Care Home: Foley House

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What the care home does well The manager operates a robust recruitment process that ensures the right people were employed to work at the home. A family member told us they felt their relative was "Well looked after". Professionals we spoke with told us they felt people were happy living at Foley House. The staff members demonstrated good knowledge of how each person preferred to be cared for and supported. Visitors are always made welcome, and are able to develop a rapport with management and staff. What has improved since the last inspection? Since the previous inspection of this service more staff members have achieved the level 2 qualification in British Sign Language to enable them to communicate more effectively with people living at the home. Some communal areas of the home have been refurbished to continue to keep the environment a pleasant place to be. What the care home could do better: Medication administration practices within the home need to improve in order to ensure the continued health, safety and well being of the residents. Daily recording needs to be more detailed to accurately reflect the care and support that is provided for each individual. Detailed daily records will help the manager to audit the care being provided for people, and ensure that staff are following the guidelines in the care plans and are meeting peoples` assessed needs. Risk assessments should be undertaken when people are admitted to the home in order to minimise any potential risks of harm or injury. The system of staff supervision needs to be routinely adhered to. This is so staff have the support and guidance they need to carry out their duties safely. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Foley House 115 High Garrett Braintree Essex CM7 5NU     The quality rating for this care home is:   one star adequate 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: Jane Greaves     Date: 0 4 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 31 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 31 Information about the care home Name of care home: Address: Foley House 115 High Garrett Braintree Essex CM7 5NU 01376326652 01376326652 enquiries@foleyhouse.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Foley House Trust care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 sensory impairment Additional conditions: The maximum number of service users who can be accommodated is 21 The registered person may provide the following categories of service: 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: Sensory Impairment - Code SI Date of last inspection Brief description of the care home Foley House offers residential care to deaf and deaf/ blind adults. The premises have three floors and were originally built in 1881. Some areas of the home would not be easily accessible for those requiring the use of a wheelchair. The main building has seventeen rooms, most of which have en-suite facilities. There is a choice of several sitting areas and there is a separate dining room. In addition there is a purpose built unit providing modern facilities which comprises of four en-suite bedrooms, assisted bathroom, training kitchen, dining area and recreation room. Care Homes for Older People Page 4 of 31 Over 65 0 21 Brief description of the care home This facility is also used for activities for the service users. The home is currently registered to cater for 5 day care service users. The current fees payable for care and accommodation range from £473.80 to £695.19 per week depending on peoples assessed needs. Additional charges are made for Hairdressing, Chiropody and newspapers. This information was provided by the registered manager during the visit to the service in August 2009. Care Homes for Older People Page 5 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit that took place over 8 1/4 hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent observing and interacting with some people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent us the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Care Homes for Older People Page 6 of 31 Views expressed by visitors to the home during the site visit and some professionals involved with the home have been incorporated into this report. Feedback on findings was provided to the care manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager, the staff team and visitors for the help and co-operation throughout this inspection process. The previous key inspection of this service took place on 23rd August 2007. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs will be assessed before moving into Foley House, this may not include sufficient detail for staff to provide person centred care. Evidence: The homes Statement of Purpose and Service User Guide were comprehensive providing people considering moving into the home with a clear picture of the services and facilities they may expect to be offered. Foley House has a web site for people to access that provides comprehensive information about the services and facilities provided at the home including some photographs. The managers AQAA stated that wherever possible prospective residents were visited in their own home and told about what the care home has to offer them, and encouraged to visit the care home as many times as they wished prior to admission. Care Homes for Older People Page 10 of 31 Evidence: The care manager told us that in most cases prospective residents were visited in their own home in order to undertake a full assessment of their individual needs. However, because of the specialism of the home people often lived some considerable distance away and it was therefore not always possible to visit. We looked at a sample of four residents files during this inspection site visit, the sample included the file for one person recently admitted to the home for a trial visit. In this example the management didnt actually go out and visit the person before admission. They had communication with the persons social worker and it was deemed they had sufficient information to provide care and support for a trial period. The care manager reported spending time with the person and their social worker on the day of their arrival in order to explore their personal needs and wishes in greater detail. The pre admission assessment forms we saw did not provide specific detail of how people wished their personal support to be provided. For example one file told us that the person needed supervision with hair care, bath and nail care however there was no detail of how much supervision was needed, how often they would like to have a bath or how the persons privacy and dignity would be maximised whilst providing personal support. The care manager told us this information had not been available when the person came to Foley House and they were working with the individual to ensure their needs were being met according to their personal preferences. Daily records did not provide the evidence to confirm this. The pre admission documents we looked at for one person recently admitted for a trial visit to the home did not contain evidence to show us that potential risks to the individual had been assessed. This means there was no information for care staff to follow to keep the person as safe as possible. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally receive good care however some shortfalls in care planning, risk assessment and medication practice may mean their safety and well being are not always protected. Evidence: We looked at care plans for four people living at Foley House. The care plans were clearly written identifying presenting issues and the aim and plan of care to meet the need. There were records in place to monitor peoples health, with good records of medical appointments and comments. The service provided care and support specifically to people with hearing impairments. Records showed us that most of the staff team had been trained to level 1 in British Sign Language. This provided them with basic vocabulary. The care manager told us that 10 staff members had undrtaken training in British Sign Language level 2 in the past year and 50 had passed which provided them with greater communication skills. The registered manager and staff members told us that not all people living at the home used British Sign Language to communicate, some used a Makaton style of Care Homes for Older People Page 12 of 31 Evidence: communication and some had no recognised method of communication. A visitor to the home told us of an instance where a staff member had accompanied a resident to a health care consultation at hospital, neither hospital staff or the accompanying care staff member had sufficient skills to convey the information from the consultant to the resident. We saw that care plans were regularly reviewed ensuring that peoples changing needs were identified. It was not always clear where amendments to the care regime had taken place. For example the care plan for one person stated that they were able to walk short distances and there was an exercise regime to be followed daily. A subsequent care plan review showed that the individual was now permanently wheelchair bound. There was a clear audit trail throughout the review process however the main care plan was not amended to reflect the current position and strategies in place to meet the identified changed needs. This means that staff would need to check through all the reviews in the care plan to see which areas of need had been amended. Daily records showed us that a person recently admitted to the home was provided with assistance to get up, washed, dressed, and eat. Bearing in mind this was the first week of the person living at the home and there was little information available in the pre admission assessment, there would be an expectation of detailed daily notes so that an appropriate plan of care could be devised to meet the individuals specific needs and preferences. Senior staff meeting minutes of July 2009 included reference to record keeping. The notes stated that there was insufficient detail included within the daily records for healthcare concerns to be discussed with professionals. Three of the care plans we looked at showed us that risk assessments were in place for such areas as moving and handling, shaving, walking and falls, use of bed rails, smoking, medication and challenging behaviours. Evidence was available to confirm that the risk assessments were reviewed regularly in conjunction with the care plans. The care plan for a person recently admitted to the home did not include any assessments to identify potential risks to the persons health, safety or welfare. The individual had hearing and sight impairments and was accommodated on the top floor of the home in an isolated room. The care manager told us that the risk assessments had not been completed at the time of the persons admission. At this visit we noted a door alarm had been fitted to alert staff if the individual left their room and a safety barrier had been installed at the top of the staircase to further promote the persons Care Homes for Older People Page 13 of 31 Evidence: safety. The care manager reported that footplates were always taken to one side when a person was sitting stationery in their wheelchair. We were told this was in the event that the person tried to stand up, the chair could tip resulting in possible injury to the individual. We saw people in their wheelchairs at the dining table. After lunch we saw 2 people being moved in the wheelchairs from the dining room to the lounge, their wheelchair footplates remained turned to the side, they were not deployed under peoples feet. A visitor told us staff instructed residents feet up, feet up. This is not good practice and could place people at risk of injury. We looked at medication storage and administration practices in the home. Peoples consent to medication administration, by the home, was sought and recorded on the care files. We observed a staff member administer the lunchtime medications. These were safely stored in a trolley that was secured in a locked facility when not in use. We saw there was a system of second signature, where staff were available to do so, to verify medications given. This was identified as being good practice and would further ensure residents safety and welfare if it became regular practice. Medications were supplied to the home monthly from a local pharmacy. There was a blister pack system in use for most medications. Some medications were supplied in their original boxes. On one of these boxes we observed that there was no date to indicate when the packet had been originally opened and therefore no opportunity to audit the stock of this medication. Staff told us they were not aware of the need to date a packet to indicate when it was opened. We saw records of medication for a person recently admitted to the home on a trial basis. There was a list of the various medications that had been brought into the home with the person however there was no record to show the amounts of the medications received. Staff told us the persons medication had arrived at the home in such as way that staff had no means of telling the medications apart and how many of which there were. This meant there was no audit trail of this persons medication to confirm they had been administered in accordance with the prescribed instructions. Staff did not demonstrate awareness of the need to be able to audit the medications in the home to promote the safety and well being of the residents. Where residents had refused medications this was clearly marked on the rear of the Medication Administration Record (MAR)sheets and stored in a bottle in the trolley for Care Homes for Older People Page 14 of 31 Evidence: return to pharmacy. Staff told us they had not received medication training for approximately 3 years. The staff training matrix only showed us this years staff training provision. This showed us that no members of the staff team had attended medication training in 2009 and did not provide detail of when they had last received training in this important area. The care manager reported, subsequent to the visit, that all staff responsible for the administration of medication had attended refresher training in 2008. We did not see evidence of this on the files sampled at the inspection. One file sampled indicated that external pharmacy training had been provided in November 2007, the other file did not contain evidence of medication training. It was reported that a senior member of staff, who was a qualified trainer, had facilitated this training. The managers AQAA identified areas the service feels it did well such as Provide trained staff and use professional support where necessary. Review health care needs in house and with GP and other services regularly. Provide person centred support. 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 living at Foley House were provided with opportunities for activity and stimulation, these may not always be appropriate to meet everybodys needs. Evidence: The managers AQAA stated that the service provides residents with a comprehensive choice of activities, social, educational and recreational and ensure adequate stimulation. The service employed one full time and one part time activity co-ordinator. Examples of in house activities provided to engage the residents were Bingo, cards, jig saws, draughts, painting and jewellery making. Examples of group activities undertaken included coffee mornings, fetes, pantomime, magician, traveling museum, Cinema visits, bowling and holidays. The activities co-ordinator and care manager told us that funding for outings and activities was limited. The managers AQAA identified that one area where the service could improve was to enable residents to partake more fully in fund raising activities. Records of activities people engaged in were limited and provided little evidence of stimulation. The activity co-ordinator acknowledged there were shortfalls in recording Care Homes for Older People Page 16 of 31 Evidence: however was able to describe the level of input provided for people living at the home. It was reported that some people refused to take part in the activities provided. This was not documented, therefore there was no evidence to show what efforts had been made to encourage people to take part in activities, or what efforts had been made to find alternative activities they would be interested in taking part in. Family members and professionals spoken with subsequent to this visit told us Activities are rubbish, minds are not stimulated enough and If the signing was of a better standard and staff were able to communicate more residents minds would be looked after better. Staff told us that the same people kept going out and there was little provision for the older residents, especially those that were less ambulant. It was explained that this was because the majority of the older residents needed wheelchairs to access the community and there was not the manpower to be able to take more than two people out at a time. It was also explained to us that the younger residents were keen to attend art classes and drama classes whereas some of the older residents displayed little interest in activity outside the home. The registered manager told us that the annual holidays were taken in static caravans in Norfolk this year. Records of a residents meeting in February 2009 showed us this had been discussed. We saw many photo collages displayed around the home that showed us that many events and outings had taken place. On the afternoon of this visit two people were baking cakes in the kitchen with the assistance of the activities co-ordinator. One person was very keen to show me a portfolio of their art work. We were told that a reminiscence person had visited the home, the care manager reported this had been a huge success with at least 95 of the residents participating and interacting. Minutes of a residents meeting held in February showed us that events such as a coffee morning, summer fete, annual holiday and a visiting traveling museum were discussed. We looked at the menu, this showed us that people were provided with choice at each mealtime. The cook told us that if any person did not like the daily choices then an alternative would be provided. Staff told us Food is very good here, its excellent. We saw that the food was taken to dining room on a hot trolley and dished up individually Care Homes for Older People Page 17 of 31 Evidence: by the cook. A professional spoken with during this inspection process told us that they felt the service provided a good nutritionally balanced diet for the people living at the home. The activities room included a kitchen unit along with an area for tables and chairs to undertake craft work and painting. There was a Washer/dryer, oven, hob and and sink unit. Some residents chose to do their own washing and drying. The activity coordinator told us that one day a week, those residents who wished to were supported to buy and cook their own food and wash up afterwards. Residents were able to access the scullery to make themselves cups of tea. Some residents assisted in washing up, we observed this at this visit. During a physical tour of the home we noted jugs of fruit squash and baskets of fresh fruit available for residents to access in both communal lounges. 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 were cared for safely through procedure and practice at the home Evidence: The home and the commission had not received any complaints from residents or relatives since the last inspection. There was a complaints procedure made available to the residents and visitors. A staff member told us: If a resident complained about anything I would encourage them to talk to management. If they chose not to I would try and deal with it myself. The care manager told us that people living at Foley House were provided with access to advocates from the local RAD office, if required. Professionals we spoke with confirmed the availability of advocates. An adult safeguarding policy and procedure was in place, including Whistle Blowing, providing information and guidance for staff to follow in response to a suspicion, allegation or evidence of abuse. Records showed us that all staff had received the appropriate training in recognizing and safeguarding vulnerable adults from abuse. Discussion with staff members confirmed they we aware of their responsibilities should there be any suspicion of abuse. Appropriate recruitment procedures were in place that enhanced the residents Care Homes for Older People Page 19 of 31 Evidence: protection ensuring the right people were employed to work at the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant home that is suitable to meet their needs. Evidence: We undertook a physical tour of the building with the care manager. We saw all the communal areas and some peoples private rooms. The registered manager reported that some of the communal areas of the home had been refurbished and re carpeted since the previous inspection site visit. The training room and front office had been redecorated, boilers and water tank had been replaced and a recent Essex County Council monitoring visit had resulted in new thermostatic valves being fitted throughout the home to keep people safe from the risk of scalds. There was a kitchen/dining room that was used for art and craft sessions as well as providing the opportunity for people to do some baking or their own washing if they wished to. The home was arranged over 3 floors with a through the floor passenger lift so as to be accessible to all people living there. We saw the home was clean and well maintained. There was no evidence of any offensive odours. The standard of hygiene was very good. The laundry was well organised and residents were pleased with the laundry service. Care Homes for Older People Page 21 of 31 Evidence: The home was well equipped, with specialist equipment, to meet the needs of individuals. The care manager reported that all residents were provided with vibrating pillow alarms to alert them in the event of a fire, but some individuals chose not to use these. We saw that risk assessments were in place for people who chose not to use the vibrating pillow alerts. We saw that people were encouraged to personalise their rooms with their own belongings that reflected their personalities. We noted there was a lack of storage available at the home. The registered manager acknowledged this was the case and said that they did their best to keep any equipment such as wheelchairs, walking aids and hoists out of the way in places that people didnt frequent to avoid any risks of trips or falls. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive their care and support from a safely recruited staff team. Evidence: There were 18 people living at the home at the time of this inspection. The staff roster indicated that there were 3 staff on duty for day shifts and two staff on waking night duty. Additional catering, activity and domestic staff are employed in sufficient numbers to meet peoples needs. Staff told us that the day shifts can sometimes be difficult as one staff member often had to attend hospital appointments with residents thus leaving two people on duty to care for the remaining residents. The care Manager reported she was always available to provide hands on cover on the floor in this instance. Staff reported there had been a lot of agency usage to cover for holidays and sickness. The care manager reported that a regular care agency was used to cover these absences, regular staff were provided to cover to ensure consistency of care and support for the people living at Foley House. We looked at staff rotas, these confirmed that residents were supported by a regular team of staff. We looked at recruitment records for two recently employed staff. These showed us that staff did not start to work at the home until satisfactory references and completed Care Homes for Older People Page 23 of 31 Evidence: Criminal Record Bureau disclosures were received. On both files we saw written applications, a contract between the service and the worker, evidence that an employee handbook had been provided, a written record of the interview and a job description that clearly outlined the employees rights and responsibilities. The managers AQAA stated: We provide a comprehensive training programme and regular supervision and appraisal systems identifying training needs as well as opportunities for staff to discuss procedures etc. Staff told us that they did not have regular supervision whilst another staff member said that seniors undertook supervision. One of the files we looked at contained a contract stating that supervision would take place every two months however there was no evidence available to confirm this had routinely taken place. The file for a staff member employed since the previous inspection contained no records of supervision. Staff files we looked at confirmed that recent training had taken place in areas such as abuse, health and safety, food hygiene, Infection Control and Fire awareness. This training had taken place over a three day period and delivered by means of DVD and question and answer sheets. There were no records available to show how peoples competency was assessed following this training. On one staff file we looked at we saw a record of an observation of practice in administration of medication. We saw evidence in one staff file to confirm that induction training in line with Skills for Care had been completed, the care manager reported that one other person was still working to complete this induction. We found the staff training matrix provided for us at the inspection site visit was not up to date. On first glance it appeared that training in Protection of Vulnerable Adults had not been recently provided for a large part of the staff team. Further discussion with the management showed that in fact it was poor recording and people had attended this training. The staff training matrix showed us that 20 of the 24 people employed to work at the home had achieved the level 1 qualification in British Sign Language (BSL1). This level equips people with some vocabulary to allow communication at a basic level. The care manager told us that 10 staff members were put forward for BSL2 last year, 50 of these had passed. The training matrix confirmed that 5 people working at the home had achieved BSL level 2. BSL 2 develops vocabulary and conversational skills and increases the ability to read what people are saying. Care Homes for Older People Page 24 of 31 Evidence: The care manager told us that historically Essex County Council funding had assisted with BSL training however, now this had ceased the service was encountering difficulty providing this training within their budget. The registered manager reported that to fill in the gaps between purchasing a company training course we use DVD to ensure staff are still up to date in the meantime and I am aware aware that BSL in essential to the well being of some of our residents and keen to stress that these courses are on going. This training is essential for staff to learn the skills needed to effectively communicate with many of the people living at the home. The staff training matrix showed us that 10 staff members had achieved a minimum of NVQ 2 in care and that 5 staff members were working towards this qualification. Care Homes for Older People Page 25 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 live in a safe and well managed home. Evidence: The registered manager was a director of the Trust and had achieved the Registered Managers Award, NVQ 4 qualification in management and was a professional trainer. The managers AQAA stated that the management team had an open door policy and encouraged colleagues to involve themselves in the day to day running of the home. Staff reported varied views regarding the management of the home, comments included: Communication from management is absolutely dreadful, we get shut out of everything and no issues with management and had found them to be very supportive. Always able to go to them with either work or personal problems. The managers AQAA, staff and management told us that the Trustees visited the home on a monthly basis to undertaken formal inspections. We saw reports of these visits that confirmed the quality of services and facilities provided were regularly Care Homes for Older People Page 26 of 31 Evidence: monitored. The what we could do better section of the managers AQAA stated we would like to extend more invitations for the trustees to visit informally. Staff also told us Would like to see more trustee involvement. Staff confirmed there was an annual quality assurance process where their views were sought alongside residents and other stakeholders. The managers AQAA stated: Quality audits are carried out. Family members we spoke with confirmed receiving questionnaires from the home, providing them with the opportunity to share their views about the services and facilities on offer. We looked at records of staff meetings and residents meetings. These records were brief however provided information about what issues had been discussed. We looked at certificates relating to equipment and service to the home. These were in place and updated as required. 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 3 14 More detail about peoples specific needs and preferences needs to be obtained via the pre admission assessment process. This is so that people can be assured their needs and wishes will be met. 17/09/2009 2 7 13 Risk assessments must be undertaken for any person moving into the home. This is so that unneccessary risks to peoples safety and welfare may be eliminated and they can be cared for as safely as possible. 30/09/2009 3 7 15 Where reviews identify any 30/09/2009 changes in peoples personal care or support these must be clearly documented in the Care Plan This is so all staff have ready access to the most up 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 to date instruction to help them provide the right care and support for people. 4 9 13 All medications brought into the care home must be properly recorded. This is so that an audit trail can confirm that people receive their medications safely as prescribed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/08/2009 1 7 Daily records need to contain accurate detail of the individual care and support provided for people. This is so that consistent care can be provided for individuals and so that there is sufficient information to inform care plan reviews and other professionals involved in the persons care and support. Care Homes for Older People Page 30 of 31 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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