taken if needed. The director showed us copies of of surveys she had carried out independently of the home that she uses as her own check on the quality of service offered. The organisations polices and procedures have been reviewed and updated as legislation dictates. The AQAA lists the polices that are in place and confirms that they have all been reviewed in the last year. Personal details are now stored away from public gaze and are kept confidential since a lock was fitted to the cupboard were they are stored during this inspection. Staff are asked to read and sign the organisations policy on confidentiality when taking up their post. A sample of health and safety records were inspected and were found to be in order, we identified some any health and safety infringements during this inspection around fire safety and keeping chemicals safely locked away, which have been detailed earlier in this report. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Systems must be maintained in the home so that medication is properly recorded. A failure to record medication in line with guidance can lead to mistakes that can put people living in the home at risk. 08/07/2010 2 29 19 Care must be taken that our guidance is followed if there are extenuating circumstances where staff are needed to start working at the home before their CRB check has been received. If staff are needed to start work before their CRB has arrived it must not be considered stating them before at least their references and a pova first has been received. 14/07/2010 Care Homes for Older People Page 27 of 30 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 3 38 13 Any requirements placed on 14/07/2010 the service by the fire officer must be complied with within the set timescale. If the fire officer doesnt contact the service by 30/06/2010 the home must immediately contact him to seek his advice about issues highlighted in the this report. 4 38 13 Cleaning materials must not 14/07/2010 be accessible to people who may misuse them and cause harm to themselves. Staff must be reminded of the importance of keeping the residents safe from harm by making sure that the cupboard containing the cleaning materials is kept locked. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The care plans would benefit if they were written in a more person centred way that reflect the person as a whole, also people moving into the home or their representative should be included in the process of developing the care plan and should be asked to indicate that they have read and agreed with the plan by signing and dating them. A lock has now been fitted to the cupboard where the care plans are stored, we recommend that an audit is Page 28 of 30 2 10 Care Homes for Older People 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 undertaken to identify other practises in the home that may compromise peoples confidentiality. 3 15 We recommend that the home should look for ways of giving people more opportunity to choose what they eat on a daily basis and the home should consider finding a way to enrich peoples mealtime experience by giving them an alternative meal to choose from. The rota should be a true record of who has worked in the home, when and in what capacity and copies must be retained for future examination. It is recommended that the rota should be remolded to be clearer, so that it can easily be identified who is working in the home on any given date. 4 27 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!