Care Home: Firtree House Nursing Home

What the care home does well People benefit from an assessment before they decide to move into Firtree House. This ensures that the home is suitable to meet their needs. Residents enjoy living in a comfortable, clean, attractive, well decorated and furnished environment. They benefit from suitable facilities and equipment, which help to maintain their independence. The home is run by an experienced and qualified manager. Residents benefit from a well established, supported and supervised staff team who care for, understand and anticipate their needs and wishes. The views of residents and their representatives are listened to and receive appropriate consideration. People benefit from their views being sought about how the home is run. Individuals changing personal, health and social care needs are met. All current residents benefit from support from staff to manage their medication. People are treated with dignity and respect. They are recognised as individuals and are able to exercise some choice over their lives. People can choose to take part in group activities or pursue their individual interests; they enjoy keeping in contact with their relatives and friends. Residents are provided with good quality and varied meals. Residents are protected by the system in place for safeguarding their finances. Their health and safety is promoted by the testing and maintenance of systems and equipment in the home. What has improved since the last inspection? The Statement of Purpose has been amended to contain accurate information about the Registered Provider of care. The organisation has developed a new Resuscitation Policy to provide guidance for staff. What the care home could do better: Procedures in place designed to protect residents from abuse would be improved by the assessment of residents capacity together with prioritizing associated staff training. Residents changing personal, health and social care needs could be better reflected in care plans and risk assessments. The systems in place for the administration of medication which aim to protect residents would be improved by the appropriate storage of all controlled drugs. Staff are provided with training which aims to meet the needs of residents, although this could be better evidenced in written records. The systems in place for staff recruitment, which aim to protect residents, could be better evidenced if all information was kept at the home. Key inspection report Care homes for older people Name: Address: Firtree House Nursing Home 30 St James` Road Tunbridge Wells Kent TN1 2JZ     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: Helen Martin     Date: 1 9 0 1 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: Firtree House Nursing Home 30 St James` Road Tunbridge Wells Kent TN1 2JZ 01892523954 01892545241 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Firtree Care Ltd care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Firtree House Nursing Home provides nursing care and accommodation for 50 older people. Firtree Care Limited owns and operates the Home. Firtree House is located in a residential area of Tunbridge Wells with shops, public transport and other usual town amenities being close by.. Firtree House Nursing Home consists of a detached property and garden with car parking facilities at the front of the building. There is accommodation on 3 floors in the newer part of the building and on 2 floors in the older part of the Home. The Home has two shaft lifts. There is a staff call system with various television and telephone points throughout the Home. The Home employs care and nursing staff, working a roster, which gives 24-hour cover. The Home also Care Homes for Older People Page 4 of 30 Over 65 50 0 3 0 1 0 2 0 0 8 Brief description of the care home employs other staff for catering and domestic duties. Current fees for the home range from 526.00 to 1000.00 per week. Additional costs include hairdressing, chiropody, newspapers and magazines. Full information about the fees payable, the service provided and the homes Statement of Purpose are available from the Registered Manager. 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: 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: Firtree House Nursing Home provides nursing care and accommodation for up to fifty older people. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This Key Unannounced Inspection included a visit to the home in Tunbridge Wells on 19th January 2010, where the Responsible Individual, Registered Manager, Head of Care, one Carer, one Nurse, one Chef, the Administrator and Service Users were spoken with. Some judgements about the quality of the service provided were taken from observation and conversation. Some records and documents were looked at together with the premises and facilities of the home. Currently a Safeguarding Vulnerable Adults investigation is being undertaken within a Care Homes for Older People Page 6 of 30 confidential multidisciplinary process. There have been no outcomes to date and issues have not yet been found to be substantiated or unsubstantiated. Therefore these issues have not been included within this inspection report. However this visit does include looking at any regulatory issues relating to Safeguarding procedures. All information received since the last Key Inspection is reviewed as part of our inspection methodology. All of the above have been included within this inspection process and some of the gathered evidence is mentioned within this report where appropriate. 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: Procedures in place designed to protect residents from abuse would be improved by the assessment of residents capacity together with prioritizing associated staff training. Residents changing personal, health and social care needs could be better reflected in care plans and risk assessments. The systems in place for the administration of medication which aim to protect residents would be improved by the appropriate storage of all controlled drugs. Staff are provided with training which aims to meet the needs of residents, although this could be better evidenced in written records. The systems in place for staff recruitment, which aim to protect residents, could be better evidenced if all information was kept at the home. Care Homes for Older People Page 8 of 30 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 statement of purpose has been reviewed in order to provide clear and accurate information for residents and their representatives, about the registered Provider Firtree Care Ltd. People benefit from an assessment before they decide to move in, which ensures that the home is suitable to meet their needs. Evidence: The home has a statement of purpose and service users guide, designed to give people information about the home before they move in. This is available in large print and on a CD. The registered Provider for Firtree House is Firtree Care Ltd., which is a trading subsidiary of the Caring Homes group. It was noted on the day of inspection that the statement of purpose stated that the registered body for Firtree House was Caring Care Homes for Older People Page 11 of 30 Evidence: Homes. This was incorrect and potentially misleading. Shortly after the day of inspection, the statement of purpose was amended to read: The Registered Provider of care is Firtree Care Ltd. Company Number 02628796, which is a trading subsidiary of the Caring Homes Group. The owner explained that people thinking about moving into Firtree House are assessed by the home to ensure that their needs can be met. This information is recorded with the aim that care plans for the help that people need are developed from this. The home does not provide any intermediate care. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated with dignity and respect. Residents changing personal, health and social care needs are met but could be better reflected in care plans and risk assessments. There are systems in place for the administration of medication designed to protect residents, although these would be improved by the appropriate storage of all controlled drugs. Evidence: Individual plans of care for each resident are developed. These aim to identify the action required from staff to meet residents personal, social and health care needs. Issues identified in care plans and risk assessments include: mobility, personal care, nutrition, memory loss and monitoring for the risk of pressure sores, weight loss and falls. Care plans also contain some biographical and life history information, with a social care assessment. Records of activities are kept separately. During this visit three sets of care plans were looked at. All were clear and easy to follow, although Care Homes for Older People Page 13 of 30 Evidence: one had not been reviewed recently within the last month. This latter set of care plans contained a care plan review record that was last completed on 1st March 2009. The individual care plans were last dated December 2009. The dates on the two sets of documents were different. Because of this inconsistency, records showed two different dates for the last care plan review, both of which were not within the last month. This file also contained assessments and risk assessments, seven of which were looked at. Of these seven, one was dated November 2009, one July 2009 with a Malnutrition Universal Screening Tool dated 2008 and a manual handling assessment with no date. The remaining three risk assessments were dated December 2009. None of the assessments had been reviewed within the last month. The Registered Manager stated that all residents who need assistance with eating have been identified. Currently some residents living in the home receive a liquidized or soft diet, need assistance with food, have chewing difficulties, have Dementia and may get confused and some may be assisted to eat in bed. There are nutritional care plans and risk assessments, although some seen had not been recently updated. There are no specific separate care plans and risk assessments for choking. The Registered Manager stated that this is because they are unnecessary as currently there are no residents who are at risk of choking or who have swallowing difficulties. The Registered Manager said that residents had their food liquidized due to problems chewing and not swallowing difficulties. It is the Registered Providers responsibility to comply with the Care Home Regulations 2001, which require that all care plans recording residents health and welfare needs and how these are met, are kept under review and up to date. A requirement has been made. In December 2009 we received a copy of the new Resuscitation Policy from the organisation. The policy is to be used in conjunction with a resuscitation status record for individual residents. The Registered Manager stated that individuals wishes had been discussed with residents and their families who were due to return forms to the home by the end of January 2010. It was said that these would then be forwarded to the relevant GPs for their agreement and signature. The Registered Manager stated that all residents whom their GP agreed were inappropriate for resuscitation would have a written record in their care plan by 28th February 2010; this record and the resuscitation status of individual residents would be reviewed regularly with their care plans. Care Homes for Older People Page 14 of 30 Evidence: Residents health care needs are met. Monitoring visits from health care professionals are recorded in care plans. These show that health and social care professionals are accessed to support staff to meet residents needs including consultation and referral to medical professionals. Some residents who live in the home are diagnosed with Dementia. The Head of Care stated that their primary need was that of nursing. Issues relating to the Mental Capacity Act and Deprivation of Liberty Safeguards are mentioned under the Complaints and Protection section of this report. Systems are in place within the home regarding the administration of medication, which aim to protect residents. Currently no residents manage their own medication and all benefit from support from staff to do so. Medication is stored in a designated room in locked cupboards and trolleys. There is a designated fridge for medication that requires it. On the day of inspection, some drugs were stored outside of the designated controlled drug storage area as it was too small. Subsequent to this inspection the Providers response to the draft report stated that this was Oramorph solution, although did not give the strength prescribed. Our pharmacy inspector advises that Oramorph solution in high strength is a controlled drug and must be stored as such; Oramorph solution in a lower strength is not classed as a controlled drug but it is good practice to store it as such. Therefore the provider is recommended to store all Oramorph solution as a controlled drug. Medication Administration Records are completed with clear details. However, some entries for the application of creams used ticks and not signatures. The Registered Manager stated that from now onwards a different system would be used, which included staff signatures. Qualified nurses administer medication. The Head of Care stated that their competency to do so was assessed and records were seen. It is planned that all nurses will undertake further training to update their knowledge. Residents are treated with dignity and respect. During this visit, staff were observed to be kind and helpful, attend to residents needs in privacy and respond quickly when needed. There is a good rapport between residents and staff. Staff spoken with demonstrated a good understanding of individuals needs and described their roles well. Residents spoken with indicated that staff looked after them well. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are recognised as individuals and are able to exercise some choice over their lives. Residents can choose to take part in group activities or pursue their individual interests; they enjoy keeping in contact with their relatives and friends. Residents can choose what they eat and are provided with good quality and varied meals. Evidence: People move into Firtree House knowing the nature of the service. The pace of daily life is relaxed. People can choose whether to spend time in their rooms or in the communal areas of the home, taking part in group or 1:1 activities or pursuing their own interests. At the time of this visit, residents were at ease talking with staff who responded appropriately and listened to their views. Residents spoken with had no complaints about their care. One resident said that they lived in the home for eight years and liked it; they were friends with the staff who were very nice; they had no complaints Care Homes for Older People Page 16 of 30 Evidence: about anything. There are two Activities Coordinators who work flexible hours dependent on residents wishes and needs; residents can choose to take part in a variety of activities such as collage, painting, knitting or bingo and some enjoyed cookery on the morning of this visit, when they made pies and cakes. A diary for activities in January included arts and crafts, reminiscence, quizzes, music and morning tea. The Activities Coordinators provide 1:1 time in the afternoons for residents who either cannot or prefer not to take part in group activities. One resident spoken with explained that liked to be quiet, preferred to pursue their own individual interests and enjoyed some 1:1 time and visits from their friend. The home provides a well equipped room for residents activities. Small reminiscence areas have been created in the corridors. One bathroom has been developed as a more sensory facility. The home has a pet cat. Residents are encouraged to keep in contact with their relatives and friends if they wish and visitors are welcome at any reasonable time. Visitors can spend time with the residents in the lounges, dining area, the conservatory, or residents own rooms. The Head of Care said that trips out are arranged in the warmer months and that last summer residents enjoyed going to Knowle Park and Hastings. The Activities Coordinators take people for walks to the local park. The home has access to a minibus and is in the process of fundraising for their own vehicle. Residents spoken with said the food was good. One resident explained that because they were diabetic the staff were careful about what they ate; they had to have their food minced up, although they did not need any help in eating and described their favourite foods. The menu is planned in advance and shows a variety of meals. An alternative to the main meal can be provided. Residents can choose what they like to eat and their choices are recorded. Special diets and dietary needs are catered for. Dietary needs and assistance with eating are also mentioned in the Health and Personal Care and Staffing sections of this report. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of residents and their representatives are listened to and receive appropriate consideration. Procedures in place designed to protect residents from abuse would be improved by the assessment of residents capacity together with prioritizing associated staff training. Evidence: At the time of this visit, residents were at ease talking with staff who responded appropriately and listened to their views. Residents spoken with had no complaints about their care. One resident said that they lived in the home for eight years and liked it; they were friends with the staff who were very nice; they had no complaints about anything. A written complaints policy and procedure is available for residents and their representatives and complaints received are recorded. Currently a Safeguarding Vulnerable Adults investigation is being undertaken within a confidential multidisciplinary process. There have been no outcomes to date and issues have not yet been found to be substantiated or unsubstantiated. Therefore these issues have not been included within this inspection report. However this visit does include looking at any regulatory issues relating to Safeguarding procedures. All Care Homes for Older People Page 18 of 30 Evidence: information received since the last Key Inspection is reviewed as part of our inspection methodology. The Registered Manager has an understanding of safeguarding procedures and reporting allegations of abuse. Written procedures are available for safeguarding vulnerable adults. Staff are provided with written procedures and training in the protection of vulnerable adults. The Head of Care stated that some residents who live in the home are diagnosed with Dementia. There were no Mental Capacity Assessments seen in care plans. Subsequent to this inspection the Providers response to the draft report stated that none of the residents whose care plans were seen had mental capacity issues. The Registered Manager stated at the time of inspection that no Mental Capacity Act assessments of any residents had been undertaken. No evidence was provided to show how residents capacity is established or how the Mental Capacity Act is followed. The Commissions website provides guidance about The Mental Capacity Act 2005 for Care Quality Commission staff and Providers of registered care. This states that normal care planning arrangements should already be providing staff with good information about a persons capacities, needs and abilities. A requirement has been made. The Registered Manager stated that as no residents are deprived of their liberty, it is currently unnecessary to complete Deprivation of Liberty Assessments, although they are aware of the process and have the documentation available. The Mental Capacity Act and Deprivation of Liberty Safeguards came into full force on 1st April 2009. During the eight months since then, three people, the Registered Manager, the Head of Care and one senior nurse have completed training in this. The Registered Manager said that other staff have received a presentation. The Head of Care stated that all staff will receive training by December 2010. The Act is designed to protect people who lack the ability to take decisions for themselves. This includes an assessment of their mental capacity. Carers and nurses who take decisions for people who lack capacity have a duty to know about and follow the Mental Capacity Act codes of practice. In order to benefit staff in the performance of their duties, the Provider is recommended to prioritize appropriate staff training in how the Mental Capacity Act affects their work. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy living in a comfortable, clean and attractive environment. Residents benefit from suitable facilities and equipment, which help to maintain their independence. Evidence: The premises are clean, bright, well maintained and attractively decorated. Residents have access to the garden and large decked area. Communal areas consist of a dining area with spacious lounges and conservatory. The home provides a well equipped room for residents activities. Small reminiscence areas have been created in the corridors. One bathroom has been developed as a more sensory facility. Residents are able to personalise their rooms and those seen are comfortable and homely. Some have ensuite facilities. Communal bathrooms and toilets are provided with adaptations. There is a call system in place which residents can use when they need staff assistance. One resident said that staff come quickly when they need to use their buzzer. There are lifts available. Residents are protected by window restrictors, door alarms and radiator guards. 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. Residents benefit from a well established staff team who care for, understand and anticipate their needs and wishes. Residents are protected by the systems in place for staff recruitment. Staff are provided with training which aims to meet the needs of residents, although this could be better evidenced in written records. Evidence: A good rapport was observed between residents and staff, who were attentive and respectful during the visit. Residents spoken with indicated that staff are good and look after them well. There were sufficient staff on duty to meet the needs of residents at the time of this visit. The Head of Care said that there are two Activities Coordinators who work flexible hours dependent on residents wishes and needs. During this visit the procedures for staff recruitment were looked at. Five staff files were seen during this visit. These showed appropriate pre employment checks, with the exception of one file which did not show evidence for all gaps in employment or a recent employment reference. The Registered Manager explained the reasons for Care Homes for Older People Page 21 of 30 Evidence: these and assured the inspector that recruitment was undertaken by the organisations recruitment agency, which held all of the appropriate documentation. It was stated that this would be transferred to the recruitment file in the home. It is the Registered Providers responsibility to comply with the Care Home Regulations 2001, which require a written reference relating to the applicants last period of employment and a satisfactory written explanation of any gaps in employment. No documentary evidence of this was available for one member of staff whose file was examined. The Head of Care described the processes for training as including a Regional Training Coordinator. It was said that courses are provided from a variety of sources including external agencies, the organization, computer E learning and within the home by the Head of Care, who is trained to do so. It was said that most training is E learning with a question and answer competency assessment; manual handling training is practical. The Registered Manager said that there are currently three new staff who are undertaking induction training and that Common Induction Standards are used. It was said that as these new staff are in the process of induction, they currently hold their own records. Therefore evidence of induction records for these three new staff was not available at the time of inspection. A blank induction record template was provided. The Registered Manager stated that induction training includes the risks and procedures regarding choking and swallowing difficulties for residents. The Head of Care stated that Speech and Language Therapy training includes issues regarding choking and swallowing difficulties. It was stated that an external agency provided this for five staff in 2007 and this was cascaded internally within the home to twelve staff in October 2009. The Head of Care said that they are in the process of arranging further Speech and Language Therapy training for all staff, which will be provided by an external agency by December 2010. Certificates for staff who have undertaken Speech and Language Therapy training are kept in their individual files. The template for induction training lists Assistance to Eat and Drink but does not specify choking and swallowing difficulties. It is recommended that it does so in order to show a fully comprehensive picture of this specific training provided by the home. The Registered Manager stated that all staff are trained in first aid, which includes the procedures for choking and resuscitation and that there are currently twenty first aiders on the staff team. The Induction template lists first aid and resuscitation. In December 2009 we received a copy of the new Resuscitation Policy from the organisation. The Registered manager stated that all staff have been trained in resuscitation and the new policy; this has been discussed at staff meetings and staff sign to say they have read and understood this. Staff undertake core training such as Care Homes for Older People Page 22 of 30 Evidence: fire safety, moving and handling, infection control, food hygiene and health and safety. The Head of Care said that some training for specific needs includes Dementia and Diabetes. The Head of Care stated that five senior staff are NVQ qualified, one at level 3 and four at level 2. In addition five care staff have completed NVQ level 2, with a further five booked to start a course this year. Certificates for staff training and qualifications are held in individual staff files. The home also maintains a training matrix for core training. Documentary evidence for staff training provided by the home at the time of this inspection included examples of certificates from staff files and the staff training matrix. Therefore both have been used as evidence within this inspection process and report. It was noted that the staff training matrix contained some recent gaps in entries. The Registered Manager stated that all PIN numbers for qualified nurses were checked as up to date and records were seen; it was said that the one out of date entry was actually current but records had not yet been updated. In order to improve clarity, the Provider is strongly recommended to record this in a format that shows when this was last undertaken and when updates are due and to keep all entries up to date. Staff training is also mentioned under the Health and Personal Care and Complaints and Protection sections of this report. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by an experienced and qualified Registered Manager. Residents benefit from their views being sought about the care they receive and how the home is run. Residents financial interests are safeguarded. Residents are protected by the homes record keeping policies and procedures. Residents benefit from well supported staff. The health and safety of residents is promoted by the testing and maintenance of systems and equipment in the home. Evidence: The manager is experienced in the running of the home and has a management Care Homes for Older People Page 24 of 30 Evidence: qualification. There is a new responsible individual since the last inspection. At the time of this visit, residents were at ease talking with staff who responded appropriately and listened to their views. Residents spoken with had no complaints about their care. One resident said that they lived in the home for eight years and liked it; they were friends with the staff who were very nice; they had no complaints about anything. There is a residents committee and an opportunity to take part in residents meetings. Residents benefit from their views being sought about the care they receive and how the home is run. The organisation has a system in place to assess the quality of care that the home provides. Annual quality assurance questionnaires were last sent out in March 2009, the results analysed by the organisations with the results fed back to the home. There is a system in place for audits of documentation, medication, care plans and health and safety; the Regional Manager audits the home on a monthly basis and a report is provided. The Head of Care stated that staff are supported to undertake their roles on a day to day basis; Formal 1:1 supervision takes place every three months; there is group supervision. Records are kept, which consist of a template for topics discussed. The Head of Care assured the inspector that individual issues are recorded. Small amounts of cash are held securely on behalf of some residents, three of which were checked which tallied with transaction records and receipts. The administrator explained the system for invoicing families and for checking individual residents newspapers and magazines. The latter is a complicated process. The administrator stated that they would request an itemized invoice and formalise records in order to improve the system. Management of issues relating to the Mental Capacity Act and Deprivation of Liberty Safeguards are mentioned under the Complaints and Protection section of this report. There are a range of written policies and procedures available as guidance for staff. Subsequent to this inspection the Providers response to the draft report stated that all policies underwent a complete review in 2009. In December 2009 we received a copy of the new Resuscitation Policy from the organisation. Previously there had not been one in place. The policy is to be used in conjunction with a resuscitation record for individual residents. The latter is mentioned under the Health and Personal Care section of this report. Care Homes for Older People Page 25 of 30 Evidence: A number of records have been looked at as part of this inspection and these have been mentioned within this report where appropriate. Accidents and incidents are recorded appropriately. Records indicate the testing and maintenance of systems and equipment within the home. The premises and the accommodation are monitored with the aim that potential hazards to the health and safety of residents can be identified and addressed. The home has been given a gold good hygiene award two years running by the environmental health officer. The Registered Manager said that the previous problems with the gas heating system had since been resolved. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person shall 30/04/2010 prepare a written plan as to how the service users needs in respect of their health and welfare are to be met. The registered person shall keep the service users plan under review. In order to reflect service users changing needs, the provider must ensure that all information regarding their health and welfare is reviewed regularly, up to date and included in care plans. 2 18 15 The registered person shall 30/04/2010 prepare a written plan as to how the service users needs in respect of their health and welfare are to be met. The registered person shall keep the service users plan under review. In order to protect Care Homes for Older People Page 28 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 vulnerable residents, the Provider must undertake a review to ensure that all care plans include information about a residents mental capacity, including where necessary assessments in line with the Mental capacity Act for those who lack capacity. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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