Care Home: Glendale

What the care home does well The home provides prospective residents with information about the care home that will enable them to make a choice about living at the home. Pre-admission assessments are undertaken to ensure the individual needs of prospective residents can be met. Care plans and risk assessments are in place that ensure their health and personal care needs are met. Residents are protected by the home`s storage and administration of medication procedures, and are treated with respect. Activities are organised at the home. Meals are varied and cater for individual choices, ensuring that residents receive an appealing and balanced diet. There is a satisfactory complaints system that enables residents and their families to raise concerns. Staff have training and an understanding of adult protection issues. The environment was clean, pleasant, safe and well-maintained. The arrangements for staffing are satisfactory, ensuring staff have the qualities and training to meet the needs of residents. The arrangements for management and administration ensures the home is run in the best interests of residents, and their safety is promoted and safeguarded. What has improved since the last inspection? Only one requirement was made at the previous key inspection. The manager had completed a needs assessment in all the units to ensure that there are sufficient staff on duty at all times. The manager told us that she is confident that there are enough staff on duty each shift to meet the needs of residents, and there is now one waking night staff in each of the five units every night. What the care home could do better: Where a person has previously worked in a position which involved contact with children or vulnerable adults, written verification of the reason why they ceased to work in that position must be obtained. Written explanation for gaps in employment must be recorded. The dates of the last reviews undertaken for the Statement of Purpose and Service User Guide should be recorded on the documents. The manager should ensure regular staff meetings take place so all information is passed through the staff team in a timely and appropriate manner. Key inspection report Care homes for older people Name: Address: Glendale Ambleside Avenue Walton-on-Thames Surrey KT12 3LW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joseph Croft     Date: 1 8 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Glendale Ambleside Avenue Walton-on-Thames Surrey KT12 3LW 01932251980 01932232593 mary.hunt@anchor.org.uk www.anchor.org.uk Anchor Trust care home 61 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 61. The registered person may provide the following category/ies of service only: Care home only - (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 (OP) Dementia (DE) Physical disability (PD). Date of last inspection Brief description of the care home Glendale is a purpose built care home for older people situated in a quiet residential area of Walton-on-Thames. The home is approximately one mile from the town centre. The majority of the accommodation is for permanent residence with a small number of respite (short stay) rooms available. Up to 26 service users may have dementia, up to eight service users may have a physical disability and up to three service users may Care Homes for Older People Page 4 of 29 Over 65 0 61 0 61 0 61 Brief description of the care home have a mental disorder. Personal and communal accommodation is provided on three floors. There are five selfcontained units, each with 12 bedrooms, assisted bathrooms, lounges, dining rooms and kitchen facilities. All bedrooms are for single occupancy, with en-suite wash hand basins and WCs. There is a courtyard and enclosed landscape gardens and parking facilities are available to the front of the home. The weekly fees are five hundred and fourteen pounds. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is Two Star. This means the people who use this service experience good quality outcomes. The Care Quality Commission (CQC) (us, we) undertook an unannounced site visit to the service on the 18th June 2009 using the Inspecting for Better Lives (IBL) process. The site visit took over seven and half hours commencing at 10:00 and concluding at 17:45. The manager and deputy manager assisted throughout this site visit. The inspection process included a tour of the premises and the viewing of the Statement of Purpose and Service User Guide. Other records sampled included care plans, risk assessments, health care records, staff recruitment and staff training records, some policies and procedures and health and safety records. The Inspector had discussions with the manager, deputy manager, four members of staff, sixteen residents, four relatives and one care manager. Care Homes for Older People Page 6 of 29 Relatives and residents spoken to during the site visit were very complimentary about the care home, the care they receive, activities, the environment, meals and the care provided by the dedicated members of staff. Surveys were received from ten residents, seven members of staff and four health care professionals. The manager returned the Annual Quality Assurance Assessment when we asked for it, and this document and surveys have been used as a source of evidence throughout this report. People who use this service prefer to be known as residents, therefore this term is used throughout this report. We would like to thank the manager, staff and residents for their cooperation during this site visit. Feedback was provided to the manager and deputy manager at the end of this site visit. The home had an Annual Service Review undertaken on the 27th June 2008, and the last key inspection was undertaken on the 20th June 2007. The weekly fees for the home are five hundred and fourteen pounds. Care Homes for Older People Page 7 of 29 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 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 29 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 29 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. People who use the service are provided with written information that will enable them to make a choice about living at the home. Assessment documentation is in place to ensure the individual needs of prospective residents can be met. Evidence: The home has a Statement of Purpose and Service User Guide that was produced by Anchor Trust. The manager told us that these had been reviewed in 2009, however, a good practice recommendation has been made that the dates these were last reviewed should be recorded on the documents. The Statement of Purpose and Service User Guide included information in regard to the aims and objectives, services provided, the Complaints procedure and all the other information as required. During discussions relatives told us that they had received information about the home before making the decision with their relative about moving in. Surveys returned from five residents informed that they received enough information about the Care Homes for Older People Page 10 of 29 Evidence: home, and five other surveys informed that they could not remember. The Statement of Purpose is also available in a CD format which is attached to the rear of this document. The manager told us that they obtain copies of the current care plans from the placing care manager, GP and any other health care professionals involved with the prospective resident. The manager would also undertake an assessment of need when residents visited the home. Three care files sampled during the site visit provided evidence that pre-admission assessments had been undertaken. These included information in regard to the religious needs, ethnicity, next of kin, GP, self help skills, social interaction, communication, mobility, medication and medical history, sight, hearing, continence, food, diet. The assessments had been signed and dated by the assessor. During discussions residents and relatives told us that they had an assessment of their needs undertaken, and they did visit the home before making a decision about moving in. One relative told us that they were very impressed during the visit as all staff immediately talked to their mum as opposed to asking them all the questions about their relative. The home does not provide intermediate care. The Annual Quality Assurance Assessment (AQAA) informs that enquiries are provided with information about the home in the homes information pack, which includes a CD. The Statement of Purpose provides a clear view of services provided at the home and the Service User Guides are available to residents on admission to the home. An assessment is carried out to ensure identified needs are met from the time of admission. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have care plans and risk assessments in place that ensure their health and personal care needs are met. Residents are protected by the homes storage and administration of medication procedures. Residents are treated with respect and their dignity is promoted. Evidence: Three care plans were viewed during this site visit. Each had a photograph of the resident. All care plans viewed also contained a copy of the Anchor Trust baseline assessment of needs that were detailed, and included information in regard to the health and personal care needs such as diet, communication, hearing, sight, environmental support and all aspects of daily care. Care plans are produced from the information recorded in these and the pre-admission assessments. All care plans viewed had been reviewed on a monthly basis. Annual reviews had been undertaken. One care plan required some information transferring from the baseline assessment, however, this was done immediately. Risk assessments were in the care plans and included risks in regard to moving and Care Homes for Older People Page 12 of 29 Evidence: handling, waterlow assessments, falls, medical condition and other identified risks pertaining to individual residents. It was noted that the risk assessments had also been reviewed on a monthly basis. Relatives spoken to during the site visit told us that they were aware of the care plans, and had been included in the annual reviews. However, one relative told us that their relative had not had an annual review undertaken. This was discussed with the manager who told us that there had been a telephone review on the 29th March 2009, and an actual review has been booked for the 8th July 2009. Some residents told us they had a care plan, others stated they could not remember. From discussions with staff, residents, relatives and from the the viewing of records, it was clear that residents have access to all health care professionals as required. Records of all health care appointments are recorded in the care plans and include the GP, Dentist, Chiropodist and Optician. Monthy weights were recorded in the care plans viewed, and fluid charts are maintained for those who require this to be monitored. The manager told us that no curent resident has a pressure sore. During discussions residents told us that they see the GP in the privacy of their bedrooms and attend all other health care appointments if they need to. Relatives told us that they are always kept informed of all appointments their relatives attend. Of the surveys received from residents, eight inform that they always receive the medical support they require and two stated that they usually receive this. Staff at the care home follow Anchor Trust Medication Plicy and Procedures that were last reviewed in April 2008. The home continues to receive medication in blister packs and printed Medication Administration Record sheets (MARs) that are delivered every month from a pharmacist. The manager told us that no current resident is self medicating. The MAR sheets were viewed and no omissions in the recordings were noted. The quantity of medication was recorded on each record viewed, and the home has a book for the recording of all medication returned to the pharmacy. Hand written MAR sheets had been signed by two members of staff. Some residents living at the home are taking a Controlled Drug (CD). The home maintains a CD register that is signed by two members of staff and all CD medication is kept secure in an appropriate locked medication cabinet within a secure room. No omissions or errors were noted in the CD register. Care Homes for Older People Page 13 of 29 Evidence: During discussions residents told us that they always receive their medication at the time they need it. We were told that only staff who have received the appropriate training administer medication. This training is provided by Anchor Trust. The sampling of six staff training files provided evidence that they had undertaken this training. During discussions the manager and staff told us that they repsect residents privacy and dignity at all times. Staff always knock on bedroom doors before entering, which was evidenced during this site visit, and the personal care needs are attended to in the privacy of bedrooms and bathrooms. This was confirmed during discussions with residents. Staff at the home follow the Anchor Trust Policy in regard to the Values of Privacy and Dignity that was last reviewed in April 2008. Three members of staff have recently achieved the Dignity Champions for Dementia award, and are to cascade this to all other staff working at the care home. Surveys received from health care professionals inform that the service respects individuals privacy and dignity. Relatives told us that residents are respected at all times. Residents told us that they receive their own mail and telephone calls. The AQAA informs that residents needs are clearly outlined in their service user plan. All residents have a service user plan that are updated monthly or when changes arise. Residents have the choice of female or male carer. A good service is received from the District Nurse, GP, Dentist, Chiropodist, physiotherapist and psychiatrist. Care Homes for Older People Page 14 of 29 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 who use the service are provided with opportunities to improve their lifestyle and maintain contact with their family and friends. Meals are varied and cater for individual choices, ensuring that residents receive an appealing and balanced diet. Evidence: The home employs one activity coordinator, and the manager told us that they are currently trying to recruit a second. Activities take place in the units twice a day, and there is a list of daily activities displayed in each unit. The three care plans sampled included the leisure interests of residents, and included photographs of individual residents taking part in thier favourite activities. Activities offered include manicures, bingo, quiz, indoor golf, of which their is a tournament between the other Anchor Trust homes, reminiscence and art and craft. The manager told us that they work closely with the National Activity Providers Association (NAPA), and explore different types of activities for older people. During discussion, residents and relatives told us that there are plenty of activities provided at the home. Residents stated that it was their choice if they wanted to partake in these activities. There are varied themes displayed at the care home that include memorabilia in regard to World War II, the 1930s and wedding attire of those Care Homes for Older People Page 15 of 29 Evidence: days. Relatives told us that the residents enjoy a very good lifestyle living at the care home, they make their own choices and are treated with respect. The manager and staff told us that external entertainers visit the home, and church services are conducted once a month for residents to attend. During discussions relatives told us that there are no restrictions to visiting the home, they can meet with their relative in the privacy of their bedroom, have meals at the home and take them out for the day. The Environmental Health Officer visited the care home on the 1st August 2008 and awarded them the Five Star Rating Certificate for their food and hygiene practices at the care home. This is valid until February 2010. The home uses a four week menu that includes fresh meat, fish, pasta, salads, fresh vegetable and fresh fruit. There is an alternative choice for each meal. The suppers provided at the home are varied and include a choice of soup, spaghetti, Cornish pasties and sandwiches. During the site visit residents were observed having drinks that included fruit juices, and snacks whenever they requested. Surveys from residents informed that there are activities available at the home, and the majority informed that they like the meals, three residents stated they sometimes like the meals. The AQAA informs that social interactions and activities are outlined in the service user plans. Residents have access to external groups that include Church and entertainers.The home is open to all visitors, and eating with relatives is encouraged. The recruitment of full time activity organiser is ongoing, and individual activities are encouraged, not just group activities. Care Homes for Older People Page 16 of 29 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 who use the service have access to a satisfactory complaints system that enables residents and their families to raise concerns. Residents are protected by staff having training and an understanding of adult protection issues. Evidence: The Care Quality Commission has not received any concerns, complaints or Safeguarding issues in regard to the care home during the last twelve months. The home has an Anchor Trust Complaints Policy and Procedure that was last reviewed in January 2008. The manager told us that this is also available on an audio cassette tape. The procedure is clear and provides a timescale for responding to complainants. A copy of the complaints procedure was on display in all the units in the care home. The manager told us that they have had two complaints during the last twelve months, one was not upheld. The home has a complaints book for the recording of complaints that was viewed during the site visit. There is also a Compliments folder with many letters and cards expressing their gratitude in regard to the care provided by staff and managers at the home. During discussions relatives told us they knew how to make a complaint but have never had the need to, however, they would talk directly to the manager, and follow Care Homes for Older People Page 17 of 29 Evidence: the procedure if they remained unhappy with the outcome. Relatives were complimentary about the home and the care provided to their relatives. Residents told us that they would talk to staff, but were happy at the home and did not need to make a complaint. Surveys received from residents informed that they know who to talk to if they are not happy. All staff surveys informed that they know what to do if a resident, relative or visitor raised concerns about the care home. The home follows the Anchor Trust Safeguarding policy that was last reviewed in April 2008. The home has a copy of recent local authority Safeguarding procedures available for staff to read. The AQAA informed that there have not been any Safeguarding referrals when the manager completed this document in April 2009. However, there has since been one referral made that is currently ongoing. Evidence was viewed that staff had received training in regard to Safeguarding Adults, and future training dates were evidenced during the site visit. Different scenarios in regard to abusive situations were discussed with the manager and three members of staff. All were knowledgeable of the procedures to be followed, and were aware that the manager must refer all allegations of abuse to the local Safeguarding Team. The AQAA informs that residents are protected by the homes abuse awareness policy, and staff are inducted in the Rights and Responsibilities and Safeguarding Adults. Care Homes for Older People Page 18 of 29 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 who use the service live in a clean, pleasant, safe and well-maintained environment. Evidence: Glendale is a purpose built care home that comprises of five self contained units that include twelve single bedrooms, lounge, dining room, kitchenette, assisted bathrooms, toilets and showers. All bedrooms have en-suite wash hand basin and toilets, are appropriately decorated, bright and the furnishing is welcoming. The bedrooms viewed included chest of drawers and bedside cabinet with lockable facilities. Residents had personlised their bedrooms with family photographs and television and audio equipment. Residents spoken to during the site visit told us that they like their bedrooms, they are comfortable and kept clean. The communal areas and bedrooms had liquid soap dispensers and paper towels. Alcohol Gel dispensers were available in the units and at the front door. On the day of the site visit one unit was closed to visitors due to a small outbreak of diarrrhoea and vomiting that had affected three residents. Signs were posted and the Environmental Health Office, GP and the Care Quality Commission had been notified. Care Homes for Older People Page 19 of 29 Evidence: The home follows the Anchor Trusts Infection Control Policy that was last reviewed in April 2008. The Annual Quality Assurance Assessment informs that fifty four staff had attended Infection Control training. Discussions took place with the trainer repsonsible for the delivery of Health and Safety training. We were told that all staff have annual refresher training in regard to Health and Safety that includes Infection Control, and he was delivering this training on the day of the site visit. All staff attendance to all training is monitored, and any absenteeism from training is followed up with the manager and member of staff concerned. The trainer told us that he had undertaken Train the Trainer training at a local university. There is a garden to the rear of the property that is appropriately maintained. The manager told us that they are going to purchase a greenhouse and provide a vegetable garden for residents to use. Of the surveys received from residents, five stated that the home is always fresh and clean, five stated that it is usually fresh and clean. During discussions relatives told us that the home is always clean and tidy and there is a good team of domestic staff who clean the home and look after their relatives laundry. Any issues are immediately resolved. On the day of the site visit the home was very clean, tidy and free from malodour. The AQAA informs that The home was built in 2002, is fully accessible and there is a lift to the first and second floor. All bedrooms are of single occupancy and have ensuite facilities. Infection Control procedures are in place. Alcohol gel is available in each unit and the front entrance. The home has a team of domestics who keep the home clean and wellmaintained. Care Homes for Older People Page 20 of 29 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. The arrangements for staffing are satisfactory, ensuring staff have the qualities and training to meet the needs of residents. Recruitment practices require further attention to ensure people who use the service are fully protected. Evidence: The manager told us that she had undertaken a review of the staffing levels for the home in June 2007, and she is confident that the numbers of staff on duty each shift are sufficient to meet the assessed needs of residents living at the home. There are two staff on duty each shift, and one waking night staff in each of the five units every night. During discussions staff told us that there are enough staff on duty each shift. Three staff surveys informed that there are always enough staff on duty, four stated there are usually enough staff on duty. Residents and their relatives told us that staff are always available to provide support and help whenever requested. Relatives were complimentary about all care staff and domestic staff working at the home. They told us that the staff are very nice, caring and nothing is too much for the staff at Glendale, They are really caring and dedicated staff. Care Homes for Older People Page 21 of 29 Evidence: During discussions one Community Support Worker told us that staff have the right skills and training to meet the needs of residents, they are always available and there are enough staff on duty whenever they visit the home. They also told us that staff would seek and act on advice provided. The Annual Quality Assurance Assessment completed by the manager informs that ninety seven percent of permanent staff working at the home hold the minmum of an NVQ level 2 and above. Three recruitment files were sampled during this site visit. Each contained an application form, two written references, health declaration, an employment history, proof of identification including a photograph, and Criminal Record Bureau (CRB) checks. The manager told us that no one commences employment at the home until all the required checks have been received. However, two application forms had gaps in employment with no explanations, and two did not have reasons for leaving their last employment that involved working with vulnerable people. The manager has since told us that this has been followed up with the staff members concerned, however, a requirement has been made in regard to this. The manager told us that agency staff are not used at the care home. Each member of staff has an individual training record where evidence of training undertaken is maintained. The manager told us that training staff have undertaken includes Dementia, End of Life, challenging behaviour, Control Of Substances Hazardous to Health (COSHH) and Deaf Awareness. Staff surveys inform that they have received training that is relevant to their role, helps them understand and meet the individual needs of residents, and keeps them up to date with new ways of working. Evidence was viewed that staff are completing induction training that is in line with the Skills For Care Council Induction Council. The AQAA informs that there are appropriate staffing levels and skill mix of staff on duty, all new staff go through the Skills for Care Council Induction and a thorough recruitment process is adhered to. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for management and administration ensures the home is run in the best interests of residents, and their safety is promoted and safeguarded. Evidence: The manager told us that she has been managing the care home since 2005, that she holds the NVQ level 4 and completed the Registered Managers Award (RMA) in 2008. Other training undertaken by the manager has included Back Care, The Mental Capacity Act, Service User Plans, Medication, Crisis Intervention and First Aid. The manager had attended the Surrey Multi-Agency Safeguarding training, and the refresher training for this has been booked for 19th June 2009. During discussions staff, residents and relatives were complimentary about the manager, stating that she is supportive and always available for advice and support. Quality assurance is undertaken through monthly meetings with residents and meetings with residents and their relatives. Minutes of residents meetings was Care Homes for Older People Page 23 of 29 Evidence: viewed. The manager undertook an annual survey of residents and their relatives in January 2009, evidence of these were viewed. However, the manager had omitted to send questionnaires to health care professionals and other stakeholders. The manager told us that these would be sent on the 22nd June 2009, and confirmed this during a telephone conversation on the 24th June 2009. The manager told us that once these had been returned that she would produce a summary of the findings. Staff meetings are not being held on a regular basis, and one survey raised an issue in regard to information not being passed on from senior staff to the care assistants on the units. This was further discussed with the manager and deputy manager. Daily handover meetings do take place, however, the manager told us that these would be further monitored by herself and the deputy manager. The manager was aware of the lack of regular staff meetings and told us this would be improved. A good practice recommendation has been made in regard to this. The manager told us that they undertake their own self assessments within the home. Each unit looks at particular standard each month. An internal audit was undertaken by Anchor Trust in July 2008, and the home scored 442 out of 570. Residents and their families handle their financial affairs. The home holds up to a maximum of one hundred pounds for each resident, and all transactions are documented, receipted and monitored by the manager and deputy manager on a weekly basis. Two members of staff sign each transaction and receipts are maintained. The sampling of six staff training files provided evidence that staff are receiving the mandatory training as required, and evidence was seen of refresher dates for staff. The AQAA informs that the servicing of all health and safety equipment used at the home is undertaken as per the manufacturers recommendations. The manager told us that the portable electrical appliance testing is due to take place in June 2009. The person with the responsibility for the health and safety in the care home showed us evidence that all matters in regard to health and safety are regularly monitored. These include Infection Control, COSHH assessments, first aid boxes, call systems and windows and restrictors. We evidenced that the home has generic risk assessments in place, and were told that these are reviewed on a regular basis. Care Homes for Older People Page 24 of 29 Evidence: The AQAA informs that the manager has attained the Registered Managers Award, is NVQ assessor, and undertakes regular training. Residents monies are well managed.The home has a business plan in place. Care Homes for Older People Page 25 of 29 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 26 of 29 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 29 19 The registered person shall not allow a person to who applies to work at the care home unless the employer has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. Where a person has previously worked in a position which involved contact with children or vulnerable adults, written verification of the reason why they ceased to work in that position must be obtained. Written explanation for gaps in employment must be recorded. 18/08/2009 Care Homes for Older People Page 27 of 29 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 1 The dates of the last reviews undertaken for the Statement of Purpose and Service User Guide should be recorded on the documents. The manager should ensure regular staff meetings take place so all information is passed through the staff team in a timely and appropriate manner. 2 33 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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