Care Home: Five Stacks Residential Home

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What the care home does well This is primarily a family based service with the proprietor in daily contact and both his daughters working in the management team. The ethos of the service has always been to provide a standard that the proprietor and his family would be proud to use themselves. This ethic has been added to over recent years by the developments in meeting the Care Homes Regulations 2001 and the service has as a whole always strives to improve its delivery of care. The coalition between the management team has strengthened the service delivery and allowed members to develop their strengths and skills. The attitude and approach of the staff towards service users living at the home is not only kind but also respectful. They carry out their duties in a calm and relaxed manner that permeates throughout the whole home. There is a strong emphasis on person centred care in the organisation of the staffs working day, with priority being given to spending time with service users particularly in social activities. The premises are maintained to a high standard and provide accommodation that supports residents needs. Activities form an integral part of the daily routine of the home and provide residents with diversion and occupation. The number of staff who holds a recognised qualification has been steadily increasing and supports the quality of care support provided at the home. What has improved since the last inspection? There is currently building work underway to develop a new wing accommodating six further bedrooms and community lounge with facilities. These works are planned to be completed in October 2009. The manager stated they plan to increase numbers from 24 residents to 30 and will liaise with the registration team regarding this. Residents are all fully aware of the proposals and works. Residents spoken with spoke positively of this change overall and the home has plans to follow a clear consultative process and ensure the Care Quality Commission CQC is fully informed of the completion of the building progress and any amendments required regarding their registration for an increase in numbers. The ongoing development of the management team and as a consequence the staff structure. The recognition of individuals` strengths within the team provides stimulation and increases the self-esteem of the team members. This aids the retention of staff and builds on the quality development of the service. The appointment of an activities coordinator supports the existing work in providing stimulation to residents daily lives and allows the service to further develop this essential part of care delivery. What the care home could do better: An audit system to check the signing, omissions of medication and transcribing of medication on MARS sheets must be in place so that possible medication issues can be monitored and good practice is always adhered to. More one to one recordings in residents social care notes would increase staffs appreciation of the diversity of their individual needs. The home should ensure a consistent and appropriate supervision and appraisal structure is in place and maintained for all staff, ensuring appropriate records are kept. The home must ensure regular fire drills are undertaken by all staff and record the date, time and names of all staff attending. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Five Stacks Residential Home 209 Point Clear Road St Osyth Clacton on Sea Essex CO16 8JD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Laker     Date: 0 5 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Five Stacks Residential Home 209 Point Clear Road St Osyth Clacton on Sea Essex CO16 8JD 01255820417 01255820417 fivestacks@tinyworld.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr John Sidney Donhou care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 24 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Date of last inspection Brief description of the care home Five Stacks Rest Home is a former family dwelling house that has been extended and improved to form the present accommodation. The detached house is located within a residential area. The accommodation is within single occupied bedrooms on the ground and first floor. There is a passenger lift available. The communal space is ample, there being a main lounge area and a kitchen/dining room. The decoration, furniture and fittings were of a high standard and the whole house represents a comfortable living Care Homes for Older People Page 4 of 30 Over 65 0 24 Brief description of the care home environment. The front of the property has been laid to hard standing but is enclosed by attractive trees and shrubs. The rear garden is large and features an enclosed fish pond formally a swimming pool with seating and and sun terrace with extensive lawns. The garden is also enclosed with attractive trees and shrubs The home changed registered category of care to Older People Dementia Care in 2004. There were conditions attached to the registration that required the home to continue to review and develop the accommodation and staff training in dementia care. There is currently building work underway to develop a new wing accommodating six further bedrooms and community lounge with facilities. These works are planned to be completed in October 2009. The manager stated they plan to increase numbers from 24 residents to 30 and will liaise with the registration team regarding this. Residents are all fully aware of the proposals and works. The home has plans to follow a clear consultative process and ensure the Care Quality Commission CQC is fully informed of the completion of the building progress and any amendments required regarding their registration for an increase in numbers. The current rate of fees for the home ranges from 550.00 pounds to 700.00 pounds per week 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: The quality rating for this home is two star. This means that people who use this service experience good quality outcomes. This key unannounced inspection looking at the core standards for care of older people took place on a weekday between 10:00 and 16:00. The registered manager and deputy were available on the day of inspection and the staff present throughout the day assisted with the inspection process by supplying records and information. This report has been compiled using information available prior to the visit such as surveys sent out, evidence found on the day of inspection and the annual quality assurance assessment (AQAA), which is required by law and is a self assessment completed by the service. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. This document will be referred to as the AQAA throughout the report. During the day the care plans and files for four of the residents were seen as well as Care Homes for Older People Page 6 of 30 three staff files, the policy folders, the medication administration records (MAR sheets), some maintenance records and the fire log. The manager also supplied a copy of the duty rota, the menus, and other pertinent documentation which was required. A tour of Five Stacks was undertaken and eight residents, four members of staff as well as the domestic staff were spoken with. The home was clean and tidy offering homely accommodation to the residents. The residents seen were relaxed and clearly felt at home in the environment using all areas of the building. All the records and files were generally well maintained and easily accessible. Interactions between staff and residents were friendly and appropriate. What the care home does well: What has improved since the last inspection? What they could do better: An audit system to check the signing, omissions of medication and transcribing of medication on MARS sheets must be in place so that possible medication issues can be monitored and good practice is always adhered to. More one to one recordings in residents social care notes would increase staffs appreciation of the diversity of their individual needs. The home should ensure a consistent and appropriate supervision and appraisal structure is in place and maintained for all staff, ensuring appropriate records are kept. The home must ensure regular fire drills are undertaken by all staff and record the Care Homes for Older People Page 8 of 30 date, time and names of all staff attending. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect to have an assessment and assurances that their needs can be met prior to entering the home. Evidence: The statement of purpose has not been altered since the last inspection and there have not been any changes in the service or the way it operates that would prompt this. The management team were advised to keep this document under review and ensure that it continues to represent the way in which the service operates. The relative of a resident spoken with during the inspection was clear that they had received information about the home prior to their family members admission via a service users guide and had been able to visit the home on several occasions as part of the admission process. Care Homes for Older People Page 11 of 30 Evidence: The assessments of three recent admissions to the home since the last inspection were inspected. All of the assessments seen were noted to have been completed prior to the admission date and cover the all areas relating to the health and welfare of individuals. This information was usually supplemented by a social services assessment. Attention to dates, times and signatures was discussed with the registered manager, this must be given more prominence so it is consistently maintained on documentation. The registered manager reported that pre-admission assessments were undertaken by a senior member of staff at the prospective residents own place of residence or at hospital depending on the needs and circumstances of the individuals at the time. The AQAA states We ensure that potential service users and their families are given enough time and literature on our home and services, by giving them unlimited time and advice from the first initial telephone call or knock at the door, sending brochures and service user guide and statement of purpose. We then invite them to visit the home unplanned on as many occasions they so wish. We invite them to come for a coffee or for lunch for informal chat with management. We ensure that they visit other homes to ensure they make the right choice for them. We like to advise them to stay for a respite break or a four week trial before making a final decision of home choice ensuring we can meet all their needs and they are happy with our service. A detailed assessment, pen picture and care plan would then be implemented, working closely with the service user, their families and multi disciplinary teams to ensure the appropriate care package is in place for the individuals needs. Residents spoken with reported that they had experienced this approach and found it helpful and reassuring. One surveys returned by a relative stated It would be my residential home of choice, were I ever to require residential care. Five Stacks does not provide 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. This judgement has been made using available evidence including a visit to this service. Residents can be confident that staff understand how to support them consistently. Evidence: The files of four residents were read to consider how the service uses care planning to support residents. The files have been re formatted since the last inspection to ensure they are more person centred. They are headed by a full -page description of the residents past and present life and give an overview of their strengths and needs. The actual care-planning documents contained reference to each of the daily living tasks and these were set out with needs, goals and actions identified. The entries provide an outline of the individuals needs and how staff should support these. the manager stated We like to treat the person not the illness. For example one care plan detailed preferred priorities of care and power of attorney arrangements and liaison and another detailed that in relation to a dementia problem one resident has to Care Homes for Older People Page 13 of 30 Evidence: go for a walk every day to help with this. The inspector was shown seperate documentation that had been devised from a piece of quality assurance work in relation to meal times. These contained a good level of person centred descriptions of individual residents abilities at mealtimes and how staff should offer support. These are also held in the kitchen as reference for staff serving meals and the descriptive style of these documents is used as a basis for reviewing other areas of their care plan. In all cases the care plans were reviewed regularly and updated information was added although in some cases the actual care plan instructions had been superseded by entries indicating that no change was required. The manager was advised to review this practice of recording. Residents records relating to health care visits and instructions in meeting health care needs were included in the care planning document and where appropriate records of issues such as fluid intake and weight were monitored. The administration of residents medication was observed. The service operates a monitored dosage system (MDS) for permanent residents. The pharmacist makes this up and has accompanying computer generated records of the prescription instructions for each drug the resident takes. Residents who are staying on a respite arrangement would not be included in this system and therefore staff complete handwritten records at the individuals admission. These contain the name of medication, their strength and the dosage to be taken. Both sets of records were up to date and maintained appropriately however it was noted that some transcribed medication records did not evidence two signatures to ensure the risk of a resident receiving the wrong medication is reduced. The observation of staff giving out medication demonstrated a competent adherence to the current pharmaceutical guidance. Staff who are responsible for dispensing medications have all undertaken a competency based medication course. The service has a written procedure for staff to follow in relation to the care of residents who are dying. The compliments book pays tribute to the way in which they have attended to this and contains the following: My relative was always treated with respect and individual care and attention. Thanks as well for the attention given to relatives in the last hours of the residentslife when staff supported them with nutrition needs and emotional needs. 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. This judgement has been made using available evidence including a visit to this service. Residents can expect the service to provide opportunities for stimulation and occupation that suits their abilities and preferences. Residents benefit from a good varied range of activities and from good links to the local community. The nutritional needs of residents are met. Evidence: The service continues to demonstrate a commitment to offering residents opportunities for fulfilment and occupation. The notice boards in the home advertise a weekly activities planner. This planner is used as a basis for the staff to undertake activities although flexibility is used so for example on the day of the inspection visit a singalong was being undertaken and for those that did not want to take part, word games and reminiscence games of places residents had visited was underway. The service has appointed an activities coordinator who works on a Tuesday and Thursday, with a lead in coordinating and collating ideas for activities and documenting how successfully residents respond to activities on offer as well as gaining insight into their past interests. It was agreed following discussion on the day of inspection that more Care Homes for Older People Page 15 of 30 Evidence: one to one recordings in residents care notes would increase staffs appreciation of the diversity of their individual needs. These records assist the home in understanding how successfully the provision has been delivered and support the planning of future activity initiatives such as the development of an allotment/pot plant area in the gardens in a response to one residents horticultural background. The team have developed some innovative thinking in providing activities such as the use of current IT memory games and old style games such as a beetle drive. They also incorporate things such as a memory supermarket game, carpet bowls, hand massage and some residents take part in setting the dining tables and wash up. A recent fete had been held where they had a band and a bar be que. Also on pancake day the residents were able to toss a frozen pancake. Verbal feedback from relatives provided to the inspector and in quality assurance responses demonstrates that relatives see the way in which the service occupies and stimulates residents is seen as a key part of their success in caring for residents. Relatives were seen visiting frequently during the inspection of the home. Those spoken with were confident about the way in which their involvement was welcomed by the home and saw their role as a partnership with the staff group in supporting the resident. One relative talked about the way the home accommodates a visit for them and their relative every two weeks to a local pub and they were over the moon they were able to see their relative in different surroundings as well as the home. The meals are all home cooked and a printed menu is available for residents who can access this to choose their meals. The staff also employs a use of visual prompting in helping residents to choose meals by presenting pictorial flash cards of food for residents to make a choice from. The service conducted a quality service audit with residents that concentrated on mealtimes which started in 2007. This has been continued and is based on variations of residents being encouraged to make their own choices with regard to food. For instance one survey encouraged residents to help themselves to the vegetables for each meal from serving bowls placed at their table. The way in which residents responded to this and how this affected their intake of vegetables from their normal diet was recorded over a period. At the end of the trial the staff could identify to what extent the opportunity for choice was helpful to residents and to what level they should support them in making the choices. This continues to be a good piece of person centred work that has given the staff insight into the individual as well as providing opportunities for dignity and respect at meal times. Care Homes for Older People Page 16 of 30 Evidence: 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. This judgement has been made using available evidence including a visit to this service. Residents can feel confident they will be listened to and their concerns acted upon and also be assured that all carers are adequately trained to safeguard their welfare. Evidence: The services complaints policy has not been changed and continues to meet the National Minimum Standard (NMS). Staff spoken with were aware of the complaint and safeguarding procedures to be followed if a concern was brought to their attention. The relatives spoken with at this inspection visit were aware of the policy and procedures and were confident that the service would resolve any issues they brought up. There is a log maintained of all complaints and compliments received in the home. No complaints have been recorded in the previous 12 months. The AQAA confirms this and also tells us All staff, service users and visitors are aware of policies and procedures, complaints and comments book in every service users room. We seek and welcome complaints and feedback as we are always looking to improve our service. To assist our service users with knowledge of how to complain, we have a notice in communal areas with a picture of the manager and easy steps to follow to guide them with this matter. All staff and support networks have relevant POVA, CRB and reference checks before entering the home. All staff have POVA training and our policies and procedures have been reviewed and updated. The management and proprietors always have time daily to ensure service users, staff, professional and Care Homes for Older People Page 18 of 30 Evidence: relatives are aware they are there to listen, this is made obvious by them being free to walk around the home with ample time to give support and seek information. Further work is being considered with regard to ensuring that those residents with cognitive impairments are able to make their views known, and this was discussed with the manager as a point of development for a service that offers a specialist support to people with dementia. Other initiatives have been made in ensuring that anyone living, working or visiting the home can make their views known. This has been through the placing of an individualised communications book for suggestions or concerns in each residents bedroom, and the instructions on the front of the book invites people to make their observations and views known by completing the book, which is read by the senior care staff at the end of each day. A relative spoken with said they used the book and had found this to be a useful medium for raising minor issues and passing on compliments. The home has a safeguarding adults policy and the staff have all been trained in recognising and reporting signs of abuse. 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. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well maintained and encourages their independence. Evidence: A physical tour of the building was undertaken with the proprietor. This tour included all communal areas and bathrooms, the laundry and some residents bedrooms. All areas of the home were clean, fresh, homely and welcoming with no odours. The AQAA informs us We take pride in our home, and its safety as a home for our service users and as a work place for our staff. Continuous maintenance is in place and a maintenance book for staff to record works to be carried out, this is checked daily by management. All staff are fully trained in Health & Safety. We are always seeking new ideas and improvements. A full-time cleaner in place and equipment to ensure a high standard of infection control is carried out at all times. They also reported that they had improved in the last twelve months by developing a pond with fish and fountain, with seating areas and a summerhouse. New carpets have been fitted in the lounge, hall and dining room. All paint work has been updated throughout the home, and additionally building work is currently underway to provide a new wing with a new lounge, conservatory, further dining room, further kitchen area, treatment room, another bathroom with hoist, disabled toilet, another lift and six further bedrooms with a further secured landscaped garden area. Care Homes for Older People Page 20 of 30 Evidence: The manager stated on the day of inspection We provide a homely, comfortable, safe environment for residents with different communal areas in which residents are able to socialise if they wish. Bedrooms have ensuite facilities and comments from residents families and visitors remark on the home having a welcoming and lovely friendly atmosphere, and is always well appointed and clean. Areas are very well maintained and maintenance staff are efficient and active in sorting out any problems quickly and efficiently. Relatives spoken with spoke positively of the environment and the services provided. Staff training and annual refresher infection control training is planned as part of the homes ongoing training programme. There is currently building work underway to develop a new wing accommodating six further bedrooms and community lounge with facilities. These works are planned to be completed in October 2009. The manager stated they plan to increase numbers from 24 residents to 30 and will liaise with the registration team regarding this. Residents are all fully aware of the proposals and works. Residents spoken with spoke positively of this change overall and the home has plans to follow a clear consultative process and ensure the care Quality Commission CQC is fully informed of the completion of the building progress and any amendments required regarding their registration for an increase in numbers. Care Homes for Older People Page 21 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. This judgement has been made using available evidence including a visit to this service. Residents are looked after by a staff team who are aware of their needs and wishes and are subject to a thorough recruitment process and can be confident that the staff that have sufficient skills to support them. Evidence: Staffing levels are maintained appropriate to the needs and number of people living in Five Stacks. Individuals consulted felt that there are generally always sufficient staff available when they need them, and relatives consulted felt that staff have the right skills and experience to look after residents properly. Staff members stated that they all support one another and a number of staff have been at the home for many years. Throughout the inspection visit the atmosphere was calm and peaceful. Service users consulted with also commented that they did not feel rushed at any time of the day, they were given time to get up and did not feel that staff were stretched. The staff interacted with residents in a respectful and pleasant manner. People living at the home and their relatives gave very positive feedback about the staff employed to work at the home. One resident stated Staff are very helpful and very caring and another commented This is the best home I know and I am very happy with what is done for me here. Discussion with the manager and examination of records confirmed that the service is Care Homes for Older People Page 22 of 30 Evidence: proactive in its staffing, recruitment and training, with planning for the potential needs of people who may use the service in the future. Staff files were examined to determine how the service carried out its recruitment process. These documents on the files seen demonstrated a robust approach with checks made on the persons Criminal Records Bureau (CRB) check, and the Department of Health Safeguarding POVA first list, as well as two written references, and proof of the persons identity. These with the completed application form assist the service to determine whether the person is of a suitable background to work with vulnerable people. Training needs are documented and staff can identify their own training needs. The manager was aware of staff training needs and organised training on a regular basis. The staff training programme is ongoing and a matrix of training staff currently held was available. This provides both staff and managers with an at a glance understanding of when qualifications have become outdated and where staff have gaps in their skills and development. The training plan provided staff with courses to give them skills in health and safety issues such as fire safety training, food handling, medication and moving and handling. In addition there were dementia, deprivation of liberty, mental capacity act, privacy and dignity, palliative care and NVQ qualification courses undertaken. Staff spoken with including the cook confirmed they attended training courses, some planned that week and that these were very helpful. In addition a discussion with the manager indicated that these course had influenced the homes practice, for example the dementia awareness course had highlighted that red doors as an indicator for toilets were beneficial and the deprivation of liberty course raised an awareness whereby do not disturb signs had been distributed to all service users for use. The development of individual training profiles that use information gathered from supervision and residents needs assessments further enhances the skills base of the service. The AQAA the service provided to the Commission indicated that 15 of the current 22 care staff held an NVQ level 2 or above. This exceeds the NMS of 50 of staff holding a recognised qualification. Evidence was available to confirm that staff meetings take place regularly where training, activities, new staff and policies and procedures are some of the things discussed, the outcomes of these meetings are cascaded through the staff tiers and the areas to ensure good communication throughout the service. The AQAA indicates, the staff team considers itself capable of keeping abreast of changes in legislation. They analyze results of Quality Assurance questionnaires and compile from that the development of the service. The staff believe that they provide a service that meets the needs of the service users in their care. The service has a commitment to listening to both staff and service users and regularly making changes Care Homes for Older People Page 23 of 30 Evidence: to their practice when offered best practice recommendations to promote improvements. Care Homes for Older People Page 24 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. This judgement has been made using available evidence including a visit to this service. Residents and relatives can be confident in the operation of the service and the leadership provided by the management team. Evidence: Since the last the previous registered manager has left. The manager currently in post has held the post since August 2008 and is also one of the proprietors of the business. She has been involved in running Five Stacks since it opened in April 2000. An application has been made for registration to the CQC and additionally she holds the Registered managers award and NVQ level 4 qualifications. She confirmed that she did feel supported in her role and that staff had supported her and that they all worked well together. A deputy manager has also been recruited since the last inspection and has been in post since September 2008. The management tasks have been reviewed and shared between the Management team made up of the registered manager, deputy and administrators. This Care Homes for Older People Page 25 of 30 Evidence: arrangement not only makes better use of the time available to the manager, but also utilises the skills and strengths shared in this team. One of the administrators for example has implemented the quality assurance programme and carried out the mealtime audit, while another had been instrumental in developing the culture and ethos in the home. This provides opportunities for the manager to concentrate on skills and development of the staff team through supervision and training. There is continuing evolvement planned with the senior care staff taking a lead in areas of the homes development. The manager stated We all work together and take more responsibility for the atmosphere and development of the home. The AQAA states The well-being of the service users is at the forefront of the managers and proprietors minds, we have a strong family run environment and ethos, all service users are thought of as our Grandmothers or Grandfathers. She demonstrated a good knowledge and understanding of the service and of care and management practices, and training records showed that she attended training to update her skills and knowledge. Residents and staff spoken with reported that the manager was supportive and approachable, and it was noted that she spends time working alongside staff in the home, and therefore provides a good level of support and was able to monitor practices. Another initiative in this area yet to be implemented is that of staff members observing their colleagues practice to ensure consistency and support each other in understanding the diversity and individuality of each service users needs. The service holds monies on behalf of some residents and the records for these were checked at this visit. They demonstrated a robust system of auditing and provided evidence of both income and expenditure with associated receipts. The service operates a constant system of monitoring customer satisfaction including ongoing audits. Responses indicated a high level of satisfaction of the care and services provided at the home. People spoken with feel the manager is very approachable and runs the home well. One person said, the manager and staff are very kind and helpful. The home had systems in place to maintain the health and safety of the home, and a clear policy statement of the arrangements to maintain health and safety in the home, including employer and employee responsibilities. Staff training records showed that staff had received training in relevant health and safety topics, including the moving and handling of people. The home maintains records to show that equipment and utilities are regularly serviced, and that appropriate internal checks are carried out (e.g. routine testing of fire alarms and emergency lighting, checking of bath and shower hot tap temperatures, checks on central hot water temperatures re risk of legionella.) The home has a range of risk assessments on safe working practices, including fire risk assessments and the use/storage of chemicals (with hazard sheets available for Care Homes for Older People Page 26 of 30 Evidence: the chemicals used). Fire drills are not consistently undertaken at present and need to be held on a more regular basis to safeguard residents and ensure staff are aware of the appropriate actions to take. The last fire drill held was recorded in January 2009 and there have been none since. Care Homes for Older People Page 27 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 28 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 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 12 More one to one recordings in residents social care notes would increase staffs appreciation of the diversity of their individual needs. The home should ensure a consistent and appropriate supervision and appraisal structure is in place and maintained for all staff, ensuring appropriate records are kept. The home must ensure regular fire drills are undertaken by all staff and record the date, time and names of all staff attending. 2 36 3 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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