Care Home: Forest Lodge Care Home

What the care home does well A warm and welcoming atmosphere is evident on arrival and people using the service, staff and visitors maintain good relationships. The home is comfortably maintained and people may personalise their bedrooms as they wish. Staff treat people in a caring and professional manner and people using the service speak highly of the staff and the care they receive. Relatives are made welcome at any time and staff make an effort to celebrate occasions and anniversaries with people using the service. The food is varied and appealing and people say they get choices at each meal time. There are always alternatives available and homemade cakes. People using the service feel that they can live a life of their choosing and that their rights and choices are respected. They feel that they can spend their time as they wish and that they have everything that they need to be comfortable. People are assured that any concerns will be addressed and resolved and that they are protected from abuse. What has improved since the last inspection? Plans of care and risk assessments have further developed, working towards ensuring that these are in place for people`s specific needs. Medication that has been omitted now has a reason for this documented so that this can be monitored. Some policies and procedures have been updated so that staff have some of the necessary information needed to follow good practice and legislation. Further redecoration and the purchase of equipment has taken place to ensure that people live in a comfortable environment and the necessary aids are available for them. Staff are no longer employed with only a POVA 1st in place unless they are supervised to ensure that people using the service are protected form unsuitable people being employed. Liaison with the fire authority has taken place in regard to propping open fire doors, working towards ensuring that people are protected from the risk of fire. What the care home could do better: People must be formally informed that the staff are able to meet their needs before they make a decision to move into the care home.Plans of care and risk assessments must be in place and kept up to date in regard to people`s specific needs. The recording and auditing of medication needs to improve to make sure that people using the service are protected. The recruitment process must be improved upon to ensure that people using the service are fully protected from unsuitable people being employed. The staff training programme needs attention to make sure that people are supported by staff who are well trained and knowledgeable. The general management of the service must be improved upon to allow for this to be run and managed in the best interest of people using the service and make proper provision for their health and welfare. The Local Fire Authority must be contacted to discuss the smoking arrangements in the care home. A quality monitoring system must be introduced to ensure the monitoring and improvement of the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Forest Lodge Care Home 20 Forest Road East Nottingham NG1 4HH     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: Karmon Hawley     Date: 1 9 0 5 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 34 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 34 Information about the care home Name of care home: Address: Forest Lodge Care Home 20 Forest Road East Nottingham NG1 4HH 01159780617 01159422582 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Riaz Khan care home 28 Number of places (if applicable): Under 65 Over 65 0 28 28 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 28 28 0 The Registered Person may provide the following category/ies of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places 28) Dementia - Code DE (maximum number of places 28) Mental Disorder, excluding learning disability or Dementia - Code MD (maximum number of places 28). The maximum number of service users that can be accommodated is 28. Within the maximum number of 28 service users Mr Khan may continue care of the following: one service user aged 55 years of age with Alcohol Dependency as identified in an application dated 22/8/03 and one service user aged 61 years as identifed in an application dated 19/3/05 Date of last inspection Brief description of the care home Forest Lodge provides care for a maximum of 28 people. The service is registered to accept older people and up to six people who have Dementia. Care Homes for Older People Page 4 of 34 Brief description of the care home The home is a large, detached house within one mile of the city centre and close to the tram route. It overlooks the Forest recreation ground and is also close to the Arboretum Park. The accommodation is arranged over two floors and includes some bedrooms with en-suite toilets. There is a vertical lift and a chair lift to provide access to the first floor. There are two lounges, a dining room and a conservatory offering a choice of communal space. There is an external patio area and ample car parking. A sloped entrance provides access for wheelchair users. Staff are multi-lingual and current service users are from various cultural backgrounds. The cost of the service is currently between £298.21 and £323.36 per week. This fee does not include hairdressing, chiropody, toiletries, magazines, external transport or holidays. Care Homes for Older People Page 5 of 34 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: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We did receive this back from the owner when we asked for it; therefore we used it as part of our planning for this inspection. Care Homes for Older People Page 6 of 34 We received 10 completed Have your say surveys from people using the service, staff and relatives. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with staff and people using the service to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. During the course of our visit we began to find evidence of a continued breach of a regulation concerning the administration of medication because of this we took some evidence to discuss with our enforcement team in regard to the possibility of taking further action. What the care home does well: What has improved since the last inspection? What they could do better: People must be formally informed that the staff are able to meet their needs before they make a decision to move into the care home. Care Homes for Older People Page 8 of 34 Plans of care and risk assessments must be in place and kept up to date in regard to peoples specific needs. The recording and auditing of medication needs to improve to make sure that people using the service are protected. The recruitment process must be improved upon to ensure that people using the service are fully protected from unsuitable people being employed. The staff training programme needs attention to make sure that people are supported by staff who are well trained and knowledgeable. The general management of the service must be improved upon to allow for this to be run and managed in the best interest of people using the service and make proper provision for their health and welfare. The Local Fire Authority must be contacted to discuss the smoking arrangements in the care home. A quality monitoring system must be introduced to ensure the monitoring and improvement of the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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. Although an official preadmission assessment is not always completed, people are assured that their needs will be assessed and met prior to moving into the care home. The service does not offer intermediate care. Evidence: The manager visits people in the community if possible prior to admission to ensure that staff can meet peoples needs. An informal assessment takes place at this time; however there is no evidence of an official preadmission assessment taking place as required. Despite this we saw that peoples needs are met and plans have been made for admission by way of the social worker assessments. Staff spoken with feel that they receive enough information about people before they move into the care home to make sure that they can support them appropriately. Care Homes for Older People Page 11 of 34 Evidence: In the questionnaires that were returned to us people using the service tell us that they receive enough information about the service before they make a decision to move into the care home. The service does not offer intermediate care. Care Homes for Older People Page 12 of 34 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. Due to the lack of care plans and risk assessments in place for peoples specific needs, people may not be fully protected from risks and thier needs may not be met. People using the service are not always protected by the medication practices. Evidence: The administrator/activities coordinator is currently researching assessment tools that are used by the Alzheimers Society so these may be utilised within the care home. These identify peoples strengths and areas where they need support, which will enable staff to support people more appropriately. Following research a new life history profile has been implemented and two peoples files are complete. These offer personalised information about peoples lives and what is important to them so that staff are aware of this information. There is evidence that people using the service have been involved in the planning of their care to ensure that they receive help and support in their preferred way, however Care Homes for Older People Page 13 of 34 Evidence: some plans of care are task focussed and contain only brief information about the support that people need. Peoples religious and cultural needs are clearly outlined so that staff can support people appropriately to ensure that these are met. Some plans of care examined are out of date and do not offer the required information about peoples needs to ensure that they are supported appropriately. Also within some case files, there are insufficient or no plans of care in place for all identified needs, such as erratic and behaviour that may be challenging and how people will be supported during these times to ensure that they and others using the service are protected. Whilst some risk assessments are in place for peoples identified needs such as falls, to ensure that these are managed and people are protected, these are not in place in some files for medication management where there have been issues and in regard to behaviour that may be challenging. People using the service feel that their needs are met and that staff care for them as they wish. Staff spoken with say, it is important to make sure we give people care and look after them properly giving them choices at all times, and it is important that people are cared for and looked after and they have got everything they need and are entitled to. When examining plans of care we can see that people using the service are supported to access specialist services such as the district nurse, psychologist, doctor and dentist as needed. During the tour of the care home we can see that specialist equipment such as beds, cushions and mattresses are in place for people that may need them. One relative spoken with discussed how staff assist their relative to move using a hoist. Staff spoken with state that people can see the doctor and other specialist as needed. People using the service tell us. I can see the doctor if I need to, and I can see someone about my glasses when I need to. Staff who administer medication have been trained to do so, however on examining the medication records we saw that some medication that had entered the building Care Homes for Older People Page 14 of 34 Evidence: had not been logged nor written up on the medication record chart. There is no auditing system in place which identified this. This resulted in the medication not being administered as prescribed to ensure the persons health and wellbeing is maintained. Some doses were missed whilst others had been administered despite this not being written down on the chart. At the time of the inspection there was no explanation for this, therefore due to a requirement set at the previous inspection not being met, we issued a Code B notice under The Police and Criminal Evidence Act 1984 to enable us to seize evidence and interview staff with a view to assessing the findings in relation to enforcement action. The provider did send us some further information the following day to provide some evidence as to why this occurred. This information is currently being assessed by the enforcement team in regard to any further action we may take. All other records in regard to medication examined are kept as required and staff spoken with are able to discuss good practices despite the above. Throughout the inspection we could that a good relationship is maintained between staff and people using the service. Staff treat people using the service in a respectful manner and maintain their dignity at all times. Staff spoken with are able to discuss how they ensure that peoples privacy and dignity is promoted. Care Homes for Older People Page 15 of 34 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 are supported to lead a life of their choosing which satisfies their needs and to maintain contacts with those that are important to them. Evidence: Staff support people on a daily basis with various activities such as arts and crafts, games, dominoes, trips out and gardening if they wish to join in with these. School children also visit the home to spend time playing games with people using the service. There have been various attempts to extend the activities that are on offer; however people that are currently using the service do not wish to participate in any other than that which is offered. Nevertheless the activities coordinator is open to suggestions and will provide different activities if they are requested. People using the service offer the following comments about life in the care home; its alright here I get cans of larger and fags so I am happy with that, I have been here four months, its alright here, I am looked after, its not bad at all. I do odd jobs Care Homes for Older People Page 16 of 34 Evidence: around the place in the garden and I tend to watch TV which I am happy with, the hairdresser comes here to do my hair. I enjoy doing the garden and I clean the smoke room, they are my jobs, it does depend on what the weather is like as to what I do. If it is raining I watch the TV, I am happy with what I am doing. I can go down the market on my own if I want, there are no problems, I am happy and settled here, I am looked after, I get my food and I am warm so I cant grumble. I usually watch TV or sleep as there is nothing much else to do, but I am happy with it as at my age I cant do much more. The staff are nice, there is nothing I want, I am comfortable, and I have been here for four years, I am happy and settled, the staff are like friends, I feel like part of a family. One relative spoken with feels that people need more stimulation, however people are looked after well and they are given choices in their everyday life. Staff spoken with feel that there could be more activities on offer, but at present people using the service are not interested in doing anymore that what they already are. Although there are no church service currently held in house people using the service are supported to maintain their faith should they wish and facilities to enable this will be sought if needed. Religious festivals and celebrations are however celebrated within the care home. So that people can maintain contacts with people that are important to them there are no restrictions on visiting and visitors may be received in private should this be requested. We saw several visitors made welcome when they visited during the inspection and one visitor confirms that they are always made welcome when they come and that they are offered a cup of tea. People using the service also tell us that their family and friends can come whenever they like and that they are made welcome. Staff tell us, visitors are made welcome, they can have a cup of tea we treat them like family, and visitors are made welcome they can come any time. People using the service feel that they can spend their time as they wish and we can see that this is encouraged by staff. One person spoken with tells us, I dont tend to go downstairs therefore I spend a lot of time in my room, I occupy myself, and I can do as I want. Care Homes for Older People Page 17 of 34 Evidence: Although not all of the staff working at the care home have attended training on the Mental Capacity Act and the Deprivation of Liberty, staff are able to discuss who these may affect; I have not done the Mental Capacity Act and the deprivation of liberty training, however I am doing a course in equal opportunities at the moment which helps me in my practice, I am aware of values and that people can make their own choices and decisions. If there are issues about peoples safety, we need to explain things and why we may wish to change things for them, for example not going out on their own. We need to get to know people, their personalities and their family; it may be more difficult when people have dementia that is why we need to know as much as we can about them so that we can relate to them, and it is good that there are staff who have different languages as some people living here also have this means we can talk to them in their own language. We treat people all the same, but some people need different things to others depending upon their personalities and personal needs, we need to make sure that people have rights and choices upheld, we ask them what they want. An appealing menu is on offer with choices available at each meal. Specialist diets are also catered for and there is an Asian option for those people who would like this. Staff spoken with are aware of special diets such as diabetic diets and the reasons for these. They feel that the food on offer is good and that sufficient choices are available. People using the service all say that the food is good and plentiful and they confirm that choices are offered as are meals to meet their religious needs, the food is very good, I have halal meat, and the food is good, there are choices. The responses received in the questionnaires that were returned to us show us that people are generally satisfied with the activities on offer, the arrangements for visiting and the food on offer. Care Homes for Older People Page 18 of 34 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 using the service are assured that their complaints will be listened to and acted upon and that they are protected from abuse. Evidence: So that people know how to make a complaint if they feel the need to the complaints procedure is given to each person within the service user guide. The service has not received any complaints since the previous inspection. The complaints policy although it has not been needed, is out of date in regard to who people may need to contact if they feel that their complaint has not been addressed by the service. Staff spoken with are able to discuss how they would handle a complaint should one be received to ensure that it is dealt with. People using the service tell us, I could tell them if I was unhappy, I have no complaints; I feel that I could talk about it if I did have. One relative spoken with says, I would tell someone if I was unhappy with things. I did tell the deputy about the toilets and the hand wash, she doesnt mind being told. Care Homes for Older People Page 19 of 34 Evidence: The policy in regard to safeguarding vulnerable adults from abuse is out of date and provides people with the incorrect information; however the majority of staff have undertaken training in safeguarding vulnerable people. Staff spoken with are able to discuss their roles and responsibilities in regard to ensuring that people remain safe and protected from abuse and dealing with behaviour that may be challenging. Care Homes for Older People Page 20 of 34 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 homely and comfortable environment which is clean and tidy. Evidence: There is evidence of ongoing maintenance both internally and externally and all areas of the care home are generally well maintained. The garden remains well kept and pleasant for people who wish to sit outside. There are various seating areas around the care home with comfortable sofas for people should they wish to use these. The separate smoking area remains for those who wish to use this facility. Many bedrooms have been redecorated and new furnishings purchased to make peoples rooms both homely and comfortable. The providers have purchased a number of hospital beds to ensure that these are available for people that need them. There are also other special facilities such as specialist baths and hoists for people who may need them. Care Homes for Older People Page 21 of 34 Evidence: All areas of the care home accessed on the day of the visit are clean and tidy. One person using the service says, the place is clean and tidy the staff work hard. Care Homes for Older People Page 22 of 34 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 using the service are supported by some staff who have not completed all the compulsory training, therefore they may not have the required knowledge and skills to ensure that peoples needs are fully met. People using the service are not currently protected by the recruitment practices. Evidence: Throughout the inspection we could see that staff are available to support people using the service when needed. People using the service say that there are enough staff to help and support them when they need this and that the staff are nice and kind; the staff are good, the staff are nice and kind and they are there to help when needed. One relative spoken with feels that more staff are needed to spend time with people on an individual basis as care tends to be task focussed. Staff spoken with offer the following comments; the staff team get on well, however there is not always enough staff, there are only 3 staff when there is 27 people to get up, the manager helps once people are up, and the staff team all get on well together there are enough staff, there is plenty of time to sit and talk with people in Care Homes for Older People Page 23 of 34 Evidence: the morning and usually after dinner. When new staff start working at the care home they undertake an induction so that they are aware of their roles and responsibilities. Although this induction is not at a recognised standard, staff spoken with feel that the induction programme is sufficient to ensure that people know all that they need to so they can support people using the service; new members of staff have inductions; I usually train up new staff when they start. We saw within staff files that people undertake an induction; however within one file this was the only training that had been completed since employment had begun six months ago. Most staff have either undertaken or are working towards completing the National Vocational Qualification level 2 in care (NVQ - a nationally recognised work and theory based qualification designed to enhance knowledge and skills in caring for people). Staff spoken with confirm that they have undertaken this training and that it has helped them in their development. Staff files examined show us that not all of these contain all the required documentation such as photographs and references to make sure that people using the service are protected from unsuitable people being employed. Staff spoken with tell us that the recruitment process that they underwent is thorough and that they had a Criminal Record Bureau (a police check to see if an individual has a police caution or criminal record) check before they started working at the care home. Although staff continue to undertake compulsory training and a number of courses such as manual handling and dementia care have been undertaken since the previous inspection, deficits remain in the following areas, first aid, health and safety and fire. Staff spoken with feel supported in their training and development, I have done all my training with my other job, I only work here one shift a week, however I am up to date with training and feel supported in my development here, and If I need anything I can talk to the managers, they have been very helpful as my English writing is still not that good, I have done medication training, my NVQ and all other compulsory training, I do not miss any courses. One person spoken with feels that the staff are well trained to carry out their job role. Care Homes for Older People Page 24 of 34 Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a care home where they are enabled to have a say in how the care home is managed, however the general management of the care home does not allow for quality outcomes to be delivered in all areas. Evidence: The manager is registered with the Care Quality Commission and has completed the Registered Managers Award (a nationally recognised work and theory based qualification designed to enhance management knowledge and skills). There are some concerns about the general management of the service. This is in regard to a number of issues such as; care planning and risk assessments, the lack of up to date records in some areas, medication management, a lack of a training programme which ensures that all staff have completed compulsory training, insufficient supervisions to monitor the performance and development of staff and the lack of formal audits and quality review systems, which would identify these issues and Care Homes for Older People Page 26 of 34 Evidence: allow for improvements to be made. The provider and management team are currently working towards implementing systems to address these issues and they have devised an action plan with clear outcomes and timescales to ensure full compliance is achieved. Staff spoken with feel that the manager is always supportive and approachable. One person using the service tells us that they feel that the management is very good and that the service is well run. The responses that we received in the questionnaires that were sent to us compliment the general management and running of the care home. People using the service may express their views about the service by way of meetings and questionnaires. At the previous residents meeting everyone said that they are satisfied with the activities and food on offer, therefore they agreed to continue with these in a similar fashion. The questionnaires are sent on an annual basis and are not yet due to be sent, when these are the results are analysed. A person using the service informs us that they have not been to a meeting but they had completed a questionnaire in the past, however they feel that staff always ask them how they are and if things are ok all the time anyway. Regular staff meetings also take place where issues such as training, development and documentation are discussed. We received completed questionnaires from several people using the service, staff and relatives, all of which were positive in nature. To ensure that peoples finances are secure no one at the care home is responsible for these. If a cost is incurred then the relevant person responsible for peoples finances is invoiced. There is reference to who is responsible for peoples money and how people are supported in accessing this within plans of care. A person using the service informs us that they havent got a bank account, however they do have some money in their purse and if they need anything the staff get it for them. Care Homes for Older People Page 27 of 34 Evidence: Although staff have undertaken some supervision sessions to support their development, these have not taken place this year. The records of previous supervisions are brief in nature and do not outline how the session has gone or how this benefited the staff member in their development. One member of staff said that they have had supervisions in the past and the deputy manager has discussed this with them in their own language to make sure that they understood the process. A number of polices and procedures in the care home have not been updated to make sure that they contain up to date information, however on speaking with staff they are able to discuss good practice recommendations as needed. The annual quality assurance assessment informs us that all equipment in the care home has been serviced as required. We examined the gas and electrical certificates that confirm that these have been tested and serviced as needed to ensure that people using the service are protected. Since the previous visit a number of special fire door release guards have been purchased to stop fire doors being propped open to ensure that people are further protected should there be an outbreak of fire within the care home. However we did see that staff have not undertaken recent training in fire prevention and some people using the service are able to smoke in their bedrooms and whilst regular checks are made these bedroom doors are propped open. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13(2) Medication that has been 10/07/2008 administered is required to be signed for to ensure that people using the service receive their medication as prescribed. This is an outstanding requirement and further enforcement action is currently being considered. Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 You must ensure that people 23/07/2009 receive their medication as prescribed. This will ensure that people receive their medication as prescribed and their health and wellbeing is maintained. 2 7 15 Plans of care and risk 30/06/2009 assessments must be up to date at all times in regard to the support that people need. This will ensure that staff have the necessary information and people using the service are supported appropriately. 3 7 13 Risk assessments must be in 29/07/2009 place in regard to peoples specific needs. This will ensure that risks are reduced and people are protected. Some progress has been Care Homes for Older People Page 30 of 34 made, however further development is required to ensure that full compliance is achieved. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. 4 7 15 Plans of care must be in place in regard to peoples specific needs. This will ensure that peoples needs are fully met. Some progress has been made, however further development is required to ensure that full compliance is achieved. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. 5 9 13 You must ensure that staff do not administer medication that has not been correctly documented on the medication record. This will ensure that peoples health and wellbeing are maintianed. 6 9 13 You must ensure that all medication that enters the building is recorded. 23/07/2009 23/07/2009 29/07/2010 Care Homes for Older People Page 31 of 34 This will ensure that an audit trail is availiable to monitor that people using the service have been receiving thier medication as prescribed. 7 31 12 You must ensure that the 30/07/2009 general management of the service allows for this to be run and managed in the best interest of people using the service and makes proper provision for the health and welfare of people. This will ensure the health, safety and welfare of people using the service is promoted and maintained. 8 33 24 You must ensure that a quality monitoring system is in place which allows for issues to be highlighted and improvements to be made. This will ensure that people receive a consistent quality service. 9 36 18 Staff must be appropriately supervised. This will ensure that staff maintain good practices and they have the opportunity to develop their skills and knowledge in caring for people using the service. 10 37 17 Policies and procedures must be up to date and contain all the required information. This will ensure that staff 30/07/2009 30/07/2009 14/08/2009 Care Homes for Older People Page 32 of 34 have the necessary information required to maintain good practice and legislation is followed. Some progress has been made, however further development is required to ensure that full compliance is achieved. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. 11 38 23 You must liase with the fire 30/06/2009 authority in regard to people using the service smoking in thier nedrooms with their doors propped open. This will ensure that Fire legislation is followed and people using the service remain safe. 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 3 Implement a preadmission assessment that meets the National Minimum Standards to fully demonstrate that people are being assessed before they are admitted to the care home and that staff are able to fully meet their needs. Utilise the life history files to develop plans of care so that they are more person centred. Staff undertake a minimum of 6 supervision sessions a year. 2 3 7 36 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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