Care Home: Florence House

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What the care home does well Care plans, where possible, are signed by the resident, indicating that they have agreed and consented to receiving the care, as planned. Stock levels, of medication, were of an acceptable level, indicating that the home had a control of medication coming in and going out of the home. Activities at the home were varied and frequent, providing residents with access to regular stimulation and entertainment. A number of volunteers visit the home and residents we spoke with appreciated their input telling us, `The volunteers are very good at talking to us, always very cheerful`. Residents enjoyed a relaxed and pleasant lunch, where they were served a tasty and nutritious meal. The staff were knowledgeable about the needs of the residents and, as there was a sufficient number of staff on duty, they were able to provide 1:1 attention and provide activities to the residents. The home`s kitchen has been awarded four stars by the local environmental health officer , indicating that residents receive food that has been prepared in a hygienic and safe way. What has improved since the last inspection? One of the requirements has been met: this was regarding offering people the choice of when to have a bath. There has been improvement in the way that the home recruits staff and, on the whole, a requirement that was made about recruitment and staff information, has been met, although further improvement must be made. What the care home could do better: The standard of care planning must improve to ensure that the staff have the appropriate guidance and provide consistent and up-to-date safe care to eliminate any risks posed by substandard care records. The administration of some of the medication must be carried out in accordance with the manufacturer. This is to ensure that people are not placed at any risk of harm. Medication records must record the amount given when variable doses of medication are prescribed. This will ensure that people are not given too little or too much medication. The temperature of the room, where medication is kept, should be monitored and recorded to demonstrate that the quality of the medication is monitored and maintained. When medication is being given the unlocked medication trolley must not be left in an unsupervised manner. This is to ensure that no unauthorised person has easy access to the medication stored within this trolley. The layout of the home could be better to provide better signage and orientation aids to help people find their way about. Areas of the home looked tired and in need of maintenance: the decor needs to improve and discoloured/stained corridor carpets need to be cleaned or replaced so that residents live in a more pleasant and better maintained environment. Residents should have access to a lockable space in their bedrooms to keep their money, valuables and medication in securely. The home`s complaints procedure should be advertised more widely around the home and should be produced in a format that residents can read more easily. Information, about agencies involved in protecting vulnerable adults-now known as safeguardingshould also be made available so that residents, their visitors and staff know who to contact should the need arise. Residents` independent living skills should be promoted and maintained wherever possible and staff should refrain from helping residents with tasks that they are able to do themselves. All required information, including a check from the Vetting and Barring Scheme, must be obtained before any person is allowed to work at the home. This is to ensure that no resident is placed at risk of harm from unsuitable staff. Receipts should be obtained for purchases made by the residents, to include those for hairdressing and chiropody. The training of staff, in safe moving and handling, must improve and competency checks on manoeuvres, must be carried out to ensure that no person is placed at risk of injury due to unsafe moving and handling practices carried out by untrained and unskilled staff. A risk assessment must be carried out to ensure that the manner in how keys are kept- to lock and unlock the door where hazardous substances are stored-is safe and any risks identified should be managed. Key inspection report Care homes for older people Name: Address: Florence House 220 Park Road Peterborough Cambridgeshire PE1 2UJ     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: Elaine Boismier     Date: 1 2 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Florence House 220 Park Road Peterborough Cambridgeshire PE1 2UJ 01733315900 01733702272 florencehouse@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Park Road Baptist Housing Association Ltd care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Florence House is a charitable organisation owned by Park Road Baptist Housing Association Ltd situated in a residential area of Peterborough, close to the Central Park. Accommodation, for twenty-one older people, is provided on two floors in seventeen single rooms and two double rooms, all with ensuite facilities. The home has a large lounge and dining room with a lounge area. There are gardens to the front and rear of the property. The home is near to the city centre of Peterborough has a wide range of shopping and leisure facilities. There are road and rail links from Peterborough to London and other major cities. The fees range from £405 to £450 per week. Further information about fees, including any additional costs, can be obtained from the home. Copies of our reports are available, on request, from the home, or they can be obtained from our website at www.cqc.org.uk 0 1 0 6 2 0 0 9 0 Over 65 21 Care Homes for Older People Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, The Care Quality Commission (CQC), carried out this unannounced key inspection (KI), by two Inspectors, between 9:50 and 14:10, taking 4 hours and twenty minutes to complete. Before the inspection we received ten surveys from the residents; five surveys from the staff and two surveys from health care professionals. We looked at information that we have received about the home since our last key unannounced inspection that included two safeguarding meetings held in September 2009. During this inspection we looked around the premises and looked at some of the documentation. We case tracked two of the fifteen residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with some of the staff who were looking after them. We compared what we saw and heard with the peoples individual records. We also spoke with and watched other people who Care Homes for Older People Page 5 of 31 were not part of our case tracking. We spoke also to some of the other staff, including the Manager. In addition to these described methods we ate lunch with the residents so we could check the quality of food and observe how staff interacted with, and assisted them to eat. For the purpose of this inspection report people who live at the home are referred to as people, person, resident or residents. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The standard of care planning must improve to ensure that the staff have the appropriate guidance and provide consistent and up-to-date safe care to eliminate any risks posed by substandard care records. The administration of some of the medication must be carried out in accordance with the manufacturer. This is to ensure that people are not placed at any risk of harm. Medication records must record the amount given when variable doses of medication are prescribed. This will ensure that people are not given too little or too much medication. The temperature of the room, where medication is kept, should be monitored and recorded to demonstrate that the quality of the medication is monitored and maintained. When medication is being given the unlocked medication trolley must not be left in an unsupervised manner. This is to ensure that no unauthorised person has easy access Care Homes for Older People Page 7 of 31 to the medication stored within this trolley. The layout of the home could be better to provide better signage and orientation aids to help people find their way about. Areas of the home looked tired and in need of maintenance: the decor needs to improve and discoloured/stained corridor carpets need to be cleaned or replaced so that residents live in a more pleasant and better maintained environment. Residents should have access to a lockable space in their bedrooms to keep their money, valuables and medication in securely. The homes complaints procedure should be advertised more widely around the home and should be produced in a format that residents can read more easily. Information, about agencies involved in protecting vulnerable adults-now known as safeguardingshould also be made available so that residents, their visitors and staff know who to contact should the need arise. Residents independent living skills should be promoted and maintained wherever possible and staff should refrain from helping residents with tasks that they are able to do themselves. All required information, including a check from the Vetting and Barring Scheme, must be obtained before any person is allowed to work at the home. This is to ensure that no resident is placed at risk of harm from unsuitable staff. Receipts should be obtained for purchases made by the residents, to include those for hairdressing and chiropody. The training of staff, in safe moving and handling, must improve and competency checks on manoeuvres, must be carried out to ensure that no person is placed at risk of injury due to unsafe moving and handling practices carried out by untrained and unskilled staff. A risk assessment must be carried out to ensure that the manner in how keys are kept- to lock and unlock the door where hazardous substances are stored-is safe and any risks identified should be managed. 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that there is a good standard of information about the home to help them in their decision where to live. They can also be confident that their needs will be assessed, before they move in, to ensure that the home is a suitable place for them to live. Evidence: There is statement of purpose and residents guide that give good information about the home and the services it offers. These documents had been updated to include the new details of the new Care Quality Commission. In addition to this, prospective residents are issued with a brochure about the home and a copy of the homes last annual report which lists, amongst other things, members of its management committee, staff details, the treasurers report and testimonies from current residents. Each resident is also issued with a contract that states the terms and conditions of their stay at the home. Care Homes for Older People Page 10 of 31 Evidence: Residents we spoke to told us they had visited the home prior to moving in to assess its facilities and some knew the home well already, having been involved in a local church. Residents told us it was the homes Christian ethos that particularly attracted them to it. All of the ten residents surveys said that the person received enough information to help them in their decision where to live. During the two safeguarding meetings held, in September 2009, the home agreed that the pre-admission assessment process would need to be improved, to ensure that a person admitted to the home, would have their needs met in a safe and proper way. As part of our case tracking we examined both of the peoples care records and we found that both of these people had their needs assessed before they moved into the home. The assessments contained details, for example, of their dietary likes and dislikes and how they were able to look after themselves. We saw that, from our observations, including talking with the staff and the Manager, that these peoples needs were being met-one of whom was admitted to the home after the safeguarding meetings of September 2009. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a good standard of health and personal care although they can not be wholly confident, that they will be fully protected and safe, due to the current standard of care records and current methods of storage of medication. Evidence: As part of our case tracking we looked at two of the peoples care records and we discussed our findings with the Manager. We noted that there are risk assessments, for areas such as malnutrition and the development of pressure sores: these were actively reviewed each month. This told us that the home was actively monitoring such risks. We also found evidence, from the records and from visiting one of the peoples rooms, that equipment had been provided to reduce the persons risk of pressure sore development. There were, within the care files, a record of the persons life history, to include where they were born and information about their family life. This told us that these people were valued as unique individuals. Care Homes for Older People Page 12 of 31 Evidence: We saw, however, that, although the care plans were reviewed on a monthly basis, these were not reviewed when there was a change of the persons needs. For example, we read that one of the people was able to walk, with the aid of walking sticks and with some guidance from the staff. We observed this person and noted that they were unlikely to be able to walk with this level of independence: the Manager said that the person was highly unlikely to be able to walk with such aids and support and agreed that the care plan was not updated. We also noted that this person was assessed to have unintentional weight loss: a risk assessment was in place and this demonstrated that the person was at a high risk of malnutrition. We saw that they had been weighed, as according to the care plan, each month and that they had experienced a loss of over three kilogrammes since November 2009. Their care plan said that the person was to have their food and drinks, that they had taken, recorded. We could find no record of this and the staff told us that this method of recording had ceased as they considered the person was eating and drinking well, including prescribed nutritional supplements, although the care plan had not been updated to reflect this change of recording of the persons food and drink intake. Following on from this we saw that the same person was assessed, by the speech and language therapist (SALT), and the SALTs guidance, to help the person with their swallowing and talking, was found in the persons room. We asked the person if they were continuing with this guidance from the SALT: they told us that it was considered no longer necessary. We could find no care plan about the SALT guidance and the reason why this guidance was no longer followed. For one of the people, who had a history of experiencing seizures, there was a care plan for this condition although the guidance for the staff did not provide details of how to fully protect the person when they were experiencing these episodes, such as how their airway must be protected. When speaking with a member of staff they were able to tell us what they would do to protect this person if they experienced a seizure and we were satisfied with their response. The care plan for personal care described the person has having capabilities although there was no description as to what the person was capable of doing when providing their own personal care. We saw, when speaking with the person, they were unable to move their right hand and their fingers were bent (contractured) towards the palm. In our examination of their care plans we could find no written guidance for the staff in how to protect the Care Homes for Older People Page 13 of 31 Evidence: persons right hand, from the risk of their finger nails coming into (potentially) harmful contact with the skin of their palm. We saw that, currently, the persons skin of their palm was intact. We found evidence that, wherever possible, the person had signed their care plan, indicating that they had consented to the care provided. The Manager agreed with our findings that the standard of care plan documentation was less than that of an acceptable standard. She informed us that as a result of the safeguarding meetings, of September 2009, she has arranged for some of the staff to attend training in care planning. The home has a small turnover of staff and those staff we spoke with had a good knowledge of the residents needs. As a result of the Managers action to improve the staff training and the standard of knowledge of the current staff we expect the home to improve the standard of care plans and care records as part of the homes quality assurance. All of the ten residents surveys said the person always or usually received the care, including medical care, and support that they needed. Both of the health care professionals surveys said that the residents are supported with their personal and health care and that this support is delivered in a manner that respects and values the dignity of the residents. Comments from the surveys included, for example, The caring is first class and the residents are all treated as individuals and Residents (are) treated with respect. We saw that people were well dressed and had clean hair and finger nails. The hairdresser was visiting the home and we saw that some of the residents were attending the hairdressing salon to have their hair done. During our case tracking and in our discussion with the Manager, we found evidence that residents have access to a range of health care professionals, including SALT, district nursing services, general practitioners and, according to peoples personal allowance records, private chiropody. We looked at the storage, recording and administration of medication. Medication is mainly stored in a drugs trolley that was kept secured to the wall, within the dining area. Although records of the air temperature were not recorded, a thermometer above this trolley recorded the air temperature to be 21 degrees centigrade. The medication policy, in front of the file for the medication administration records (MARS) Care Homes for Older People Page 14 of 31 Evidence: correctly noted that the temperature for the safe storage of medication should not exceed 25 degrees centigrade. It was unclear, due to the lack of records, how the quality of the medication was ensured. The Manager agreed to introduce a record of air temperatures where the medication is kept. On the whole MARs were recorded satisfactorily with a few omissions. It was noted, however, that a medication, Alendronic acid, was given with other medication. This poses a high risk of harm to any resident who has this medication prescribed for them. The blister pack noted that the staff were to read the product information leaflet although the Manager stated that the dispensing pharmacy had not provided such information. She told us that she was aware that Alendronic acid must not be given with food until 0.5 hours later although she was not aware that other medication must not be given at the same time as that of the Alendronic acid. She agreed to take immediate action and she also agreed to contact the dispensing pharmacy to obtain the essential information to guide the staff in the safe administration of this medication. One less positive comment provided in one of the residents surveys said that the home could do better by making sure there is Greater care in the administering of medication although the person did not elaborate further. Stock levels were of an acceptable level, indicating that the home has a control of medication coming in and going out of the home. Where variable doses of medication were prescribed the MARS provided no record of the doses given i.e. one or two. This standard of recording poses a risk of residents receiving either too little or too much medication. The Manager agreed that action would be taken to improve this standard of recording. After lunch we observed how medication was being given to some of the residents. We saw that this was done in a hygienic manner and that the residents dignity was valued. We saw, however, that the drugs trolley was left unlocked and the doors wide open, whilst the member of staff went to give the residents their medication: the trolley was not within the member of staffs vision as they had their back to the trolley. This practice was unsafe and we have made a requirement about this. We saw that the staff interacted with the residents in a respectful and caring manner. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to live a good social life. Evidence: The majority (9) of the residents surveys said that the home provided suitable activities that the person could take part in. A specific member of staff is employed to facilitate activities with residents and details of forthcoming events were advertised around the home and in the residents bedrooms. These included Scrabble, arts and crafts, reminiscence, poetry and movies. Residents we spoke to told us they were rarely bored and that there were regular outings organised by staff: recent trips had included Christmas shopping in Peterborough, a visit to a Farm and one resident told us that they had greatly enjoyed a trip to a local college for an organ recital. A number of volunteers visit the home and residents we spoke with appreciated their input telling us, The volunteers are very good at talking to us, always very cheerful. Residents are actively encouraged to take part in the daily life of the home and one resident told us that they regularly helped to chop the Brussel sprouts, write up the daily menu on the board and organise thank you letters on behalf of residents. Care Homes for Older People Page 16 of 31 Evidence: We saw some of the residents playing a word game with some of the staff and we also saw, as part of our case tracking, that the residents care records contained information of activities that they had taken part in, to include quiz nights, having a manicure and attending prayer and hymn meetings. Whilst we were at the home a local church minister conducted a prayer meeting, where a number of residents attended the service and some of the residents were having their hair done by a visiting hairdresser. Following our last KI a requirement was made, that said Residents should be given choice over their lives especially as to when they have a bath or not. The timescale for this requirement to be met was due by the 5th July 2009. We discussed with the Manager and we also spoke with people, who were not part of our case tracking. Evidence indicated that this requirement has been met as people are offered a choice although they were quite satisfied to have a bath when this was offered to them. We saw, from peoples care records and from the visitors signing in book, that people can receive their guests when and where they like. As part of our case tracking we noted from their care records, that they had spent Christmas day with their family, outside of the home. Another person told us that they have their family visit them and that they enjoy being taken out to the local park, by them, when the weather is warmer. Eight of the ten residents surveys said the person always or usually liked their meals with the two remaining surveys saying that sometimes this was the case. One of the surveys added that the home could do better because (I am) not always happy with the meals but this is being addressed. Lunch on the day we visited consisted of sausage casserole with mashed potatoes, boiled potatoes, Brussel sprouts, carrots and swede followed by lemon tart and custard for dessert. The food was tasty, plentiful and nutritious and the gravy and vegetables were served separately so that residents could help themselves as to what, and how much, they wanted. A good choice was offered: one resident told us that they were been given fish instead as they did not like meat and another resident told us that they were given six different types of vegetables to eat as they did not like potatoes. Lunch was a relaxed and pleasant affair and residents that needed it were given time to eat their meal. We watched one staff member sit beside a resident and sensitively prompt them to eat. This resident was also given a plate guard so they could manage their food more easily. However, we saw some of the staff offer help to residents who could clearly manage to serve themselves, thereby compromising their Care Homes for Older People Page 17 of 31 Evidence: independence. We discussed this finding with the Manager who agreed to take action to ensure that this practice improved to foster peoples independence at meal times. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns will be listened to and action taken to address these. They can also be confident that they will be safe from the risk of harm. Evidence: Details of how to complain were included in the homes guide for residents and their contract of residency. In response to the safeguarding meetings, of September 2009, action had been taken to improve information about the homes complaints procedure: there was a poster on display in the entrance way giving details of how to complain. However, this was in a position not easily accessible by residents and was also produced in small print, making it hard for people with visual impairments to read. Residents we spoke to during our inspection told us they felt able to raise concerns and particularly identified the homes Manager and administrator as staff they could talk to and who would take their concerns seriously. One resident told us they had complained that residents were not getting enough protein at their tea time meal. They stated that staff listened to this and, as a result, two dishes were offered now instead of just one. Staff we spoke to had a satisfactory understanding of the adult protection systems in their local area and the part they play should the need arise. We viewed the homes policy on adult protection which was adequate. Staff had signed to say that they had read and understood this policy. Care Homes for Older People Page 19 of 31 Evidence: As a result of a complaint made against the home a safeguarding meeting was held in September 2009 and this was reconvened later in the month. This was the first experience the home had of safeguarding procedures and, initially, representatives of the home found the safeguarding procedures worrisome. However, by the second, reconvened meeting, it was felt, by the safeguarding agencies, that the representatives of Florence House, had a greater understanding why such meetings were held and how areas of care and management could improve (these we have noted on in this inspection report to include care records and the availability of information of how to make a complaint). The allegations made against the home, were not substantiated. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents bedrooms are pleasant however some of the areas of the home are not well maintained and give it tired and neglected atmosphere. Evidence: Four of the five staff surveys had comments about the homes environment, to include, (Florence House) is friendly and homely and Beautiful atmosphere. One comment from these surveys was less positive, saying that the home could do better to Improve decor, modernise. Newer equipment. We undertook a tour of the home and found it to be clean, hygienic, free from strong smells and residents bedrooms were comfortable. The home was surrounded by a well-maintained and easily accessible garden- one resident told us that they greatly enjoyed walking out there everyday. Another resident told us that they liked their bedroom, as it had large windows that let a lot of light in, and went on to say, Its the best in the house. Another resident also liked their bedroom as it overlooked the garden, however they wished it was a little bigger. We noted the following shortfalls during our tour. The layout of the home has many corners and corridors and we found there were few signs and orientation aids to help people find their way around easily. Carpets along some of the corridors were stained/discoloured and paintwork on doors and skirting boards was scuffed and Care Homes for Older People Page 21 of 31 Evidence: marked, giving the home a rather neglected feel. Pictures were placed along some of the corridors but some were hung too high up for residents to see easily. None of the bedrooms we viewed contained a lockable space for residents to store money, valuables or medication safely. Residents have access to a large lounge area but all the chairs were lined up against the wall making it very difficult for them to communicate easily with each other and also difficult to see the television without turning their heads. Every seat in this lounge had a continence aid on it, giving the home a rather institutional feel. We discussed the issues about the environment of the home, with the Manager, for her to consider what action must be taken to improve the homes environment and we have also made a requirement about the environment of the home. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be cared for by generally well trained staff although they can not be fully confident that the current recruitment procedures will protect them from unsuitable staff. Evidence: All of the ten residents surveys said that the staff were always or usually available when the person needed them. We saw that the staff were working in an unhurried manner and had the time to give 1:1 attention to the residents. We noted that the staff promptly responded to call bells. According to the Manager the home currently employs nineteen care staff and ten of these have a National Vocational Qualification, Level 2, or equivalent i.e. 52.6 indicating that people should be in safe hands. We have noted that within the last inspection report staff information (Standard 29) was reported under Standard 18 (Complaints and Protection). For the purpose of this inspection we assessed staffing information, and staff recruitment procedures under this section, Staffing and under Standard 29. At our last KI a requirement was made that stated The manager must protect both residents and staff by ensuring that safety checks are carried out on all members of staff and volunteers. The timescale for action was due by the July 2009. To assess the progress made to meet this Care Homes for Older People Page 23 of 31 Evidence: requirement we examined two files of staff who were recruited since our last KI. We found that all the required information was available, such as proof of identification and two satisfactory written references. Criminal record bureau checks were also applied for, before the person was allowed to work at the home. There was, however, one piece of required information that was not obtained before the person was allowed to work at the home: the person commenced working at the home without a check to see if the member of staff was entered on the Vetting and Barring scheme. The Manager agreed that this was the case. As this requirement was not met in full we have made a new requirement. We observed how this member of the staff was interacting with the residents and we also looked at their record of supervision. We were satisfied that the persons interaction with the residents was appropriate and respectful and that their work performance was monitored by the Manager. All of the five surveys from staff said that the person was satisfied with their induction and ongoing training. One of these surveys said Staff has the opportunity to develop their careers e.g. they get the opportunity to do various courses that are relevant to do the job. Another of these surveys said that the competency checks of staff could be better by adding (The) management of how well staff are applying their training on the job, consistent with clients specific needs i.e. checking that staff are competent when doing their work. Examination of two staff files and speaking with some other members of staff, including the Manager, evidence indicated that the staff have opportunities to attend training, such as dementia care awareness. We discussed the content of the induction training programme, with the Manager, and have made suggestions how this could improve to include, for example, infection control and safeguarding awareness. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they live in a home that is generally well-managed. Evidence: The Manager has demonstrated a willingness to improve the current standards of care records. Following the safeguarding meetings, held in September 2009, she has taken action and has accessed training for some of the staff to attend, to improve the understanding and improve the current standard of care plans. In addition, although this could be better, she has improved the availability of information about how to make a complaint, in response to an outcome of these safeguarding meetings. This tells us that the Manager is responsive to findings and willing to take action to address any identified shortfalls within the service. We also found that she agreed with our findings of our inspection and that she was eager to take action to improve areas of concerns that this inspection had identified. One of the two requirements has been met with the second requirement being almost met. This tells us that the Manager is fully aware of her legal responsibilities as a Care Homes for Older People Page 25 of 31 Evidence: Registered Manager. The home receives visits, at least once a month, by a representative of a the registered provider. Reports for these visits were seen for November and December 2009 and these recorded views of residents and staff and audits of documentation and the environment. As part of the homes quality assurance we saw that the management team for the home had taken views of residents and, according to the Manager, these have yet to be collated to formulate an action plan. The home safeguards some, but not all, of the peoples monies. We counted three of these peoples monies and found, generally the record of balances, reconciled with the amount of monies available. There was, however, no receipts obtained, by the home, for items such as hairdressing and chiropody, to demonstrate that the items paid for, were valid. The Manager agreed to take action to improve this area of protection of residents. Records for emergency lighting; hot water temperatures; fire alarms; certificates for service of the hot water and central heating boiler and the hard (electrical) wiring of the home were seen and all of these were satisfactory and in date. As part of our case tracking we visited the two peoples bedrooms and we found that portable appliance tests had been carried out, and were in date, for items such as televisions and bedside lamps. The staff told us, and this was confirmed by two of the staff training records, that they have attended training in fire safety. The homes kitchen has been awarded four stars by the local environmental health officer, indicating that residents receive food that has been prepared in a hygienic and safe way. As part of our case tracking we observed how the staff assisted these people in transferring from their chair to their wheelchair. For one person this was carried out in a safe manner; for the second person this was not the case. We saw that the staff had applied a moving and handling belt around the persons waist although this was not used: the person was assisted out of their chair, by the staff levering the person, with the use of their arms. This is not acceptable practice and we have made a requirement about this. We looked at both of these two staff training records and we spoke with one of these people. We found that both of the staff had attended moving and handling training although the latter member of staff had not attended this training since working at the home. Although there is no legal requirement for moving and handling training to be Care Homes for Older People Page 26 of 31 Evidence: domain specific, this is good practice. The Manager agreed to take action to improve this standard of care. We saw that the keys to the room where hazardous substances are stored, were hung on a hook outside the door and were accessible to any of the residents. The Manager stated that no risk assessment had been carried out with regards to the manner of where these keys are kept, but agreed that she would carry out a risk assessment. Care Homes for Older People Page 27 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The storage of medication must be kept safe at all times. This is to ensure that no unauthorised person has access to medication. 20/01/2010 2 19 23 Corridor carpets must be cleaned and scuffed and badly marked woodwork must be repainted. You must do this so that residents live in a pleasant and well maintained environment. 01/05/2010 3 29 19 All the required information, including Vetting and Barring checks, about staff, must be obtained before they are allowed to work at the home. This is to ensure that no resident is placed at risk of harm by unsuitable staff. 02/02/2010 Care Homes for Older People Page 29 of 31 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 4 38 13 Staff must follow safe moving and handling practices. This is so that no resident is placed at risk when being assisted to move by staff. 21/01/2010 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 16 The complaints procedure should be made more accessible and visible to residents so they know what to do if they want to raise concerns Care Homes for Older People Page 30 of 31 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. 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